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Extracranial carotid atherosclerosis in patients with and without transient ischemic attacks and coronary artery
1Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.
Insights
Extracranial carotid atherosclerosis is linked to both transient ischemic attacks (TIA) and coronary artery disease (CAD). Age and other risk factors influence these findings, suggesting TIA and CAD patients need careful cerebrovascular assessment.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Extracranial carotid atherosclerosis is a significant risk factor for cerebrovascular events.
- The relationship between carotid atherosclerosis and concurrent coronary artery disease (CAD) or transient ischemic attacks (TIA) requires further clarification.
Purpose of the Study:
- To evaluate the extent of extracranial carotid atherosclerosis in patients with and without cerebrovascular and coronary atherosclerosis.
- To determine if differences in carotid atherosclerosis prevalence are attributable to age and other risk factors.
Main Methods:
- B-mode ultrasound scores were used to assess carotid atherosclerosis in four patient groups: hospital controls (HC), coronary artery disease (CAD), transient ischemic attack (TIA), and TIA + CAD.
- Statistical adjustments were made for age and other risk factors.
Main Results:
- Unadjusted B-mode scores were highest in TIA and TIA + CAD groups, intermediate in the CAD group, and lowest in the HC group.
- After adjusting for age and risk factors, significant differences in carotid atherosclerosis were not found between CAD, TIA, and TIA + CAD groups.
- The HC group consistently showed significantly lower adjusted B-mode scores.
Conclusions:
- Accentuating development of carotid atherosclerosis is associated with both TIA and CAD.
- Observed differences in carotid atherosclerosis between coronary and cerebrovascular patients are partly due to differing risk factor profiles, particularly age.
- Patients with CAD warrant a low threshold for cerebrovascular evaluation due to potentially accelerated extracranial atherosclerosis.
Abstract:
We examined the extent of extracranial carotid atherosclerosis as evaluated by a B-mode ultrasound score in four groups of hospitalized patients: hospital controls free of both cerebrovascular symptoms and coronary atherosclerosis (HC, n = 245); patients with coronary atherosclerosis but without cerebrovascular symptoms (CAD, n = 382); patients with transient ischemic attacks but asymptomatic for coronary atherosclerosis (TIA, n = 107); and patients having both transient ischemic attacks and symptomatic coronary events (TIA + CAD, n = 39). The unadjusted B-mode scores were lowest for the HC group, intermediate for the CAD group, and highest for the TIA or TIA + CAD groups (no difference between these two groups). However, after adjustment for age (or age and other risk factors), we could find no significant differences among the CAD, TIA, and TIA + CAD groups, while the HC group had significantly lower adjusted scores. These data suggest that 1) accentuated development of carotid atherosclerosis is associated with both TIA and CAD and 2) the apparent differences in extracranial carotid atherosclerosis between coronary and cerebrovascular patients are partly attributable to differences in risk factor profiles (most notably age). The potentially accentuated rate of development of extracranial atherosclerosis in patients with CAD mandates a low threshold for cerebrovascular evaluation in CAD patients.