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Cerebral atherosclerosis as predictor of stroke and mortality in representative elderly population
B Lernfelt1, M Forsberg, C Blomstrand
1Department of Geriatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. bodil.lernfelt@vgregion.se
Insights
In elderly individuals, carotid atherosclerosis is common. Bilateral carotid plaques predict stroke and mortality risk in men, linked to early cardiovascular factors, but not in women.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Neurology
Background:
- Carotid atherosclerosis is a significant health concern in aging populations.
- Understanding its link to cardiovascular risk factors is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between cardiovascular risk factors, carotid bifurcation atherosclerosis, and subsequent stroke or mortality risk.
- To analyze these relationships in a representative elderly population sample.
Main Methods:
- A population-based study involving 142 men and women assessed at ages 70 and 76.
- Carotid circulation evaluated at age 78 using duplex sonography and transcranial Doppler.
- Follow-up for 5 years to track mortality and stroke hospitalizations until age 83.
Main Results:
- High prevalence of carotid plaques (82% men, 79% women); bilateral plaques in 57% of men and 46% of women.
- Bilateral plaques correlated with systolic blood pressure and ischemic heart disease at age 70.
- Men with bilateral plaques had significantly higher stroke/mortality risk (74%) vs. others (21%); this association was not observed in women (33% vs. 26%).
Conclusions:
- Carotid atherosclerosis is highly prevalent in the elderly.
- Bilateral carotid plaques are linked to earlier cardiovascular risk factors and predict future stroke/mortality risk in men.
- The predictive value of bilateral carotid plaques for stroke and mortality differs between sexes in older adults.
Background And Purpose:
The aim of this study was to assess the relationship between cardiovascular risk factors, atherosclerotic disease in the carotid bifurcation, and the risk of stroke and mortality in a representative population sample.
Methods:
One hundred forty-two men and women participated in a population study at ages 70 and 76 years. At age 78, extracranial and intracranial circulation was examined by means of duplex sonography and transcranial Doppler techniques. Mortality and hospitalization for stroke were analyzed over a 5-year follow-up period up to age 83 years.
Results:
Carotid plaques were identified in 82% of the men and 79% of the women. Bilateral plaques were found in 57% of the men and 46% of the women, and stenosis resulting in >50% diameter reduction occurred in 28% of the men and 17% of the women. Carotid stenosis >75% was observed in 7 subjects (0.5%). Bilateral plaques at age 78 were correlated with systolic blood pressure and ischemic heart disease at age 70 years. The pulsatility index was 1.0 to 1.4 in 63% and > or =1.5 in 13% of the study population. The pulsatility index was correlated with systolic and diastolic blood pressure, serum cholesterol, and triglycerides. Men with bilateral carotid plaques at age 78 years had an increased risk of stroke or mortality during the 5-year follow-up period (74% bilateral plaques versus 21% unilateral or no plaques). This was not found in the women (33% versus 26%).
Conclusions:
Carotid atherosclerosis was prevalent in a majority of elderly subjects. Bilateral plaques were correlated with systolic blood pressure and ischemic heart disease at age 70 years and predicted the risk of stroke and mortality in men but not in women.