The natural history of carotid bruits in elderly persons

To determine the relative risk for cerebrovascular events in elderly patients with carotid bruits.

Population-based prospective study.

Community-based home for the aged.

All patients were residents of a home for the aged and were at least 75 years old in 1985.

Two hundred and forty-one residents were examined for carotid bruits and signs of previous stroke. The mean age of the residents was 86 years. Twelve percent of residents had asymptomatic carotid bruits. The prevalence of asymptomatic carotid bruits was 8% in residents who were 75 to 84 years of age, 10% in residents who were 85 to 94 years of age, and 13% in residents who were at least 95 years old. Interval cerebrovascular events and cause of death were ascertained from chart review, and recorded events in survivors were confirmed by a repeat examination. The 3-year cumulative incidence of cerebrovascular events in asymptomatic residents with carotid bruits was 10%, compared with 9% in residents without carotid bruits, yielding a relative risk of 1.1 (95% CI, 0.45 to 2.7). In 60% of surviving residents, baseline carotid bruits were no longer present at the time of follow-up examination. The disappearance of these bruits was not associated with the occurrence of interval cerebrovascular events.

The prevalence of asymptomatic carotid bruits increases with advanced age. Carotid bruits do not greatly increase the risk for subsequent stroke in elderly patients. Carotid bruits may often disappear without clinical sequelae.