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The prognostic significance of asymptomatic carotid bruits in the elderly
R I Shorr1, K C Johnson, J Y Wan
1Department of Preventive Medicine, University of Tennessee-Memphis, 38163, USA.
Insights
Asymptomatic carotid bruits may slightly increase stroke risk in younger elderly individuals with isolated systolic hypertension. However, carotid bruits are not a reliable stroke risk marker in older adults (70+).
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Neurology
Background:
- Isolated systolic hypertension is common in older adults.
- Carotid bruits are sometimes detected during physical examination.
- The association between asymptomatic carotid bruits and stroke risk in this population is not fully understood.
Purpose of the Study:
- To investigate the relationship between asymptomatic carotid bruits and the incidence of subsequent stroke.
- To assess the predictive value of carotid bruits for stroke in elderly individuals with isolated systolic hypertension.
Main Methods:
- Retrospective cohort study utilizing data from the Systolic Hypertension in the Elderly Program (SHEP) trial.
- Included 4,442 participants aged 60 years or older without prior cardiovascular events.
- Follow-up averaged 4.2 years to ascertain stroke development.
Main Results:
- Carotid bruits were present in 6.4% of participants at baseline.
- The adjusted relative risk of stroke for those with carotid bruits was 1.29 (95% CI 0.80, 2.06).
- A trend towards increased stroke risk was observed in participants aged 60-69 (RR 2.05), but not in those aged 70+ (RR 0.98).
Conclusions:
- Asymptomatic carotid bruits may be associated with a small increase in stroke risk in younger elderly individuals (60-69) with isolated systolic hypertension.
- Carotid bruits have limited utility as an independent stroke risk marker in asymptomatic elderly individuals aged 70 and older with isolated systolic hypertension.
Objective:
To determine the association between asymptomatic carotid bruits and the development of subsequent stroke in older adults with isolated systolic hypertension.
Design:
Retrospective cohort study.
Setting:
The Systolic Hypertension in the Elderly Program (SHEP), a 5-year randomized trial testing the efficacy of treating systolic hypertension in noninstitutionalized persons aged 60 years or older. From the original 4,736 SHEP participants, we identified a cohort of 4,442 persons who had no prior history of stroke, transient ischemic attack, or myocardial infarction at randomization.
Measurements And Main Results:
The end point for this ancillary study was the development of a stroke. The average follow-up was 4.2 years. Carotid bruits were found in 284 (6.4%) of the participants at baseline. Strokes developed in 21 (7.4%) of those with carotid bruits and in 210 (5.0%) of those without carotid bruits. The unadjusted risk of stroke among persons with carotid bruits was 1.53 (95% confidence interval [CI] 0.98, 2.40). Adjusting for age, gender, race, blood pressure, smoking, lipid levels, self-reported aspirin use, and treatment group assignment, the relative risk of stroke among persons with asymptomatic carotid bruits was 1.29 (95% CI 0.80, 2.06). Among SHEP enrollees aged 60 to 69 years, there was a trend (p = .08) toward increased risk (relative risk [RR] 2.05; 95% CI 0.92, 4.68) of subsequent stroke in persons with, compared to those without, carotid bruits. However, among enrollees aged 70 years or over, there was no relation between carotid bruit and subsequent stroke (RR 0.98; 95% CI 0.55, 1.76). In no other subgroup of SHEP enrollees did the presence of carotid bruit independently predict stroke.
Conclusions:
Although we cannot rule out a small increased risk of stroke associated with bruits in asymptomatic SHEP enrollees aged 60 to 69 years, the utility of carotid bruits as a marker for increased risk of stroke among asymptomatic elderly with isolated systolic hypertension aged 70 years or older is limited.