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Stroke, Vol 23, 1752-1760, Copyright © 1992 by American Heart Association
DH O'Leary, JF Polak, RA Kronmal, SJ Kittner, MG Bond, SK Wolfson Jr, W Bommer, TR Price, JM Gardin and PJ Savage
BACKGROUND AND PURPOSE: This article describes the prevalence of
extracranial carotid atherosclerosis assessed by ultrasonography, its
association with risk factors, and its relation to symptomatic coronary
disease and stroke in men and women aged > or = 65 years. METHODS:
Maximum percent stenosis, maximum common carotid artery wall thickness, and
maximum internal carotid artery wall thickness were assessed using duplex
ultrasound in 5,201 men and women aged > or = 65 years in the
Cardiovascular Health Study, a study of the risk factors and natural
history of cardiovascular disease in the elderly. Existing coronary disease
and stroke were assessed by physical examination and participant history.
RESULTS: Detectable carotid stenosis was present in 75% of men and 62% of
women, although the prevalence of > or = 50% stenosis was low, 7% in men
and 5% in women. Maximum stenosis and maximum wall thickness measurements
increased with age and were uniformly greater at all ages in men than in
women (p < 0.00001). Established risk factors for atherosclerosis
(hypertension, smoking, diabetes) and indications of vascular disease (left
ventricular hypertrophy, major electrocardiographic abnormality, bruits,
and history of heart disease or stroke) related to all three carotid artery
measures in the elderly. Of the three ultrasound measures, the best
correlate for a history of coronary disease was maximum internal carotid
artery wall thickness. For stroke the best correlate was common carotid
artery wall thickness. Multiple logistic regression models of prevalent
coronary heart disease and stroke that included the ultrasound findings
indicated, after adjustment for age and sex, that maximum internal wall
thickness and maximum common carotid wall thickness were significant
correlates of both. Maximum stenosis did not add significantly to the
correlation. CONCLUSIONS: In the elderly the incidence of carotid
atherosclerosis was high, although the frequency of severe disease was low.
The prevalence and severity of carotid atherosclerosis continued to
increase with age even in the late decades of life, and more disease was
found in men than in women at all ages. Known risk factors for
atherosclerosis continued to relate to carotid abnormalities in the later
decades of life, both in symptomatic and asymptomatic subjects.
ARTICLES
Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group
Division of Radiology, Geisinger Medical Center, Danville, Pa.
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