Prevalence of and Risk Factors Associated with Carotid Artery Stenosis: The Tromsø Study

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Abstract

Background and Purpose: To assess prevalence, distribution, ultrasound characteristics and determinants of carotid artery stenosis in a large, population-based study of both women and men. Methods: A total of 6,727 persons aged 25–84 years were screened for extracranial stenosis with Duplex ultrasound of the right carotid artery. Risk factors were compared in 225 persons with stenosis and 5,514 persons without. Results: The prevalence of carotid stenosis was higher in men than in women, where 3.8% (95% CI, 3.2–4.6%) had carotid stenosis, compared to 2.7% (95% CI, 2.2–3.3%) in women (p = 0.001). The prevalence gradually increased by age in both genders. Cholesterol, HDL cholesterol, fibrinogen, systolic blood pressure levels and current smoking were independently associated with carotid artery stenosis in both women and men. The presence of carotid stenosis was significantly associated with a history of cerebrovascular disease, coronary heart disease and peripheral artery disease. For each 10% increase in the degree of carotid stenosis, the risk of having had a cerebrovascular event increased by 26%. Conclusions: The prevalence of carotid stenosis in the general population, as measured by ultrasound, is low. Age, male gender, smoking, total cholesterol, HDL cholesterol (inverse), fibrinogen and systolic blood pressure are all independent predictors of carotid artery stenosis.

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Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromsø study.

Eva Stensland-Bugge, Kaare H Bønaa, Oddmund Joakimsen (2001)

Ultrasound measurement of carotid artery intima-media thickness (IMT) is regarded as a valid index of atherosclerosis. Age and sex differences in the distribution of, and risk factors for, IMT have not been investigated thoroughly. In 1994-1995 a total of 6408 men and women aged 25-84 years living in the municipality of Tromsø, Norway, underwent ultrasound examination of carotid artery IMT and measurements of cardiovascular risk factors. Age, systolic blood pressure, total cholesterol, HDL cholesterol, body mass index, and smoking were independent predictors of IMT in both sexes. Fibrinogen levels and physical activity were associated with IMT in men only, whereas triglyceride levels were associated with IMT independently of HDL cholesterol in women only. A family history of cardiovascular disease (CVD) was an independent predictor of IMT in both sexes, also when controlling for traditional CVD risk factors. The magnitude of the association between most risk factors and IMT did not differ depending on age, but the effects of physical activity and triglycerides were more pronounced at higher age. These data suggest that there are significant age and sex differences in the distribution and the determinants of subclinical atherosclerosis.

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Intersonographer Reproducibility and Intermethod Variability of Ultrasound Measurements of Carotid Artery Stenosis: The Tromsø Study

Ellisiv B. Mathiesen, Oddmund Joakimsen, Kaare H Bønaa (2000)

Background and Purpose: Knowledge of the reproducibility of a diagnostic method is important in order to evaluate its usefulness. Few studies have examined interobserver and intermethod agreement on ultrasound measurements of carotid stenosis. Methods: Intersonographer agreement on ultrasound measurements of carotid plaque morphology and the estimated degree of stenosis by three ultrasound methods were assessed in a random sample of 51 participants with stenotic carotid arteries selected from a population health survey. The degree of stenosis was assessed by measurements of velocity, lumen diameter reduction and cross-sectional lumen area. Intermethod agreement on the degree of carotid stenosis was also assessed. Results: Agreement on plaque echogenicity and heterogeneity was moderate (κ = 0.56 and κ = 0.60, respectively). The mean degree of stenosis and median absolute difference between observers of the estimated degree of stenosis by the velocity method were 46.3 and 10.8%, respectively. The corresponding values were 51.0 and 5.8% for the diameter method, and 57.1 and 7.2%, for the cross-sectional lumen method. The limits of agreement for intersonographer reproducibility varied between ±19.7 and 26.5%. For all methods, reproducibility increased with increasing degree of stenosis. Differences between the methods were large in low-grade stenosis but were acceptable in high-grade stenosis. Conclusions: Considerable differences in ultrasound measurement of stenosis, which could lead to different clinical conclusions, were regularly encountered no matter what ultrasound method was used.

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Author and article information

Journal

Journal ID (publisher-id): CED

Journal ID (nlm-ta): Cerebrovasc Dis

Journal ID (doi): 10.1159/issn.1015-9770

Title: Cerebrovascular Diseases

Publisher: S. Karger AG

ISSN (Print): 1015-9770

ISSN (Electronic): 1421-9786

Publication date Subscription-year: 2001

Publication date (Print): July 2001

Publication date (Electronic): 06 July 2001

Volume: 12

Issue: 1

Pages: 44-51

Affiliations

Institute of Community Medicine and Institute of Clinical Medicine, University of Tromsø, Norway

Article

Publisher ID: 47680 Other ID: Cerebrovasc Dis 2001;12:44–51

DOI: 10.1159/000047680

PubMed ID: 11435679

SO-VID: 1555866f-30db-4d44-8651-3f57b1da219b

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Figures: 1, Tables: 5, References: 32, Pages: 8

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