Battista RN, Cote R, Abrahamowicz M, Langlois Y; International Society of Technology Assessment in Health Care. Meeting.

Abstr Int Soc Technol Assess Health Care Meet. 1992; 23.

Montreal General Hospital, Division of Clinical Epidemiology, PQ, Canada.

BACKGROUND: The presence of cervical bruits has been used to identify carotid atheroslerosis in asymptomatic patients. Estimates of the prevalence of cervical bruits range from 4% to 7% among asymptomatic persons older than 50 years. OBJECTIVE: To examine among asymptomatic patients with cervical bruits whether the severity of stenosis of the carotid artery, as determined by Duplex Ultrasonography, is associated with unfavorable clinical outcomes. METHODS: An inception cohort of asymptomatic persons with cervical bruits was assembled. Patients were recruited from May 1988 to November 1991 from five participating University Teach Hospitals in Montreal and Quebec City, Quebec. All patients were examined initially by a study physician. Information was gathered on several risk factors and associated medical conditions including: hypertension, diabetes mellitus, heart disease, peripheral vascular disease, hyperlipidemia, smoking, and previous vascular surgery. Initial laboratory investigations included a complete blood cell count, a lipid profile, glucose level, and an electrocardiogram. A baseline complete neurological evaluation was performed. All eligible patients underwent a baseline duplex ultrasonographic examination of their cervical arteries. The clinical assessment and the duplex ultrasonography were repeated at 6-month intervals throughout the study period. OUTCOMES: The following unfavorable outcomes were monitored; transient ischemic attacks, ischemic or hemorrhagic strokes, acute myocardial infarction, unstable angina, and death. RESULTS: All 557 patients in the inception cohort were followed for an average of 19.5 months (+/- 11 months). Sixty-two unfavorable outcomes were recorded. The mean age in the cohort was 65 years (+/- 10 years) and 61% of patients were females. The following medical conditions were recorded: hypertension (43%), hyperlipidemia (32%), heart disease (29%), and diabetes (16%). thirty-six per cent of patients were smokers. The proportional hazards model was used to examine the association of carotid stenosis with clinical outcomes. Patients with a stenosis greater than 50% had an 80% greater risk of unfavorable outcomes than those with a lesser stenosis (p = 0.04) after adjusting for gender, age, history of heart disease, hypertension, hyperlipidemia, smoking and diabetes. While a history of heart disease was positively associated with the outcomes of interest at an estimated risk increase of 150% (p = 0.001), hyperlipidemia was inversely associated with the clinical end-points at an estimated risk decrease of 40% (p = 0.02). CONCLUSION: A greater than 50% stenosis of the carotid artery is strongly associated with cardiovascular and neurovascular morbidity and death among asymptomatic patients with cervical bruits, as demonstrated by duplex ultrasonography.

Publication Types:

• Meeting Abstracts

Keywords:

• Arteries
• Auscultation
• Carotid Arteries
• Carotid Artery, Common
• Carotid Stenosis
• Cohort Studies
• Female
• Heart Diseases
• Humans
• Hypertension
• Ischemic Attack, Transient
• Physical Examination
• Proportional Hazards Models
• Quebec
• Risk Factors
• diagnosis
• ultrasonography
• hsrmtgs

Other ID:

• HTX/94910553

UI: 102211889

From Meeting Abstracts