(Stroke. 1998;29:2371-2376.)
© 1998 American Heart Association, Inc.
Original Contributions |
Asymptomatic Internal Carotid Artery Stenosis Defined by Ultrasound and the Risk of Subsequent Stroke in the Elderly
The Cardiovascular Health Study
From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (L.S.), University of Washington, Seattle, Wash; Department of Neurology (D.L.), Wake Forest University, Winston-Salem, NC; Department of Radiology (D.H.O.), Tufts–New England Medical Center, Boston, Mass; Department of Radiology (J.F.P.), Brigham and Women's Hospital, Boston, Mass; and Departments of Surgery and Neurosurgery (S.K.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pa. Participating institutions and principal staff are listed in the Appendix.
Correspondence to W.T. Longstreth, Jr, MD, Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Ave, Seattle WA 98104-2499. E-mail wl{at}u.washington.edu
Background and Purpose—We sought in this study to relate carotid ultrasound findings in asymptomatic older adults to the 5-year risk of various cerebrovascular outcomes used in the Asymptomatic Carotid Atherosclerosis Study (ACAS).
Methods—The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years and older. Analyses of internal carotid artery stenosis defined by multiple different cutoffs of peak systolic velocity, rather than one particular cutoff, were performed in the 5441 participants who underwent carotid ultrasound and lacked a history of transient ischemic attack or stroke. The 5-year risks of 7 cerebrovascular disease outcomes used in ACAS were estimated for each cutoff.
Results—Associations with the 5-year risk of outcomes were substantially elevated only at cutoffs with high peak systolic velocities. In this population, the number of people with such high velocities was small. For example, with a cutoff of approximately 2.5 m/s, suggesting a stenosis of >70%, the 5-year risk of an ipsilateral fatal or nonfatal stroke was 5%, and only 0.5% of the group had velocities at least this high.
Conclusions—In a group of older adults likely to participate in a screening program, as evidenced by willingness to participate in CHS, high peak systolic velocities consistent with high-grade carotid stenosis were uncommon and risk of subsequent cerebrovascular disease outcomes was relatively low. These findings do not suggest that similar populations of older adults would benefit from a program using ultrasound to screen for asymptomatic carotid stenosis.
Key Words: aged • carotid artery diseases • ultrasonography, Doppler
This article has been cited by other articles:
 |
|
 |
|
  T. Wolff, J. Guirguis-Blake, T. Miller, M. Gillespie, and R. Harris Screening for Carotid Artery Stenosis: An Update of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, December 18, 2007; 147(12): 860 - 870. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Fayad Endarterectomy and Stenting for Asymptomatic Carotid Stenosis: A Race at Breakneck Speed Stroke, February 1, 2007; 38(2): 707 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Sangiorgi, A. Mauriello, E. Bonanno, C. Oxvig, C. A. Conover, M. Christiansen, S. Trimarchi, V. Rampoldi, D. R. Holmes Jr, R. S. Schwartz, et al. Pregnancy-Associated Plasma Protein-A Is Markedly Expressed by Monocyte-Macrophage Cells in Vulnerable and Ruptured Carotid Atherosclerotic Plaques: A Link Between Inflammation and Cerebrovascular Events J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2201 - 2211. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. E Millen, P. A Quatromoni, B.-H. Nam, M. J Pencina, J. F Polak, R. W Kimokoti, J. M Ordovas, and R. B D'Agostino Compliance with expert population-based dietary guidelines and lower odds of carotid atherosclerosis in women: the Framingham Nutrition Studies Am. J. Clinical Nutrition, July 1, 2005; 82(1): 174 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Zalba, O. Beloqui, G. S. Jose, M. U. Moreno, A. Fortuno, and J. Diez NADPH Oxidase-Dependent Superoxide Production Is Associated With Carotid Intima-Media Thickness in Subjects Free of Clinical Atherosclerotic Disease Arterioscler. Thromb. Vasc. Biol., July 1, 2005; 25(7): 1452 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Yousem, R. N. Bryan, N. J. Beauchamp Jr., and A. M. Arnold A National Neuroimaging Database: A Call to Action AJNR Am. J. Neuroradiol., June 1, 2004; 25(6): 908 - 909. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Creager, D. W. Jones, J. D. Easton, J. L. Halperin, A. T. Hirsch, A. H. Matsumoto, P. T. O'Gara, R. D. Safian, G. L. Schwartz, and J. A. Spittell Atherosclerotic Vascular Disease Conference: Writing Group V: Medical Decision Making and Therapy Circulation, June 1, 2004; 109(21): 2634 - 2642. [Full Text] [PDF]
|
|
|
|
|
|
J.A. Paramo, J. Orbe, O. Beloqui, A. Benito, I. Colina, E. Martinez-Vila, and J. Diez Prothrombin Fragment 1+2 Is Associated With Carotid Intima-Media Thickness in Subjects Free of Clinical Cardiovascular Disease Stroke, May 1, 2004; 35(5): 1085 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Barr, J. J. Connors III, D. Sacks, J. C. Wojak, G. J. Becker, J. F. Cardella, B. Chopko, J. E. Dion, A. J. Fox, R. T. Higashida, et al. Quality Improvement Guidelines for the Performance of Cervical Carotid Angioplasty and Stent Placement: Developed by a Collaborative Panel of the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, and the Society of Interventional Radiology AJNR Am. J. Neuroradiol., November 1, 2003; 24(10): 2020 - 2034. [Full Text] [PDF]
|
|
|
|
|
|
L. J. Walker, A. Ismail, W. McMeekin, D. Lambert, A. D. Mendelow, and D. Birchall Computed Tomography Angiography for the Evaluation of Carotid Atherosclerotic Plaque: Correlation With Histopathology of Endarterectomy Specimens Stroke, April 1, 2002; 33(4): 977 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Golledge, R. M. Greenhalgh, and A. H. Davies The Symptomatic Carotid Plaque Stroke, March 1, 2000; 31(3): 774 - 781. [Abstract] [Full Text] [PDF]
|
|