This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/2145    most recent 01.STR.0000087360.91794.11v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gillett, M. Articles by Davis, T. M.E. Search for Related Content PubMed PubMed Citation Articles by Gillett, M. Articles by Davis, T. M.E. Pubmed/NCBI databases Medline Plus Health Information Carotid Artery Disease Diabetes Stroke Related Collections Type 2 diabetes Acute Stroke Syndromes Carotid Stenosis Risk Factors for Stroke

(Stroke. 2003;34:2145.)
© 2003 American Heart Association, Inc.

Original Contributions

Prospective Evaluation of Carotid Bruit as a Predictor of First Stroke in Type 2 Diabetes

The Fremantle Diabetes Study

Melissa Gillett, MB, BS; Wendy A. Davis, MPH; Denise Jackson, EN; David G. Bruce, FRACP Timothy M.E. Davis, FRACP

From the University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.

Reprint requests to Professor T.M.E. Davis, University of Western Australia, Department of Medicine, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia. E-mail tdavis{at}cyllene.uwa.edu.au

Background and Purpose— We sought to examine prospectively the relationship between asymptomatic carotid bruit and stroke in type 2 diabetes.

Methods— We studied 1181 (91.3%) of a community-based sample of 1294 patients with type 2 diabetes. These patients had no history of cerebrovascular disease at recruitment during 1993–1996 and were followed until the end of January 2002. Hospital morbidity and death register data relating to cerebrovascular events were also available. Cox proportional hazards models were used to determine whether carotid bruit status was an independent predictor of stroke and to identify other significant cerebrovascular risk factors.

Results— One hundred thirty-four patients (11.3%) suffered a first stroke during 6.5±2.2 (mean±SD) years of follow-up. In the first 2 years after study entry, first stroke (n=45/1181; 3.8%) was strongly predicted by the presence of carotid bruit(s) after adjustment for known cardiovascular risk factors and other potentially confounding variables (hazard ratio, 6.7; 95% CI, 3.0 to 14.9; P<0.001). Between 2 years and census, first stroke (n=89/1083; 8.2%) was not associated with carotid bruit(s) (P=0.97). Age and diastolic blood pressure were other determinants of stroke in the first 2 years, while age, atrial fibrillation/flutter, and microalbuminuria were independent predictors of subsequent stroke.

Conclusions— Type 2 diabetic patients found to have incidental carotid bruits have >6 times the risk of first stroke in the first 2 years than patients without a bruit and should receive intensified management of vascular risk factors. Carotid imaging with a view to surgical intervention in these patients remains controversial.

Key Words: carotid artery diseases • diabetes mellitus, non-insulin-dependent • stroke

This article has been cited by other articles:

				D. Sander, K. Sander, and H. Poppert Review: Stroke in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 222 - 229. [Abstract] [PDF]

				J. F. Meschia, T. G. Brott, and R. W. Hobson II Diagnosis and Invasive Management of Carotid Atherosclerotic Stenosis Mayo Clin. Proc., July 1, 2007; 82(7): 851 - 858. [Abstract] [Full Text] [PDF]

				W. A. Davis, D. G. Bruce, and T. M.E. Davis Is Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients?: The Fremantle Diabetes Study Diabetes Care, August 1, 2006; 29(8): 1764 - 1770. [Abstract] [Full Text] [PDF]

				P. Minoretti, C. Falcone, M. Calcagnino, E. Emanuele, M. P. Buzzi, E. Coen, and D. Geroldi Prognostic significance of plasma osteopontin levels in patients with chronic stable angina Eur. Heart J., April 1, 2006; 27(7): 802 - 807. [Abstract] [Full Text] [PDF]

				D. G. Bruce, W. A. Davis, and T. M.E. Davis Longitudinal Predictors of Reduced Mobility and Physical Disability in Patients With Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care, October 1, 2005; 28(10): 2441 - 2447. [Abstract] [Full Text] [PDF]

				R. M. Clifford, W. A. Davis, K. T. Batty, and T. M.E. Davis Effect of a Pharmaceutical Care Program on Vascular Risk Factors in Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care, April 1, 2005; 28(4): 771 - 776. [Abstract] [Full Text] [PDF]

				W. A. Davis, M. W. Knuiman, D. Hendrie, and T. M.E. Davis Determinants of Diabetes-Attributable Non-Blood Glucose-Lowering Medication Costs in Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care, February 1, 2005; 28(2): 329 - 336. [Abstract] [Full Text] [PDF]