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Prevalence and risk factors of asymptomatic extracranial carotid artery atherosclerosis. A population-based study
Insights
Asymptomatic carotid artery disease prevalence increases significantly with age and is higher in men. Key risk factors include blood pressure, smoking, fibrinogen, and apolipoproteins, varying by age and sex.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Vascular Biology
Background:
- Asymptomatic carotid artery disease (ACAD) is a significant risk factor for stroke.
- Understanding its prevalence and risk factors is crucial for preventive strategies.
Purpose of the Study:
- To evaluate the prevalence and identify risk factors of ACAD in a community-based population.
- To analyze the influence of age and sex on ACAD risk factors.
Main Methods:
- Analysis of 909 individuals (aged 40-79) from the Bruneck Ischemic Heart Disease and Stroke Prevention Study.
- Duplex scanning for prevalence assessment and Doppler criteria for stenosis grading.
- Logistic regression models developed for different age and sex subgroups.
Main Results:
- Prevalence of ACAD increased with age, reaching 82.5% in men and 76.7% in women aged 70-79.
- High-grade stenosis (>80%) was twice as common in men.
- Systolic blood pressure was a universal predictor; smoking was key in men; fibrinogen was significant in the elderly; apolipoproteins showed differential effects based on age and sex; diabetes was a risk factor in elderly men.
Conclusions:
- ACAD prevalence is strongly influenced by age and sex.
- Cardiovascular risk factor associations with ACAD are dynamic and sex/age-dependent.
- Findings can enhance risk prediction and guide preventive measures for ACAD.
Abstract:
To evaluate the prevalence and risk factors of asymptomatic carotid artery disease, we analyzed a sample of 909 men and women (aged 40-79 years) drawn from the community-based Bruneck Ischemic Heart Disease and Stroke Prevention Study. For the four decades of age (40-49, 50-59, 60-69, and 70-79 years), respective prevalence rates as assessed by duplex scanning were found to be 8.2%, 39.7%, 66.4%, and 82.5% in men and 3.3%, 22.3%, 48.7%, and 76.7% in women. High-grade stenosis (> 80%) classified by Doppler criteria was twice as frequent in men (2.4%) as in women (1.1%). Age and sex were found to be particularly strong and independent predictors of asymptomatic carotid artery disease. Accordingly, separate logistic regression models were developed for both men and women in the elderly (65-79 years) and middle-aged (50-64 years) groups. Systolic blood pressure turned out to be the only attribute with independent significance in all subgroups examined. Cigarette smoking, recorded as pack-years, emerged as the leading risk factor of carotid atherosclerosis in men. Serum fibrinogen levels were found to be highly indicative of carotid artery disease in elderly men and women. For apolipoprotein B predictive significance was observed in the middle-aged populations, whereas apolipoprotein A-I had a protective effect in elderly women. Diabetes mellitus completed the risk factor profile for elderly men. In summary, the relation between cardiovascular risk factors and asymptomatic carotid artery disease showed a dynamic dependence on sex and age. These findings may help to improve the efficacy of risk prediction in the general population and facilitate well-directed preventive measures.