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Duplex Doppler and spectral flow analysis of racial differences in cerebrovascular atherosclerosis
A Gil-Peralta1, M Alter, S M Lai
1Neuroepidemiology Section, Medical College of Pennsylvania, Philadelphia 19129.
Insights
Black patients exhibited significantly less carotid artery stenosis compared to white patients, even after accounting for age and other risk factors. Race was identified as an independent risk factor for carotid stenosis.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Racial Health Disparities
Background:
- Carotid artery disease is a significant cause of stroke.
- Racial disparities in cardiovascular disease prevalence are well-documented.
- Understanding the underlying factors contributing to these disparities is crucial for targeted interventions.
Purpose of the Study:
- To compare the prevalence and severity of carotid artery stenosis between black and white patients.
- To investigate potential risk factors, including age, hypertension, ischemic heart disease, diabetes mellitus, and smoking, that may explain racial differences.
- To determine if race is an independent predictor of carotid stenosis.
Main Methods:
- A comparative study involving 99 black and 106 white patients.
- Duplex ultrasonography, including B-mode imaging and Doppler spectral analysis, was used to assess carotid artery stenosis.
- Statistical analyses, including multivariate analysis, were employed to evaluate risk factors and racial differences.
Main Results:
- Black patients demonstrated significantly less extracranial internal carotid artery stenosis compared to white patients.
- Common risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and smoking did not fully account for the observed racial difference.
- Age was correlated with carotid stenosis in both racial groups, but blacks had less stenosis overall, even when age was considered.
- Multivariate analysis confirmed race as a significant and independent risk factor for carotid stenosis (p < 0.0001).
- A significant interaction between hypertension and race was also observed.
Conclusions:
- Race is a significant independent risk factor for carotid artery stenosis.
- The observed racial disparity in carotid stenosis is not fully explained by traditional risk factors like age, hypertension, diabetes, or smoking.
- Further population-based studies are warranted to validate these findings.
- Carotid duplex ultrasonography is a valuable noninvasive tool for such epidemiological research.
Abstract:
We compared carotid artery disease in 99 black and 106 white patients using duplex ultrasonography (B-mode imaging and Doppler spectral analysis). Blacks had significantly less stenosis of the extracranial internal carotid artery than whites. Among the risk factors investigated, hypertension alone, ischemic heart disease, diabetes mellitus, and smoking failed to explain the racial difference. Although carotid stenosis of greater than or equal to 40% correlated significantly with age in both races (p = 0.001 in whites and p = 0.005 in blacks), blacks had significantly less carotid stenosis of any degree even when age was taken into account. Multivariate analysis showed that race is a significant and independent risk factor for carotid stenosis (p less than 0.0001). Hypertension interacting with race was also significant. Our results require verification in population-based studies. Carotid duplex ultrasonography offers a noninvasive method for carrying out such studies.