Abstract WP224: Should Carotid Bruit Be Abandoned as a Marker of Carotid Stenosis and Cardiovascular Disease in Older Persons? The Cardiovascular Health Study

Abstract

Importance: Auscultation for carotid bruit has been considered part of physical examination for over five decades. Objective: To test whether a carotid bruit (CB) can identify patients with internal carotid artery stenosis (50% or greater) and those at risk of myocardial infarction (MI), ischemic stroke and/or death among elderly persons. Methods: We analyzed data from the Cardiovascular Health Study a population-based, prospective observational cohort study of risk factors for cardiovascular disease in adults 65 years or older. CB was auscultated and maximum percent stenosis was assessed using duplex ultrasound at baseline visit. Longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years to identify incidence of ischemic stroke, MI and death using annual extensive clinical examinations and 6 monthly clinic visits, and contact by phone to ascertain occurrence of cardiovascular events. We performed Cox proportional hazards analysis to determine the effect of CB on incidence of MI, stroke and death during follow up after adjusting for potential confounders. Results: The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2466 (41.9%) were men. CB was identified in 361 (6.1%) of 5888 persons. Carotid stenosis (50% or greater) was identified in 79 of 361 person with CB (sensitivity of 28.6%). No CB was auscultated in 197 out of 276 patients with carotid stenosis (specificity of 94%). During follow-up, higher proportion of persons with CB experienced ischemic stroke (10.8% versus 7.2%, p=.01), MI (15.0% versus 8.9%,p=<.0001) and death (36.3% versus 21.7%,p=<.0001). There were no differences in the risk of stroke (HR 1.2, 95% CI 0.9-1.5) between persons with CB compared with those without CB in the multivariate analysis after adjusting for age, gender, race hypertension, diabetes and smoking. There was a significantly higher rate of death among persons with CB (HR 1.3, 95% CI (1.1-1.5; p-<.01) and MI (HR 1.4, 95% CI 1.0-1.8; p-.03) compared with those who did not after adjusting for potential confounders. Conclusions: In this study, CB was a not a reliable marker for identification of carotid stenosis and those at risk for ischemic stroke. The current analysis does not support continued use of carotid bruit as part of physical examination.