Stroke, Vol 25, 759-765, Copyright © 1994 by American Heart Association
MI Chimowitz, DG Weiss, SL Cohen, MR Starling and RW Hobson 2nd
BACKGROUND AND PURPOSE: Patients with carotid stenosis have a high
frequency of asymptomatic coronary artery disease (CAD). The purpose of
this study of patients with asymptomatic carotid stenosis was to test the
hypothesis that patients without a history of CAD have the same cardiac
prognosis as patients with a history of CAD. METHODS: Men enrolled in the
Department of Veterans Affairs study on the efficacy of carotid
endarterectomy for asymptomatic carotid stenosis underwent a baseline
cardiac evaluation (history, physical examination, and electrocardiogram)
to document previous angina or myocardial infarction. Patients were
randomized to medical therapy alone or medical therapy and carotid
endarterectomy. Medical therapy consisted of aspirin 650 mg twice daily and
treatment of risk factors. All episodes of angina, myocardial infarction,
or sudden death during follow-up (average of 47.9 months) were recorded.
RESULTS: Of 444 men enrolled in the study, 200 (45%) had a history of CAD.
During the study 86 (43%) of 200 patients with CAD and 81 (33%) of 244
patients without a history of CAD had cardiac ischemic events (P = .03). In
patients without a history of CAD, the first cardiac event was myocardial
infarction or sudden death in 45 patients (56%). Factors that were
independently associated with cardiac events in patients without a history
of CAD were diabetes (odds ratio [OR], 2.14; 95% confidence interval [CI],
1.15 to 3.97), intracranial occlusive disease (OR, 2.13; 95% CI, 1.13 to
4.02), and peripheral vascular disease (OR, 2.04; 95% CI, 1.14 to 3.66).
Forty-two percent of patients with two of these factors and 69% of patients
with all three factors had cardiac events. CONCLUSIONS: Men with carotid
stenosis and no history of CAD have a lower rate of cardiac events than men
with carotid stenosis who have a history of CAD. However, a subgroup of
patients with carotid stenosis and no history of CAD who have coexistent
intracranial occlusive disease, diabetes, or peripheral vascular disease
have a risk of cardiac events similar to that of patients with a history of
CAD.
ARTICLES
Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167
Department of Neurology, Ann Arbor Veterans Affairs Medical Center, University of Michigan.
This article has been cited by other articles:
 |
|
 |
|
  E. Touze, C. P. Warlow, and P. M. Rothwell Risk of Coronary and Other Nonstroke Vascular Death in Relation to the Presence and Extent of Atherosclerotic Disease at the Carotid Bifurcation Stroke, December 1, 2006; 37(12): 2904 - 2909. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Fletcher, K. Berra, P. Ades, L. T. Braun, L. E. Burke, J. L. Durstine, J. M. Fair, G. F. Fletcher, D. Goff, L. L. Hayman, et al. Managing Abnormal Blood Lipids: A Collaborative Approach Circulation, November 15, 2005; 112(20): 3184 - 3209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Ainsworth, C. C. Blake, A. Tamayo, V. Beletsky, A. Fenster, and J. D. Spence 3D Ultrasound Measurement of Change in Carotid Plaque Volume: A Tool for Rapid Evaluation of New Therapies Stroke, September 1, 2005; 36(9): 1904 - 1909. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Arenillas, J. Candell-Riera, G. Romero-Farina, C. A. Molina, P. Chacon, S. Aguade-Bruix, J. Montaner, G. de Leon, J. Castell-Conesa, and J. Alvarez-Sabin Silent Myocardial Ischemia in Patients With Symptomatic Intracranial Atherosclerosis: Associated Factors Stroke, June 1, 2005; 36(6): 1201 - 1206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Iemolo, A. Martiniuk, D. A. Steinman, and J. D. Spence Sex Differences in Carotid Plaque and Stenosis Stroke, February 1, 2004; 35(2): 477 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Circulation, September 9, 2003; 108(10): 1278 - 1290. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Stroke, September 1, 2003; 34(9): 2310 - 2322. [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. FRIEDLANDER, N. R. GARRETT, and D. C. NORMAN The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus J Am Dent Assoc, November 1, 2002; 133(11): 1516 - 1523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C. Gates, M. Eliasziw, A. Algra, H. J.M. Barnett, and R. W. Gunton Identifying Patients With Symptomatic Carotid Artery Disease at High and Low Risk of Severe Myocardial Infarction and Cardiac Death Stroke, October 1, 2002; 33(10): 2413 - 2416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Spence, M. R. Malinow, P. A. Barnett, A. J. Marian, D. Freeman, and R. A. Hegele Plasma Homocyst(e)ine Concentration, But Not MTHFR Genotype, Is Associated With Variation in Carotid Plaque Area Stroke, May 1, 1999; 30(5): 969 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Landesberg, Y. Wolf, D. Schechter, M. Mosseri, C. Weissman, H. Anner, R. Chisin, M. H. Luria, N. Kovalski, M. Bocher, et al. Preoperative Thallium Scanning, Selective Coronary Revascularization, and Long-Term Survival After Carotid Endarterectomy Stroke, December 1, 1998; 29(12): 2541 - 2548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F Muldoon and M. H Criqui The emerging role of statins in the prevention of coronary heart disease BMJ, December 13, 1997; 315(7122): 1554 - 1555. [Full Text]
|
|
|
|
 |
|
 P. M. Okin, M. J. Roman, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Relation of Exercise-Induced Myocardial Ischemia to Cardiac and Carotid Structure Hypertension, December 1, 1997; 30(6): 1382 - 1388. [Abstract] [Full Text]
|
|
|
|
|
|
J. H. Wong, J. M. Findlay, and M. E. Suarez-Almazor Regional Performance of Carotid Endarterectomy : Appropriateness, Outcomes, and Risk Factors for Complications Stroke, May 1, 1997; 28(5): 891 - 898. [Abstract] [Full Text]
|
|
|
|
|
|
M. I. Chimowitz, R. M. Poole, M. R. Starling, M. Schwaiger, and M. D. Gross Frequency and Severity of Asymptomatic Coronary Disease in Patients With Different Causes of Stroke Stroke, May 1, 1997; 28(5): 941 - 945. [Abstract] [Full Text]
|
|
|
|
|
|
P. M. Okin, M. J. Roman, R. B. Devereux, and P. Kligfield Association of Carotid Atherosclerosis With Electrocardiographic Myocardial Ischemia and Left Ventricular Hypertrophy Hypertension, July 1, 1996; 28(1): 3 - 7. [Abstract] [Full Text]
|
|
|
|
|
|
K. Sutton-Tyrrell, H. G. Alcorn, H. Herzog, S. F. Kelsey, and L. H. Kuller Morbidity, Mortality, and Antihypertensive Treatment Effects by Extent of Atherosclerosis in Older Adults With Isolated Systolic Hypertension Stroke, August 1, 1995; 26(8): 1319 - 1324. [Abstract] [Full Text]
|
|