This Article Full Text Full Text (PDF) 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 Joakimsen, O. Articles by Arnesen, E. Search for Related Content PubMed PubMed Citation Articles by Joakimsen, O. Articles by Arnesen, E. Related Collections Carotid Stenosis Doppler ultrasound, Transcranial Doppler etc. Epidemiology

(Stroke. 2000;31:1871.)
© 2000 American Heart Association, Inc.

Original Contributions

Prediction of Mortality by Ultrasound Screening of a General Population for Carotid Stenosis

The Tromsø Study

Oddmund Joakimsen, MD; Kaare H. Bønaa, MD, PhD; Ellisiv B. Mathiesen, MD; Eva Stensland-Bugge, MD Egil Arnesen, MD

From the Institutes of Community Medicine (O.J., K.H.B., E.B.M., E.S.-B., E.A.) and Clinical Medicine (O.J., E.B.M.), University of Tromsø, Tromsø, Norway.

Correspondence to Oddmund Joakimsen, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway. E-mail Oddmund.Joakimsen{at}ism.uit.no

Background and Purpose—The extensive use of ultrasound examination of carotid arteries has revealed stenosis in many asymptomatic subjects, and clinical studies have shown that carotid stenosis is a risk factor for cardiovascular disease and death. However, information on stenosis as detected in a general population and its relation to mortality is scarce. The purpose of this population-based study was to assess whether carotid stenosis is a predictor of death.

Methods—In 1994 to 1995, 248 subjects with suspected carotid stenosis were identified among 6727 men and women 25 to 84 years of age who were examined with ultrasound. These subjects and 496 age- and sex-matched control subjects were followed up for 4.2 years, and the number and causes of deaths were registered.

Results—The unadjusted relative risk for death was 2.72 (95% CI, 1.57 to 4.75) for subjects with stenosis compared with control subjects. Adjusting for cardiovascular risk factors increased the relative risk to 3.47 (95% CI, 1.47 to 8.19). The adjusted relative risk in persons with stenosis and no cardiovascular disease or diabetes was 5.66 (95% CI, 1.53 to 20.90), which was higher than in subjects with stenosis and self-reported disease (1.79; 95% CI, 0.75 to 4.27). There was a dose-response relationship between degree of stenosis and risk of death (P=0.002 for linear trend). Carotid stenosis was a stronger predictor of death than self-reported cardiovascular disease or diabetes.

Conclusions—Carotid stenosis is a strong and independent predictor of death.

Key Words: : carotid stenosis • mortality • population-based studies • ultrasonography

This article has been cited by other articles:

				B. M.B. Goessens, F. L.J. Visseren, L. J. Kappelle, A. Algra, Y. van der Graaf, and for the SMART Study Group Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease: The SMART Study Stroke, May 1, 2007; 38(5): 1470 - 1475. [Abstract] [Full Text] [PDF]

				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]

				E. Touze, O. Varenne, G. Chatellier, S. Peyrard, P. M. Rothwell, and J.-L. Mas Risk of Myocardial Infarction and Vascular Death After Transient Ischemic Attack and Ischemic Stroke: A Systematic Review and Meta-Analysis Stroke, December 1, 2005; 36(12): 2748 - 2755. [Abstract] [Full Text] [PDF]

				S. H. Johnsen, E. B. Mathiesen, E. Fosse, O. Joakimsen, E. Stensland-Bugge, I. Njolstad, and E. Arnesen Elevated High-Density Lipoprotein Cholesterol Levels Are Protective Against Plaque Progression: A Follow-Up Study of 1952 Persons With Carotid Atherosclerosis The Tromso Study Circulation, July 26, 2005; 112(4): 498 - 504. [Abstract] [Full Text] [PDF]

				S. H. Johnsen, E. Fosse, O. Joakimsen, E. B. Mathiesen, E. Stensland-Bugge, I. Njolstad, and E. Arnesen Monocyte Count Is a Predictor of Novel Plaque Formation: A 7-Year Follow-up Study of 2610 Persons Without Carotid Plaque at Baseline The Tromso Study Stroke, April 1, 2005; 36(4): 715 - 719. [Abstract] [Full Text] [PDF]

				P. N. Post, J. Kievit, J. M. van Baalen, W. B. van den Hout, and J. H. van Bockel Routine Duplex Surveillance Does Not Improve the Outcome After Carotid Endarterectomy: A Decision and Cost Utility Analysis Stroke, March 1, 2002; 33(3): 749 - 755. [Abstract] [Full Text] [PDF]