Prevalence Of Carotid Atherosclerosis Research Articles

Association of baseline cholesterol level and its 10-year change with carotid atherosclerosis in the population of Peking University community

To explore the association of baseline cholesterol level in 1992 and its 10-year change from 1992 to 2002 with the prevalence of carotid atherosclerosis. In 1992, 1985 subjects of the community of Peking University, aged 35 - 64, underwent physical examination and blood-lipid test to study the cardio-vascular disease (CVD) risk factors. In 2002, the second survey on CVD risk factors was conducted among the existing 1932 subjects, now aged 45 - 74. In addition, B-mode ultrasonography of the carotid artery was performed too. The complete data of 1331 subjects were analyzed. (1) In 2002, the prevalence rates of intimal medial thickening (IMT) and carotid plaque in the study population were 47.8% and 29.9% respectively. (2) The post-10-year prevalence rate of carotid plaque was 19.7% in the subjects with the baseline cholesterol < 3.64 mmol/L, and was 46.8% in those with the baseline cholesterol 6.24 mmol/L, with a thickening rate 3.1 times that of the subjects with the baseline cholesterol < 3.64 mmol/L. The higher the baseline TV level, the higher the prevalence rates of carotid plaque and IMT. (3) The prevalence rate of carotid plaque was 32.0% in the subjects with normal TC in both 1992 and 2002, and 50.0% in those with hypercholesterolemia in both 1992 and 2002. Carotid atherosclerosis is a prevalent disorder in the people aged 45 - 74 in Beijing. The prevalence rates of carotid plaque and IMT increase with the elevation of baseline cholesterol level.

Type-2 diabetes and carotid stenosis: a proposal for a screening strategy in asymptomatic patients

The objective of this prospective observational study was to establish the prevalence of carotid atherosclerosis in an asymptomatic diabetic population and to determine predictive factors for a screening optimization. A total of 300 consecutive type-2 diabetic subjects (166 males, 134 females) underwent a physical examination and duplex carotid scanning. Patients with a recent cerebrovascular event (< or = 6 weeks) or previous carotid surgery were excluded. The prevalence of carotid stenosis > or = 60% or occlusion was 4.7%; the prevalence of carotid atherosclerosis was 68.3%. Risk factors for stenosis > or = 60% or occlusion were the presence of diabetic retinopathy (OR: 3.62; 95% CI: 1.12-11.73), ankle-brachial index (ABI) <0.85 (OR: 3.94; 95% CI: 1.21-12.84) and a personal history of neurological disorders (OR: 4.54; 95% CI: 1.16-17.81). Being female was a protective factor (OR: 0.09; 95% CI: 0.01-0.78). The two factors in the analysis limited to the male population were an ABI < 0.85 (OR: 3.66; 95% CI: 1.04-12.84) and a personal history of coronary heart disease (OR: 3.34; 95% CI: 1.01-11.01). If male diabetics without either of these two factors are excluded, the negative predictive value for carotid stenosis is 96.6%. In conclusion, the prevalence of atherosclerotic carotid disease in diabetic patients is high. In these patients, the probability of finding >60% stenosis is highest among men with a history of coronary heart disease or an ABI <0.85.

Relationship between Serum Uric Acid Concentration, Metabolic Syndrome and Carotid Atherosclerosis

Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. Associations between hyperuricemia, metabolic syndrome and carotid IMT have been reported, but few of the studies have been conducted in a Japanese population. A total of 1,128 subjects (498 men aged, 68+/-14 years and 630 women aged 72+/-12 years) were divided into 4 groups according to serum uric acid (SUA) quartiles. We first investigated the association between SUA concentrations and metabolic syndrome; then, we assessed whether there is an independent association of SUA with carotid IMT in a population subdivided according to gender and metabolic syndrome status. In women, the prevalence of visceral obesity and metabolic syndrome were significantly increased with increased SUA quartiles, but not in men. After adjusting for age, smoking status, LDL-cholesterol, creatinine and history of diabetes mellitus, the odds ratios (95% CI) of sex-specific quartiles of SUA for metabolic syndrome were 1.0, 1.37 (0.79-2.37), 1.37 (0.79-2.38), and 1.80 (1.03-3.15) in men, and 1.0, 1.04 (0.56-1.94), 2.35 (1.30-4.22), and 2.20 (1.16-4.20) in women. After adjusting for various known risk factors, the prevalence of carotid atherosclerosis (IMT> or =1.0 mm) was higher in subjects in the second, third and fourth quartiles of SUA concentration with odds ratios (95% CI) of 2.41 (1.08-5.37), 3.33 (1.49-7.42), and 2.73 (1.17-6.35), respectively in men without metabolic syndrome but not in men with metabolic syndrome or in women with or without metabolic syndrome. The prevalence of metabolic syndrome was significantly increased according to SUA values only in women. In men without metabolic syndrome, SUA was found to be an independent risk factor for incidence of carotid atherosclerosis.

Components of the Metabolic Syndrome and Carotid Atherosclerosis

Elevated blood pressure is among the factors that contribute to the metabolic syndrome (MetS). It is not known whether subjects with MetS and elevated blood pressure are at the same cardiovascular risk as subjects with MetS but without elevated blood pressure. To clarify this point, we have evaluated the prevalence of carotid atherosclerosis in subjects with MetS with or without elevated blood pressure. A large population was examined (842 women and 1011 men). Blood pressure, lipids, glucose, and waist were measured by routine methods. Carotid atherosclerosis was evaluated by echo Doppler examination. The prevalence of MetS was 24.4% in women and 28.7% in men. The prevalence of carotid atherosclerosis was 35.1% in women and 37.3% in men (p=NS), and increased with increasing number of MetS components. Age, smoking, and systolic blood pressure (SBP) were associated with the presence of carotid atherosclerosis (logistic model), whereas age, high-density lipoprotein cholesterol, and SBP were associated with the extent of atherosclerosis (linear model). When comparing subjects with an equal number of MetS components, the prevalence of carotid atherosclerosis was significantly higher in subjects with elevated blood pressure than in those without. No difference in carotid atherosclerosis prevalence was found in subjects bearing or not bearing components of the syndrome other than elevated blood pressure. The present findings demonstrate that subjects with MetS and elevated blood pressure have increased carotid atherosclerosis compared with subjects with MetS but without elevated blood pressure. The diagnosis of MetS per se might not adequately identify subjects at elevated cardiovascular risk.

Association Between Serum Uric Acid, Metabolic Syndrome, and Carotid Atherosclerosis in Japanese Individuals

There are few data available on possible independent association between uric acid and carotid atherosclerosis. Here we first sought to investigate association between uric acid levels and metabolic syndrome in Japanese; second, we assessed whether there is an independent association of uric acid with prevalence of carotid atherosclerosis in individuals subdivided according to gender and metabolic syndrome status. Cross-sectional data from 8144 individuals who underwent general health screening were analyzed. After adjusting for age, total cholesterol, and smoking status, the odds ratios (95% CI) of sex-specific quartiles of serum uric acid for metabolic syndrome were 1.0, 1.06 (0.60 to 1.87), 2.18 (1.30 to 3.64), and 4.17 (2.56 to 6.79) in women, and 1.0, 0.92 (0.74 to 1.14), 1.52 (1.25 to 1.65), and 1.97 (1.61 to 2.40) in men. After adjusting for age, serum levels, total cholesterol, and smoking status, prevalence of carotid plaque was higher in subjects in the second, third, and fourth quartiles of uric acid level with odds ratios (95% CI) of 1.24 (1.01 to 1.52), 1.37 (1.11 to 1.68), and 1.31 (1.05 to 1.63), respectively, in men without metabolic syndrome but not in men with metabolic syndrome or in women with or without metabolic syndrome. The prevalence of metabolic syndrome showed a graded increase according to serum uric acid values in both genders. In men who did not have metabolic syndrome, uric acid was found to be an independent risk factor for incidence of carotid plaque.

Metabolic Syndrome and Carotid Atherosclerosis: Role of Elevated Blood Pressure

It is not known whether subjects with metabolic syndrome and elevated blood pressure are at the same cardiovascular risk as subjects with metabolic syndrome but without elevated blood pressure. Using B-mode ultrasonography, carotid IMT was measured in 1,297 patients (593 men and 704 women) in the medical department of Seiyo Municipal Nomura Hospital between August 1996 and April 2005. The prevalence of metabolic syndrome was 32.5% among men and 35.9% among women. On comparing subjects with an equal number of components of metabolic syndrome, it was found that the prevalence of carotid atherosclerosis was significantly higher in subjects with elevated blood pressure than in those without, and increased with the number of components in the former group (p for trend = 0.0277), but not in the latter (p for trend = 0.5159). In a stepwise multiple logistic regression analysis, after adjustment for confounding factors, elevated blood pressure (OR, 1.771; 95% CI, 1.246-2.519), low HDL-C (OR, 1.391; 95% CI, 1.053-1.836) and number of components of metabolic syndrome (OR, 1.561; 95% CI, 1.103-2.209) were significantly associated with carotid atherosclerosis. The diagnosis of metabolic syndrome per se might not adequately identify subjects at increased cardiovascular risk.

Relation of low bone mineral density and carotid atherosclerosis in postmenopausal women

Due to the lack of convincing data about the association between atherosclerosis and osteoporosis, we evaluated the association between carotid atherosclerosis and bone mineral density in a sample of apparently healthy postmenopausal women who underwent health-screening in our hospital. We also evaluated a bone turnover marker, osteocalcin; we divided the population into 2 groups according to osteocalcin levels. We found a high prevalence of carotid atherosclerosis in subjects with high osteocalcin levels and low bone mineral density.

Wall shear stress is associated with intima-media thickness and carotid atherosclerosis in subjects at low coronary heart disease risk.

Systemic and local coronary heart disease (CHD) risk factors participate in atherogenesis. The role of wall shear stress, a major local risk factor, remains to be elucidated. Two hundred thirty-four subjects were carefully characterized for the presence of hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking and were divided into low- and high-risk groups. They underwent echo-Doppler examination of the carotid arteries. Atherosclerotic plaques and stenoses were detected, intima-media thickness (IMT) was measured, and wall shear stress was calculated. One hundred eight subjects were classified as low-risk individuals. The prevalence of carotid atherosclerosis in this group was 18.5%. Wall shear stress was 24.23+/-7.21 dyne/cm(2) in individuals without atherosclerosis and 16.89+/-5.48 in those with atherosclerosis (P<0.000). In multiple regression analyses, wall shear stress, body mass index, and HDL cholesterol were inversely associated and total cholesterol was directly associated with the presence of atherosclerosis; only wall shear stress was associated with IMT. In the high-risk group the prevalence of atherosclerosis was 45.2%. Wall shear stress was 20.44+/-6.82 dyne/cm(2) in subjects without atherosclerosis and 17.84+/-6.88 dyne/cm(2) in those with atherosclerosis (P=0.037). Age was the only variable associated with both carotid atherosclerosis and IMT. In subjects traditionally considered at low CHD risk, intima-media thickening and carotid atherosclerosis are significantly associated with low wall shear stress. In contrast, in subjects at high CHD risk, the contribution of wall shear stress seems to be masked, and age becomes the only factor significantly associated with both carotid atherosclerosis and IMT.

The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients.

There has been recent interest in the importance of visceral fat (VF) for the development of atherosclerosis. The purpose of this study was to examine associations between VF and multiple risk factors as well as the prevalence of carotid atherosclerosis in chronic haemodialysis patients. We classified 77 non-diabetic haemodialysis patients into 'low VF', 'middle VF' and 'high VF' groups after determining VF area using computed tomography. Systemic atherosclerosis was assessed from intima-media thickness (IMT), plaque score (PS) and stiffness parameter beta (stiffness-beta) measured by high-resolution B-mode ultrasonography. Compared with the low VF group, the high VF group exhibited (i) significantly higher fasting plasma insulin (11.0 +/- 6.8 vs 7.1 +/- 2.9 micro U/ml, P = 0.0061); (ii) significantly higher plasma triglycerides (141.8 +/- 94.0 vs 86.5 +/- 32.5 mg/dl, P = 0.0032); and (iii) significantly lower plasma high-density lipoprotein cholesterol (42.1 +/- 14.5 vs 53.0 +/- 15.7mg/dl, P = 0.0134). Moreover, the high VF group had a higher prevalence and extent of carotid atherosclerosis: IMT was 0.69 +/- 0.13 vs 0.61 +/- 0.12 mm (P = 0.0239), PS was 4.8 +/- 3.2 vs 2.4 +/- 3.6 (P = 0.0236) and stiffness-beta was 11.4 +/- 3.1 vs 8.5 +/- 3.0 (P = 0.0082) in the high and low VF groups, respectively. We show that VF is associated with the prevalence of carotid atherosclerosis as well as with hyperinsulinaemia and lipid abnormalities in chronic haemodialysis patients.

Relationship of lipoprotein(a) with intimal medial thickness of the carotid artery in Type 2 diabetic patients in south India.

The objective of this study was to investigate the association of lipoprotein(a) [Lp(a)] levels with intimal medial thickness (IMT) in Type 2 diabetic patients in south India. We studied 587 consecutive Type 2 diabetic patients at the M.V. Diabetes Specialities Centre, Chennai. The mean age of the study group was 55 +/- 10 years and 71.2% were males. IMT of the right common carotid artery was determined using high-resolution B mode ultrasonography. Lp(a) levels were measured using ELISA. Since the frequency distribution of Lp(a) was skewed, Lp(a) values were log transformed and the geometric mean was used for statistical analysis. The tertiles of IMT were determined to analyse the association of Lp(a) and other factors with IMT. The mean Lp(a) level in the study patients was 18.9 +/- 3.1 mg/dl (geometric mean +/- sd) and the mean IMT of the study subjects was 0.93 +/- 0.19 mm (mean +/- sd). The prevalence of carotid atherosclerosis (defined as IMT > 1.1 mm) among subjects with elevated Lp(a) levels > 20 mg/dl was significantly higher compared with those with Lp(a) levels </= 20 mg/dl (26.9% vs. 16.3%, P = 0.003). Lp(a) levels increased with increase in tertiles of IMT (anova, P < 0.05). Pearson correlation analysis of carotid IMT with other cardiovascular risk factors revealed strong correlation of IMT with age (P < 0.0001), duration of diabetes (P < 0.0001), systolic blood pressure (P < 0.0001), diastolic blood pressure (P = 0.006), LDL-cholesterol (P = 0.023), HbA1c (P = 0.017) and Lp(a) (P < 0.0001). Multiple logistic regression analysis showed age (P = 0.010), LDL-cholesterol (P = 0.032) and Lp(a) (P = 0.021) to be associated with carotid atherosclerosis. The results suggest that Lp(a) has a strong association with IMT of carotid arteries in Type 2 diabetic subjects in south India.

Premature atherosclerosis in patients with systemic lupus erythematosus (SLE) detected by ultrasonography (US). Association with factors others than traditional cardiovascular risk factors

Objective: Premature atherosclerosis provokes a high morbidity and mortality in patients with SLE. The true prevalence of atherosclerotic disease in SLE and its pathogenesis is unknown. The aim of this study was to determine the prevalence of carotid atherosclerosis detected by US in patients with SLE and to evaluate the risk factors associated.

Dietary Patterns and the Odds of Carotid Atherosclerosis in Women: The Framingham Nutrition Studies

Background. We prospectively examined the relationship between dietary patterns, assessed using cluster analysis and a food frequency questionnaire, and the presence of carotid artery stenosis, a subclinical marker of atherosclerotic disease. Methods. Analyses were conducted among 1,423 Framingham Study women without cardiovascular disease (CVD) at baseline (1984–1988). Carotid atherosclerosis (stenosis ≥25%) was measured by ultrasound 12 years later. Results. Baseline differences in risk factor profiles were notable across five dietary subgroups. Compared to the more desirable profiles of women with Heart Healthy eating patterns, women who had Light Eating, High Fat, or Empty Calorie diets had higher rates of dyslipidemia and smoking and lower levels of physical activity. At follow-up, the prevalence of carotid atherosclerosis ranged from 6.8% in the Heart Health group to 17.8% in the Empty Calorie group. Compared with Heart Health women, all other groups displayed higher age-adjusted odds for carotid stenosis. In multivariate analyses, those with Empty Calorie diets had more than twofold increased odds of carotid atherosclerosis compared to Heart Health women (OR 2.28, 95% CI [1.12, 4.62]; P < 0.05). Conclusion. The association among unique dietary patterns, CVD risk factor profiles, and the presence of subclinical atherosclecosis identifies candidates and strategies for preventive behavioral interventions to promote the primary prevention of heart disease.

Biological gradient between long-term arsenic exposure and carotid atherosclerosis.

Long-term exposure to ingested arsenic has been documented to induce peripheral vascular disease, ischemic heart disease, and cerebral infarction in a dose-response relationship. This study further examined the biological gradient between ingested inorganic arsenic and carotid atherosclerosis. We studied 199 male and 264 female adult residents from the southwestern area of endemic arseniasis in Taiwan. The extent of carotid atherosclerosis was assessed by duplex ultrasonography. Diabetes mellitus was determined by oral glucose tolerance test, hypertension by mercury sphygmomanometers, and serum lipid profiles by autoanalyzers. Information regarding the consumption of high-arsenic artesian well water, cigarette smoking, and alcohol consumption was obtained through standardized questionnaire interviews. Logistic regression analysis was used to estimate the odds ratio and its 95% CI of carotid atherosclerosis for various risk factors. Three indices of long-term exposure to ingested arsenic, including the duration of consuming artesian well water, the average arsenic concentration in consumed artesian well water, and cumulative arsenic exposure, were all significantly associated with prevalence of carotid atherosclerosis in a dose-response relationship. The biological gradient remained significant after adjustment for age, sex, hypertension, diabetes mellitus, cigarette smoking, alcohol consumption, waist-to-hip ratio, and serum levels of total cholesterol and LDL cholesterol. The multivariate-adjusted odds ratio was 3.1 (95% CI 1.3 to 7.4) for those who had a cumulative arsenic exposure of > or =20 mg/L-years compared with those without exposure to arsenic from drinking artesian well water. Carotid atherosclerosis is associated with ingested inorganic arsenic, showing a significant biological gradient.

Increased prevalence of carotid atherosclerosis in hepatitis B virus carriers.

Recent experimental and epidemiological findings suggest that some infectious agents play a role in the development and promotion of atherosclerosis. We have investigated the possible association between hepatitis B virus surface antigen (HBsAg) positivity and carotid arteriosclerosis. In this cross-sectional cohort study, we analyzed data from subjects undergoing general health-screening tests, including both high-resolution B-mode carotid ultrasound and assessment of HBsAg status, between 1994 and 2001 at our institute. Of the 4686 study subjects (3137 men and 1549 women; age 22 to 88 years), 1294 (28%) had carotid artery plaque and 40 (0.9%) were positive for HBsAg, indicating they were hepatitis B virus carriers. No HBsAg-positive subjects were positive either for antibodies against the hepatitis C virus (HCV) or for HCV core proteins. Univariate analysis revealed HBsAg positivity was associated with carotid plaque with an odds ratio of 1.58 (95% CI, 1.14 to 2.19, P<0.05). When other confounding risk factors for atherosclerosis were included as covariates in the statistical analysis, HBsAg positivity was still positively associated with carotid plaque with an odds ratio of 1.57 (95% CI, 1.10 to 2.24, P<0.05). These findings suggest a possible role of chronic hepatitis B infection in the pathogenesis of carotid arteriosclerosis.

Prevalence and relation to risk factors of carotid atherosclerosis and left ventricular hypertrophy in systemic lupus erythematosus and antiphospholipid antibody syndrome

The prevalence of preclinical cardiovascular disease was determined in women with systemic lupus erythematosus (SLE) and control subjects matched for traditional risk factors. Compared with control subjects, patients with SLE had a higher prevalence of carotid atherosclerosis (41% vs 9%, p < 0.005) and left ventricular hypertrophy (32% vs 5%, p < 0.005), supporting the possibility that chronic inflammation predisposes to premature cardiovascular disease in SLE.

High prevalence of peripheral atherosclerosis in a rapidly developing country

Cardiovascular disease is rapidly increasing in developing countries experiencing epidemiological transition. We investigated the prevalence of peripheral atherosclerosis in a rapidly developing country and compared our findings with data previously reported in Western populations. A cardiovascular risk factor survey was conducted in 1067 individuals aged 25–64 randomly selected from the general population of Seychelles. High-resolution ultrasonography of the right and left carotid and femoral arteries was performed in a random subgroup of 503 subjects (245 men and 258 women). In each of the four arteries, arterial wall thickness (in plaque-free segments) and atherosclerotic plaques (i.e. focal wall thickening at least 1.0 mm thick) were measured separately. The prevalence of peripheral atherosclerosis was high in this population. For instance, at least one plaque ≥1.0 mm was found in, respectively, 34.9 and 27.5% of men and women aged 25–34 and at least one plaque ≥2.5 mm was found in, respectively, 58.2 and 36.9% of men and women aged 55–64. With reference to data found in the literature, the prevalence of carotid atherosclerosis appeared to be significantly higher in Seychelles than in Western populations. This study provides further evidence for the importance of cardiovascular disease in developing countries. Determinants should be identified and relevant prevention and control programs implemented.

Infections, immunity, and atherosclerosis: associations of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus with immune reactions to heat-shock protein 60 and carotid or femoral atherosclerosis.

Atherogenesis involves inflammatory processes in which infections are incriminated as possible contributors. We evaluated cardiovascular risk factors as well as seropositivity to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus in a population-based study. A significant association between prevalence and severity of atherosclerosis in carotid and femoral arteries and IgA antibodies to C pneumoniae was demonstrated that was not substantially altered after adjustment for established risk factors. For anti-H pylori IgG antibodies, significant correlations to vascular disease were restricted to low social status and lesions in carotid arteries. In addition, the study design allowed us to monitor lesion progression over time. In this prospective analysis, C pneumoniae seropositivity emerged as a significant risk predictor. Antibody titers against cytomegalovirus were not a marker for prevalence or incidence of atherosclerosis in this population. Further infection parameters added to the predictive value of chlamydial serology in risk assessment: Mean odds ratios for the prevalence of carotid atherosclerosis were 4.2 and 6.3 for seropositive subjects with elevated C-reactive protein levels and clinical evidence for chronic respiratory infection, respectively. For subjects with all 3 infection parameters, the odds ratio of carotid atherosclerosis reached 10.3 (P<0.0001). Concomitantly, serum antibodies to mycobacterial heat-shock protein 65 (mHSP65) correlated with seropositivity to C pneumoniae and H pylori but not to cytomegalovirus. This prospective population-based study provides strong evidence for a potential atherogenic role of persistent bacterial infection, especially C pneumoniae, as indicated by serological and clinical data and demonstrates a correlation between immune reactions to mHSP65 and bacterial infections in atherogenesis.

Occupational status, educational level, and the prevalence of carotid atherosclerosis in a general population sample of middle-aged Swedish men and women: results from the Malmö Diet and Cancer Study.

The associations among educational level, occupational status, and atherosclerosis were investigated during 1992-1994 in a general population sample of 4,176 Swedish men and women. Carotid artery intima-media thickness (IMT) and carotid stenosis were determined by B-mode ultrasound. Socioeconomic differences in mean carotid IMT and odds ratios for carotid stenosis prevalence were estimated. In women, the associations among educational level, occupational status, and IMT were weak. In men, there was no association between education and IMT, while low occupational status was associated with a thicker IMT. Women with low education had an increased odds of carotid stenosis compared with women with high education (odds ratio (OR) = 2.04, 95% confidence interval (CI): 1.53, 2.73), while this pattern was weaker among men. Women in manual occupations had an increased odds of carotid stenosis compared with women in high- or medium-level nonmanual occupations (OR = 1.75, 95% CI: 1.29, 2.36), which could not be seen among men. After adjustment for risk factors, the association between IMT and occupational status in men disappeared, while the associations among educational level, occupational status, and carotid stenosis in women persisted. The results imply that the atherosclerotic process is associated with socioeconomic status in both sexes, and they also indicate the possibility of sex differences in the mechanisms connecting socioeconomic status to atherosclerosis.

Carotid stenosis in a multiethnic population

Carotid stenosis is an important, treatable cause of stroke. Several population-based studies have shown ethnic differences in the prevalence of carotid atherosclerosis. This study was performed at a large multiethnic hospital to clarify these differences. One thousand six carotid artery ultrasounds performed by the Department of Radiology at Los Angeles County General Hospital over a 4-year period were reviewed. Patients were classified as Caucasian (n=151), Hispanic (n=515), Black (n=173), or Asian (n=167) by self-declaration and birthplace. Carotid stenosis was defined as mild (1% to 39%), moderate (40% to 59%), severe (60% to 79%), critical (80% to 99%), or total (100%). Twenty and one-half percent of Caucasian patients had greater than 59% stenosis compared with 10.1% of Hispanics, 8.7% of Blacks, and 10.7% of Asians (P<0.001). Nine and two-tenths percent of Caucasians had greater than 79% stenosis compared with 4.3% of Hispanics, 2.9% of Blacks, and 2.8% of Asians (P<0.001). There were no significant differences in age or gender representations between ethnic groups, and the indications for ordering carotid duplex sonography also did not vary by race. Caucasians and Blacks had a higher prevalence of cardiac disease, smoking, and heavy alcohol abuse. Hispanics had higher rates of diabetes. These results indicate that significant differences in the degree of carotid stenosis exist among ethnic groups. Caucasian patients in our series showed a statistically higher likelihood of having a severe or critical level of stenosis. These findings may have implications for the allocation of health care resources as ethnic minorities compose a greater proportion of the population.

Factores de riesgo cardiovascular y aterosclerosis carotídea detectada por ultrasonografía

To assess the frequency of carotid atherosclerosis and its relation to cardiovascular risk factors in a general elderly population of Mexico City. B-mode ultrasonography was performed to investigate carotid atherosclerosis in 145 CUPA (a research project) participants, between July 1993 and January 1996. The outcome was then related to cardiovascular risk factors. Prevalence of ultrasound-detected carotid atherosclerosis was 64.8%. Intimal-medial thickening was detected in 64 subjects (44.1%) and carotid plaques in 82 (56.5%); Fifty-two subjects had both intimal-medial thickening and plaques. However, only 8 subjects had carotid plaques with severe stenosis (5.5%). There were no significant differences in the prevalence of atherosclerotic lesions (male 61.9%, female 66.0%). Carotid atherosclerosis was significantly associated with age (p < 0.0001), high blood pressure (p < 0.001), isolated systolic hypertension (p = 0.01), hypercholesterolemia (p = 0.04), and diabetes mellitus (p = 0.06). Prevalence of carotid atherosclerosis increased progressively with the number of vascular risk factors. There was a high prevalence of carotid atherosclerosis in this general elderly population of Mexico City, and was almost equal to that reported in developed western countries. Age, hypertension, hypercholesterolemia, and diabetes were the strongest predictors of atherosclerosis.