Carotid Artery Atherosclerosis Among 65-year-old Swedish Men — A Population-based Screening Study

Abstract

Objective: There are limited contemporary epidemiological data on the prevalence of carotid atherosclerosis in the general population. The aim was to determine the prevalence of and risk factors associated with carotid artery atherosclerosis among 65-year-old men. Methods: This was a population-based screening study. All 65-yearold men in the County of Uppsala, Sweden, who attended screening for abdominal aortic aneurysm (AAA) 2007e2009, were invited for duplex scanning of the carotid arteries. Results: Of 4801 men invited, 4657 (97%) accepted. Carotid plaques (>2 Â 6 mm) were observed in 1169 (25%) men, 94 (2.0%) had carotid stenoses (50e99%), and 15 (0.3%) had occluded carotid arteries. In a multivariate logistic regression model, smoking (OR 1.7, 95% CI 1.5e1.9), hypertension (1.5, 95% CI 1.3e1.7), diabetes mellitus (1.2, 95% CI 1.0e1.5), and coronary artery disease (1.5, 95% CI 1.3e1.8) were associated with prevalence of carotid atherosclerosis (plaque and/or stenosis). The use of antiplatelet agents and statins in participants with a carotid plaque was 20% and 29%, respectively. The corresponding figures in participants with a stenosis were 42% and 41%. Conclusions: This study offers contemporary data on the prevalence of carotid atherosclerosis in a population-based cohort of 65-year-old men. Most of those at risk had no other clinical manifestation of atherosclerosis, and therefore had no secondary prevention.

Vascular Events and Carotid Atherosclerosis: A 5-Year Prospective Cohort Study in Patients with Type 2 Diabetes and a Contemporary Cardiovascular Prevention Treatment

“…However, as not all patients had optimal CV treatment, the rate of CV events could be further reduced in the population studied herein. Another aspect to consider is that the cohort included a low rate of significant carotid stenosis as observed elsewhere [28,29,39,40], and we cannot exclude a link between CV risk of carotid atherosclerosis for patients with stenosis > 50% or >70%.…”

Editor's Choice – Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…21 2. 2 22 About 5% of males aged >65 years who are current smokers have a >50% ICA stenosis on DUS screening 23 and smoking has been shown to increase plaque progression. 24 In a meta-analysis of 32 studies, smoking was associated with a significant increase in late ischaemic stroke (relative risk increase [RRI] 1.9, 95% CI 1.7e2.2).…”

Is Duplex carotid artery screening prior to CABG justified?

“…Although multiple imaging modalities are available, carotid duplex scanning has become a method of choice for preliminary investigation to assesses presence and severity of CAD, and in particular ICA stenosis. 13 Screening for carotid artery stenosis has not been proven a useful test in the general population. 14 Studies have shown that extracranial ICA stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery.…”