Prevalence Of Carotid Stenosis Research Articles

Impact of carotid stenosis on the outcome of stroke patients submitted to reperfusion treatments: a narrative review.

Intravenous thrombolysis (IT) and mechanical thrombectomy (MD) are the two interventional approaches that have changed the outcome of patients with acute ischemic stroke (AIS). Ipsilateral and contralateral carotid stenosis (ICS, CCS) play an important role in regulating cerebral hemodynamics, both in chronic and acute situations such as AIS. Several studies have explored their role in the incidence and severity of stroke, but very few have investigated the possible impact of ICS and CCS on the efficacy of interventional procedures. The purpose of this review was to I) highlight the incidence and prevalence of carotid stenosis (CS); II) assess the impact of ICS and CCS on cerebral hemodynamics; III) evaluate the effect of carotid stenosis on the efficacy of interventional therapies (IT and MT) for AIS; and IV) report therapeutic complications related to CS. We searched PubMed/Medline for case reports, reviews, and original research articles on English-language review topics during the period from January 1, 2000 to October 1, 2023. CS is associated with 15-20 % of the total number of AIS. ICS and CCS had a negative influence on both cerebral hemodynamics before AIS and outcome after interventional procedures (IT, MT alone or in bridging). Available data on cerebral hemodynamics and efficacy of interventional therapies for AIS suggest a negative role of CS. Therefore, early diagnosis of CS may be considered relevant to preventive and post-stroke treatment strategies.

Prevalence of stroke-related risk factors in Albania: a single-center experience.

Stroke, a prominent global cause of mortality and disability, is broadly categorized into ischemic and hemorrhagic types. An epidemiological survey of stroke and its risk factors can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and evaluate stroke-associated risk factors in Albania. This was a single-center retrospective analysis conducted in Albania for the period from May 2015 to September 2021. Data were collected retrospectively through hospital records. Stroke was defined as sudden onset of a nonconvulsive and focal neurological deficit, and ischemic stroke was diagnosed using brain computed tomography (CT), magnetic resonance (MR) imaging, or both. We examined patient history characteristics encompassing demographics, stroke history, conventional vascular risk factors, and lifestyle-related risk factors. The mean age of the 3860 patients was 74.6 ±10.4 years, and 73.5% were men. The prevalence of carotid stenosis, arrhythmia, obesity, and hypertension was significantly higher in males than in females (p < 0.001). Out of the 3860 patients in the study cohort, 641 (16.6%) subjects died, while 335 (8.7%) patients achieved complete recovery. Hemiparesis was observed in 386 (10%) patients and hemiplegia in 868 (22.4%) patients. Our analysis underscores the male predominance (2.2 : 1) in stroke cases. Carotid and vertebral artery stenosis is a significant factor, emphasizing the life-saving potential of early intervention. Social and economic factors in Albania pose challenges, demanding comprehensive strategies. Prospective trials are crucial to explore intervention efficacy, and timing, and address socioeconomic impacts on timely stroke management.

Validity and Reliability of Point-of-Care Ultrasound for Detecting Moderate- or High-Grade Carotid Atherosclerosis in an Outpatient Department.

The prevalence of carotid stenosis is considerably higher in asymptomatic individuals with multiple risk factors than in the general population. We investigated the validity and reliability of carotid point-of-care ultrasound (POCUS) for rapid carotid atherosclerosis screening. We prospectively enrolled asymptomatic individuals with carotid risk scores of ≥7 who underwent outpatient carotid POCUS and laboratory carotid sonography. Their simplified carotid plaque scores (sCPSs) and Handa's carotid plaque scores (hCPSs) were compared. Of 60 patients (median age, 81.9 years), 50% were diagnosed as having moderate- or high-grade carotid atherosclerosis. The overestimation and underestimation of outpatient sCPSs were more likely in patients with low and high laboratory-derived sCPSs, respectively. Bland-Altman plots indicated that the mean differences between the participants' outpatients and laboratory sCPSs were within two standard deviations of their laboratory sCPSs. A Spearman's rank correlation coefficient revealed a strong positive linear correlation between outpatient and laboratory sCPSs (r = 0.956, p < 0.001). An intraclass correlation coefficient analysis indicated excellent reliability between the two methods (0.954). Both carotid risk score and sCPS were positively and linearly correlated with laboratory hCPS. Our findings indicate that POCUS has satisfactory agreement, strong correlation, and excellent reliability with laboratory carotid sonography, making it suitable for rapid screening of carotid atherosclerosis in high-risk patients.

COFFEE CONSUMPTION RELATES TO A REDUCTION OF VASCULAR AND HEART DAMAGE IN WELL-CONTROLLED HYPERTENSIVES

Objective: Nutritional interventions might prevent hypertension-related organ damage but are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated heart and vascular damage in well-controlled hypertensives according to coffee consumption. Design and method: We evaluated 316 primary hypertensives (150F, 166M, aged 62.22±10.76) evaluated for target organ damage. The number of coffee cups per day was asked during the visit. Results: The median coffee consumption was 2 cups per day and patients were subdivided into tertiles: Group 1, 0-1 cups 112 patients (57F, 55M; 64.21±10.91 y.), Group 2, 2 cups, 101 patients (53F; 48 M; 61.95±10.10 y.), Group 3, &gt;2 cups, 103 patients (40F; 63M; 60.32±10.95 y.). No differences were seen in BMI, systolic and diastolic BP. Group 1 had a higher left ventricular mass than the other two groups (p = 0.0008 and p = 0.019 respectively) while no difference there was between group 2 and 3. Similarly, Group 1 had a significant reduction in E/e’ ratio (p = 0.042 and p = 0.019, respectively). No significance was found between Group 2 and 3 for left ventricular mass and diastolic function. Group 3 had an increased intima-media thickness (p = 0.004 and p = 0.005 vs Group 1 and 2, respectively). Prevalence of carotid stenosis was lower in Group 3 (p = 0.011 and p = 0.039, respectively) and was comparable in Group 1 and 2. Conclusions: Coffee consumption at least of 2 cups/day may have a role in prevention of heart remodelling and diastolic dysfunction.

C85 COFFEE CONSUMPTION RELATES TO A REDUCTION OF VASCULAR AND HEART DAMAGE IN WELL–CONTROLLED HYPERTENSIVES

Abstract Aim Nutritional interventions might prevent hypertension–related organ damage but are far to be fully defined. Coffee is one of the most used beverages all over the world. Many studies tried to define the optimal amount of coffee to understand whether coffee has a role in cardiovascular prevention. Thus, we evaluated heart and vascular damage in well–controlled hypertensives according to coffee consumption. Methods We evaluated 316 primary hypertensives (150F, 166M, aged 62.22±10.76) evaluated for target organ damage. The number of coffee cups per day was asked during the visit. Results The median coffee consumption was 2 cups per day and patients were subdivided into tertiles: Group 1, 0–1 cups 112 patients (57F, 55M; 64.21±10.91 y.), Group 2, 2 cups, 101 patients (53F; 48 M; 61.95±10.10 y.), Group 3, &amp;gt;2 cups, 103 patients (40F; 63M; 60.32±10.95 y.). No differences were seen in BMI, systolic and diastolic BP. Group 1 had a higher left ventricular mass than the other two groups (p= 0.0008 and p=0.019 respectively) while no difference there was between group 2 and 3. Similarly, Group 1 had a significant reduction in E/e’ ratio (p=0.042 and p=0.019, respectively). No significance was found between Group 2 and 3 for left ventricular mass and diastolic function. Group 3 had an increased intima–media thickness (p=0.004 and p=0.005 vs Group 1 and 2, respectively). Prevalence of carotid stenosis was lower in Group 3 (p=0.011 and p=0.039, respectively) and was comparable in Group 1 and 2. Conclusion Coffee consumption at least of 2 cups/day may have a role in prevention of heart remodelling and diastolic dysfunction.

Inflammation and endothelial function relevant genetic polymorphisms in carotid stenosis in southwestern China.

To evaluate the relationship between carotid stenosis with variants in genes referred to inflammation and endothelial function. There was a multi-center, cross sectional survey in southwestern China. The eight communities were selected at random in southwestern China. The residents aged ≥40 years volunteered to participate in face-to-face survey. Subjects with at least three of the aforementioned eight stroke related risk factors or a history of stroke were classified as high-risk population for stroke. A total of 2,377 subjects were the high-risk population for stroke in the eight communities, and degree of carotid stenosis was assessed by carotid ultrasound. Genotypes of 6 variants in 3 genes related to inflammation and endothelial function were examined. Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Carotid stenosis were found in 295 (12.41%) subjects, of whom 51 (17.29%) had moderate or severe stenosis. According to multivariate logistic regression analysis, we found that HABP2rs7923349TT was independent risk factor for carotid stenosis (OR, 1.96, 95% CI: 1.22-3.13, P = 0.005) and ITGA2rs1991013AG and HABP2rs7923349TT were independent risk factors for moderate to severe carotid stenosis (OR, 2.28, 95% CI: 1.28-4.07, P = 0.005; OR, 2.90, 95% CI: 1.19-7.08, P = 0.019). GMDR analysis showed that there was a significant gene-gene interaction between ITGA2 rs4865756 and HABP2 rs7923349, and the high-risk interactive genotype in the two variants was independently associated with a higher risk for carotid stenosis after adjusting the covariates (OR,1. 42, 95% CI 1.10-1.84, P = 0.008). Prevalence of carotid stenosis was very high in the high-risk stroke population in southwestern China. Variants in genes referred in endothelial function were associated with the carotid stenosis. The high-risk interactive genotype in ITGA2 rs4865756 and HABP2 rs7923349 was independently associated with a higher risk for carotid stenosis.

Asymptomatic Carotid Bruit/Carotid Artery Stenosis

Stroke used to be the third leading cause of death in the United States, behind coronary artery disease and cancer. However, a 2011 report states that stroke has now dropped to the fourth leading cause of death. Nearly 80% of strokes are ischemic, but only 15% of stroke patients have warning transient ischemic attacks. The management of patients with asymptomatic carotid stenosis is controversial; in this review, a stepwise approach to the management of asymptomatic carotid bruit/extracranial carotid artery stenosis is provided. Specifically, this review covers clinical evaluation, carotid bruits, vascular risk evaluation, imaging modalities, natural history of asymptomatic carotid artery disease, carotid plaque progression, natural history of asymptomatic carotid stenosis with evidence of clinically silent cerebral emboli, recommendations for carotid intervention/medical therapy, level 1 evidence supporting carotid endarterectomy in asymptomatic patients, and decision making for medical therapy alone versus intervention. Figures show color Doppler image with Doppler sampling from the right common carotid artery (CCA) and internal carotid artery (ICA), color duplex image with Doppler sampling of the distal left CCA and proximal ICA, color duplex ultrasound image of a plaque at the carotid bifurcation, magnetic resonance angiography showing severe stenosis of the right ICA and occluded left ICA, computed tomographic angiography showing severe stenosis of the left ICA with calcification, diagram for management of patients with both carotid stenosis and coronary artery disease, and protocol of management of asymptomatic bruit/carotid artery stenosis. Tables list the annual risk of stroke, prevalence of carotid stenosis in patients with bruits and in healthy volunteers, duplex velocity criteria for carotid stenosis, consensus criteria, validation of consensus criteria: duplex ultrasonography versus angiographic stenosis, risk factors for stroke, ranking of modifiable stroke risk factors, asymptomatic randomized trials comparing medical with medical and surgical treatment (stenosis &gt; 60%), and a summary of specialty/societal guidelines. This review contains 7 highly rendered figures, 9 tables, and 91 references

Asymptomatic Carotid Bruit/Carotid Artery Stenosis

Stroke used to be the third leading cause of death in the United States, behind coronary artery disease and cancer. However, a 2011 report states that stroke has now dropped to the fourth leading cause of death. Nearly 80% of strokes are ischemic, but only 15% of stroke patients have warning transient ischemic attacks. The management of patients with asymptomatic carotid stenosis is controversial; in this review, a stepwise approach to the management of asymptomatic carotid bruit/extracranial carotid artery stenosis is provided. Specifically, this review covers clinical evaluation, carotid bruits, vascular risk evaluation, imaging modalities, natural history of asymptomatic carotid artery disease, carotid plaque progression, natural history of asymptomatic carotid stenosis with evidence of clinically silent cerebral emboli, recommendations for carotid intervention/medical therapy, level 1 evidence supporting carotid endarterectomy in asymptomatic patients, and decision making for medical therapy alone versus intervention. Figures show color Doppler image with Doppler sampling from the right common carotid artery (CCA) and internal carotid artery (ICA), color duplex image with Doppler sampling of the distal left CCA and proximal ICA, color duplex ultrasound image of a plaque at the carotid bifurcation, magnetic resonance angiography showing severe stenosis of the right ICA and occluded left ICA, computed tomographic angiography showing severe stenosis of the left ICA with calcification, diagram for management of patients with both carotid stenosis and coronary artery disease, and protocol of management of asymptomatic bruit/carotid artery stenosis. Tables list the annual risk of stroke, prevalence of carotid stenosis in patients with bruits and in healthy volunteers, duplex velocity criteria for carotid stenosis, consensus criteria, validation of consensus criteria: duplex ultrasonography versus angiographic stenosis, risk factors for stroke, ranking of modifiable stroke risk factors, asymptomatic randomized trials comparing medical with medical and surgical treatment (stenosis &gt; 60%), and a summary of specialty/societal guidelines. This review contains 7 highly rendered figures, 9 tables, and 91 references

Epidemiology of atherosclerotic carotid artery disease

Atherosclerotic carotid artery disease is a significant cause of stroke in the United States and globally. Its prevalence increases with age and it is more prevalent in men and White and Native-American populations. However, the outcomes related to carotid disease are worse in women and Black patients. Research suggests the disparities exist due to a multitude of factors, including disease pathophysiology, access to care, provider bias, and socioeconomic status. The prevalence of carotid stenosis in the general population is low (3%), and routine screening for carotid stenosis is not recommended in adults. Randomized clinical trials have shown benefits of stroke risk reduction with surgery (carotid endarterectomy or stenting) for symptomatic patients. Management is controversial in asymptomatic patients, as modern medical management has results equivalent to those of surgery and ongoing randomized clinical trials will address this important question. Carotid surgery is not appropriate in asymptomatic patients with limited life expectancy. Future work should explore comprehensive care models for care of patients with carotid disease and assessment of patient-reported outcomes to measure quality of care.

Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta‐analysis

Radiation to the head and neck is a well-established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation. This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted. Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI: 19%-32%), 12% (95% CI: 7%-17%), and 4% (95% CI: 2%-8%), respectively. The cumulative 12-month incidence of carotid stenosis >50% was 4% (95% CI: 2%-5%), the 24-month was 12% (95% CI: 9%-15%), and the 36-month was 21% (95% CI: 9%-36%). The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy.

Prevalence of Carotid Stenosis and Incidence of Ischemic Stroke in Patients Undergoing Non-Coronary Cardiac Surgery.

IntroductionMany publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery.ObjectivesTo evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries.ObjectivesWe assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis.Results11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. ConclusionThe incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification

AimsRoutine screening of carotid atherosclerosis lesions is frequently suggested for people with type 2 diabetes, the presence of a carotid lesion being associated with a significant increase risk for vascular events. However, the impact of this strategy on medical management is not validated. We herein question the usefulness of such screening. MethodsWe assessed the prevalence and severity of carotid lesions in 337 consecutive people with type 2 diabetes without known cardiovascular disease who underwent a systematic carotid duplex ultrasonography. We analyzed whether the results of duplex ultrasonography allowed reclassification of cardiovascular risk level relative to the most recent international recommendations on diabetes and modified therapy. ResultsWe found that 35.9% of people had no atherosclerotic lesion. Prevalence of carotid stenosis<20%, between 20 and 50% and ≥50% were 32.9%, 28.4% and 2.7% respectively. Regarding the use of statins and LDL-C target, the result of carotid duplex ultrasonography allowed to reclassify respectively 11.8% to 55.2% of the cohort in a higher cardiovascular risk level. For the indication of antiplatelet agent, reclassification in a higher risk level concerned 6.8% of the patients. No subject had an indication of carotid revascularization. ConclusionsCarotid atherosclerosis is frequent in asymptomatic people with type 2 diabetes in primary cardiovascular prevention. Screening for carotid atherosclerosis by duplex ultrasonography seems useful to redefine the level of cardiovascular risk.

Amaurosis fugax: risk factors and prevalence of significant carotid stenosis.

PurposeThe purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF).MethodPatients diagnosed with AF and subjected to carotid ultrasound in 2004–2010 in Sahlgrenska University Hospital, Gothenburg (n=302), were included, and data were retrospectively collected from medical records.ResultsThe prevalence of significant carotid stenosis was 18.9%, and 14.2% of the subjects were subjected to carotid endarterectomy. Significant associations with risk of having ≥70% stenosis were male sex (adjusted odds ratio [aOR]: 2.62; 95% confidence interval [CI]: 1.26–5.46), current smoking (aOR: 6.26; 95% CI: 2.62–14.93), diabetes (aOR: 3.68; 95% CI: 1.37–9.90) and previous vasculitis (aOR: 10.78; 95% CI: 1.36–85.5). A majority of the patients (81.4%) was seen by an ophthalmologist prior to the first ultrasound. Only 1.7% of the patients exhibited retinal artery emboli at examination.ConclusionThe prevalence of carotid stenosis among patients with AF is higher than has previously been demonstrated in stroke patients. An association with previously reported vascular risk factors and with vasculitis is seen in this patient group. Ocular findings are scarce.

Prevalence of carotid stenosis and its correlation with incidence of perioperative stroke in patients of coronary artery bypass graft surgery

Background Stroke is the most devastating complication of coronary artery bypass graft (CABG) surgery. Presence of carotid stenosis in patients requiring CABG poses a clinical challenge as it increases the risk of stroke during surgery. Present study is retrospective analysis of prevalence of carotid stenosis in Indian patients undergoing CABG surgery and its correlation with incidence of perioperative stroke.

Study of carotid disease in patients with peripheral artery disease.

To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease. we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis. The prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses). the study of the carotid arteries by duplex scan examination is of paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients.

Co-prevalence of carotid stenosis and coronary artery disease in Chinese patients with paroxysmal atrial fibrillation.

To investigate the co-prevalence of coronary artery disease (CAD) and carotid stenosis and to determine predictors related to CAD in Chinese patients with paroxysmal atrial fibrillation (PAF), presenting without previously diagnosed or excluded CAD. Consecutive patients with PAF were recruited. CAD was evaluated using multislice computed tomography. Intima-media thickness (IMT) of the carotid artery was evaluated via ultrasonography. A total of 62/192 (32.3%) patients had CAD. Carotid stenosis was observed in 26/192 (13.5%) patients. The co-prevalence of carotid stenosis and CAD was 7.8% (15/192). The prevalence of carotid stenosis was 8.5%, 16.7%, 25.0%, and 41.7% in patients with zero-, one-, two-, and three-vessel CAD, respectively. Diabetes mellitus, maximal IMT and hyperhomocysteinaemia were independently related to the presence of CAD. The prevalence of CAD was 32.3% in Chinese patients with PAF. Carotid stenosis and CAD co-occurred in 7.8% of patients, and the prevalence of carotid stenosis correlated with the severity of CAD. Screening of carotid stenosis is recommended, especially in patients with PAF and multivessel CAD.

Retinal microvascular abnormalities are associated with early carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes mellitus

ObjectiveControversies concerning the association of retinal microvascular abnormalities (RMAs) with atherosclerosis in patients with diabetes exist. The objective of this study was to investigate the association between RMAs and carotid atherosclerotic lesions in Chinese inpatients with type 2 diabetes. MethodsThis cross-sectional study involved 2870 type 2 diabetic patients including 1602 men aged 15–90years and 1268 women aged 17–88years. Both retinal arteriosclerosis (RA) and diabetic retinopathy (DR) were determined by digital fundus photography using a standardized protocol. RMAs are defined as the presence of either RA or DR. Carotid atherosclerotic lesions including carotid intima-media thickness (CIMT), carotid atherosclerotic plaque and stenosis were assessed and compared between patients with and without RMAs based on Doppler ultrasound. The association of RMAs with carotid atherosclerotic lesions was analyzed by linear and binary logistic regression analyses. ResultsThe CIMT values in both male and female diabetics with RMAs were significantly greater than in those without RMAs after controlling for age (0.88±0.21 vs. 0.77±0.20mm for men, p=0.002; and 0.84±0.19 vs. 0.76±0.21mm for women, p=0.002). The prevalence of carotid plaque was also markedly higher in patients with RMAs than in those without RMAs after adjusting for age (54.3% vs. 23.9% for men, p<0.001; 48.4% vs. 32.0% for women, p=0.046). However, no significant difference was observed in the prevalence of carotid stenosis in either men or women with or without RMAs. After controlling for multiple confounding factors, RMAs were independently associated with increased CIMT in both men (β: 0.067,95% CI: 0.026–0.269, p=0.018) and women (β: 0.087, 95% CI: 0.058–0.334, p=0.005) with type 2 diabetes, and they were also closely associated with the presence of carotid plaque (OR: 2.17, 95% CI: 1.54–3.05, p<0.001 for men; OR: 1.38, 95% CI: 0.91–2.08, p=0.129 for women) in men with type 2 diabetes. ConclusionsRMAs were closely associated with early carotid atherosclerotic lesions in hospitalized Chinese patients with type 2 diabetes. Our results suggested that changes in retinal microvasculature may play a role in the pathogenesis of atherosclerosis and may be used as an indicator of early atherosclerosis in patients with type 2 diabetes.

Caracterización de factores asociados con estenosis carotídea en una población de alto riesgo

Moderate to severe stenosis is the less prevalent among the forms of carotid atherosclerotic disease), but it carries a high risk of ischaemic stroke. To characterise factors associated with moderate to severe carotid stenosis in a high-risk population. We performed an analysis on traditional risk factors associated with carotid stenosis ≥50% in 533 patients who received Doppler ultrasound due to a history of stroke (34%) or who had = 2 of the risk factors: age ≥55 years (86%), hypertension (65%), dyslipidemia (52%), obesity (42%), diabetes (40%) or smoking (40%). The prevalence of carotid stenosis ≥50% was 7.1%, symptomatic (associated with stroke in congruent territory) in 5.6%, bilateral in 2.1% and bilateral symptomatic in 1.5%. A 36.8% of patients had moderate to severe load (≥4) of atherosclerotic plaques (25.9% moderate: 4-6 plaques, and 10.9% severe: ≥7 plaques). By multivariate analysis we identified the age ≥75 years, dyslipidemia, and smoking as factors independently associated with carotid stenosis ≥50%, and hypertension and smoking with symptomatic stenosis. The number of risk factors was strongly associated with the prevalence of carotid stenosis. Notably, neither diabetes nor obesity explained the degree of moderate to severe carotid stenosis. As forms of carotid atherosclerotic disease, moderate to severe stenosis is less frequent than a high burden of atherosclerotic plaques. Advanced age, smoking, dyslipidemia and hypertension are the main traditional risk factors associated with the degree of carotid stenosis.

Duplex ultrasound: A diagnostic tool for carotid stenosis management in type 2 diabetes mellitus

BackgroundDiabetic patients are at increased risk of developing cardiac events and stroke, and prevention of diabetes mellitus is therefore desirable. Marked geographical and ethnic variation in the prevalence of diabetes caused by urbanisation, demographic and epidemiological transitions has rendered this one of the major non-communicable diseases in South Africa. Duplex ultrasound (DUS) plays an important role in primary health care in early detection of carotid atherosclerotic disease and the degree of carotid stenosis present. It is a reliable, cost-effective and non-invasive diagnostic tool. The purpose of this study was to determine the role of ultrasound in carotid stenosis management in type 2 diabetes mellitus (T2DM).ObjectivesTo determine the prevalence of carotid stenosis in a selected T2DM population using DUS and to correlate these findings with other predisposing atherosclerotic risk factors.MethodsThe study setting was at an academic hospital in the Western Cape using carotid DUS reports of 103 diabetic subjects ≥ 35 years old. Predisposing risk factors were correlated with degree of carotid stenosis present. Data were analysed using the Fischer exact test, Chi-square and Student t-test.ResultsCarotid DUS reports of 63 out of 103 T2DM patients revealed no evidence of a carotid stenosis, thereby lowering the risk profile. Forty patients were identified as having carotid stenosis; 22 symptomatic patients had a > 70% carotid stenosis which warranted surgical intervention. A greater prevalence of stenosis in the Caucasian group, in both the male (p = 0.0411) and female (p = 0.0458) cohorts, was noted. The overall trend suggested a relationship between T2DM and lifestyle, and a statistically significant relationship (p = 0.0063) between smoking and carotid stenosis was observed.ConclusionT2DM and predisposing atherosclerotic risk factors significantly increased the possibility of carotid stenosis development.

Correlation between carotid stenosis and severity of coronary disease in diabetic candidates for angiography in cardiology clinic of Shariati Hospital in 2011

Background: Coronary disease is the most common cause of death in the world. Because of common risk factors, atherosclerotic stenosis of coronary and carotid arteries occurs together. This study evaluated the prevalence of carotid stenosis in diabetic candidates for angiography Methods: In a cross-sectional study, 152 diabetic candidates for angiography referred to cardiology clinic of Shariati Hospital in 2011 went under angiography and Doppler echocardiography. Data were analyzed employing chi-square and ordinal regression. Results: Results indicated a negative correlation between carotid stenosis and coronary disease (P=0.017) which means without coronary disease, there was 1.7 times less risk for carotid stenosis. Age, duration of diabetes, side of carotid stenosis, and plaque size showed no effects on these variables, while female gender (P=0.03), no history of variables like smoking (P=0.026), hypertension (P<0.001), cerebral vessels disease (p=0.003), and family history of coronary disease (P=0.01) showed significant effect on relation between coronary disease and carotid stenosis. Conclusion: In diabetic patients with female gender, with history of smoking, hypertension, cerebral vessels disease and family history of coronary disease, carotid stenosis and coronary disease have co-incidence without relation to these factors. It appears that diabetes independently causes involvement in both carotid and coronary arteries.