Management of coexistent carotid artery and coronary artery disease.

Graor, Robert A.; Hetzer, N R

doi:10.1161/01.str.19.11.1441

Cited by 41 publications

(19 citation statements)

References 27 publications

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“…Although strategies have evolved for evaluating and treating symptomatic CAD in patients with carotid stenosis, 17 this is not true of asymptomatic CAD. 18 If the first cardiac event in the majority of patients with carotid stenosis and no history of CAD was angina, it would be prudent to follow patients clinically until they manifested angina before proceeding with a cardiac evaluation.…”

Section: Discussionmentioning

confidence: 99%

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Chimowitz

Weiss

Cohen

et al. 1994

Stroke

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Patients with carotid stenosis have a high frequency of asymptomatic coronary artery disease (CAD). The purpose of this study of patients with asymptomatic carotid stenosis was to test the hypothesis that patients without a history of CAD have the same cardiac prognosis as patients with a history of CAD. Men enrolled in the Department of Veterans Affairs study on the efficacy of carotid endarterectomy for asymptomatic carotid stenosis underwent a baseline cardiac evaluation (history, physical examination, and electrocardiogram) to document previous angina or myocardial infarction. Patients were randomized to medical therapy alone or medical therapy and carotid endarterectomy. Medical therapy consisted of aspirin 650 mg twice daily and treatment of risk factors. All episodes of angina, myocardial infarction, or sudden death during follow-up (average of 47.9 months) were recorded. Of 444 men enrolled in the study, 200 (45%) had a history of CAD. During the study 86 (43%) of 200 patients with CAD and 81 (33%) of 244 patients without a history of CAD had cardiac ischemic events (P = .03). In patients without a history of CAD, the first cardiac event was myocardial infarction or sudden death in 45 patients (56%). Factors that were independently associated with cardiac events in patients without a history of CAD were diabetes (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.15 to 3.97), intracranial occlusive disease (OR, 2.13; 95% CI, 1.13 to 4.02), and peripheral vascular disease (OR, 2.04; 95% CI, 1.14 to 3.66). Forty-two percent of patients with two of these factors and 69% of patients with all three factors had cardiac events. Men with carotid stenosis and no history of CAD have a lower rate of cardiac events than men with carotid stenosis who have a history of CAD. However, a subgroup of patients with carotid stenosis and no history of CAD who have coexistent intracranial occlusive disease, diabetes, or peripheral vascular disease have a risk of cardiac events similar to that of patients with a history of CAD.

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Section: Discussionmentioning

confidence: 99%

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Chimowitz

Weiss

Cohen

et al. 1994

Stroke

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“…Patients with CAD also had a higher incidence of diabetes mellitus (51. 3 Tables 1,2. cantly different between groups, as shown in Table 3.…”

Section: Prevalence Of Cvds and Clinical Featuresmentioning

confidence: 99%

“…1 In addition, patients with cerebral infarction die more frequently from CAD than from recurrent cerebral infarction or other neurological diseases. [2][3][4] There is a racial difference in the sites of prevalence for atherosclerotic lesions. Asian people have been shown to have more severe intracranial vascular lesions, whereas Western people have more severe extracranial lesions 5 and there is a strong correlation between the extent of coronary atherosclerosis and extracranial carotid atherosclerosis.…”

mentioning

confidence: 99%

Prevalence of Coronary Artery Disease in Japanese Patients With Cerebral Infarction Impact of Metabolic Syndrome and Intracranial Large Artery Atherosclerosis

Hoshino

Nakamura

Enomoto

et al. 2008

Circ J

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Background Patients with cerebral infarction have a high prevalence of asymptomatic coronary artery disease (CAD) and other vascular diseases, but there is a lack of such data for Japanese patients, so the present study investigated the prevalence of cardiovascular disease (CVD) in Japanese patients and determined the predictors of CAD. Methods and ResultsThe study group comprised 104 patients with cerebral infarction who had no history of CVD. All patients underwent coronary computed tomographic angiography, and systematic evaluation was done on the basis of the presence of other vascular diseases, CVD risk markers, and the degree of atherosclerosis. Of the total, 39 patients (37.5%) had CAD, 9 (8.7%) had carotid artery stenosis, 9 (8.7%) had peripheral artery disease of the lower limbs, and 3 (2.9%) had atherosclerotic renal artery stenosis. Multiple regression analysis showed that the presence of CAD was independently associated with metabolic syndrome (odds ratio (OR) 5.008, 95% confidence interval (CI) 1.538-16.309; p<0.01) and intracranial large artery atherosclerosis (OR 4.979, p<0.01). Conclusion Japanese patients with cerebral infarction have a high prevalence of CVD, especially asymptomatic CAD. Both metabolic syndrome and intracranial large artery atherosclerosis may be potential predictors for identifying patients with cerebral infarction who are at the highest risk of asymptomatic CAD. (Circ J 2008; 72: 404 -408)

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“…The combination of diabetes and hypertension may be an especially important risk factor for stroke. 6 A third possibility is that there is an increase in stroke secondary to the greater use of newer surgical and diagnostic procedures, especially vascular procedures. 7 Stroke cases that occur secondary to cardiac diagnostic or surgical procedures, especially bypass surgery, should be evaluated in this study.…”

Section: Incidence Rates Of Stroke In the Eightiesmentioning

confidence: 99%

Incidence rates of stroke in the eighties: the end of the decline in stroke?

Kuller¹

1989

Stroke

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Management of coexistent carotid artery and coronary artery disease.

Cited by 41 publications

References 27 publications

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167.

Prevalence of Coronary Artery Disease in Japanese Patients With Cerebral Infarction Impact of Metabolic Syndrome and Intracranial Large Artery Atherosclerosis

Incidence rates of stroke in the eighties: the end of the decline in stroke?

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