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Carotid Artery Atherosclerosis Among 65-year-old Swedish Men: A Population-based Screening Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0001-6561-9734
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
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2014 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 48, no 1, 5-10 p.Article in journal (Refereed) Published
Abstract [en]

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-year-old men in the County of Uppsala, Sweden, who attended screehing for abdominal aortic aneurysm (AAA) 2007-2009, were invited for duplex scanning of the carotid arteries. Results: Of 4801 men invited, 4657 (97%) accepted. Carotid plaques (>2 x 6 mm) were observed in 1169 (25%) men, 94 (2.0%) had carotid stenoses (50-99%), and 15 (0.3%) had occluded carotid arteries. In a multivariate logistic regression model, smoking (OR 1.7, 95% CI 1.5-1.9), hypertension (1.5, 95% CI 1.3-1.7), diabetes mellitus (1.2, 95% CI 1.0-1.5), and coronary artery disease (1.5, 95% CI 1.3-1.8) 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.

Place, publisher, year, edition, pages
2014. Vol. 48, no 1, 5-10 p.
Keyword [en]
Carotid stenosis, Atherosclerotic plaque, Prevalence, Screening
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-229726DOI: 10.1016/j.ejvs.2014.02.004ISI: 000338820900003PubMedID: 24631197OAI: oai:DiVA.org:uu-229726DiVA: diva2:738254
Available from: 2014-08-16 Created: 2014-08-12 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Screening for asymptomatic carotid atherosclerosis
Open this publication in new window or tab >>Screening for asymptomatic carotid atherosclerosis
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ischemic stroke is the most common cause of handicap in adults and the third most common cause of death in Sweden. Internal carotid artery atherosclerosis is an important cause and accounts for 20% of ischemic strokes. Screening for carotid atherosclerosis has been debated over the past two decades.

The aims of this thesis were (I) to study the prevalence of and risk factors associated with carotid artery atherosclerosis among 65 year old men, (II) to evaluate a simplified ultrasound protocol (the grayscale/mosaic method) for the exclusion of significant carotid artery stenosis for screening purpose, (III) to evaluate the required effect of primary preventive therapy in reducing risk of stroke among patients with asymptomatic carotid disease in order for screening to be cost-effective and (IV) to study natural history of carotid atherosclerosis and outcome five years after screening in 65-year old men.

The prevalence of atherosclerotic plaques was high (25%), while the prevalence of >50% stenosis was relatively low (2.0%). Smoking, hypertension, diabetes mellitus and coronary artery disease were independent risk factors and individuals with several risk factors had a higher prevalence of stenosis. Most of those at risk were not on any preventive medication. A simplified grayscale/mosaic method was found to have a high negative predictive value for significant carotid stenosis. The minimum stroke risk reduction effect required for preventive intervention to be cost effective was 22%. Carotid atherosclerotic plaque and stenosis 50-79% has a relatively benign development during five years if treated with BMT and risk factor adjustment. Very few progressed to symptomatic disease. More severe stenosis (80-99%) had higher rate of neurological events, and may benefit from additional intervention.

In conclusion, prevalence of silent atherosclerotic disease in carotid arteries was common among 65-year-old men. Most of those at risk had no secondary prevention. There is a simple DUS method that could be used for screening purpose. Screening for carotid disease is only cost-effective if the preventive strategy lowers the risk of stroke by 22%. Men with plaques and moderate stenosis have a good prognosis, but among those with severe stenosis there is a need for further intervention.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1367
Keyword
Carotid stenosis, carotid atherosclerosis, screening, cost-effectiveness, natural history, carotid ultrasound
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-328803 (URN)978-91-513-0060-3 (ISBN)
Public defence
2017-10-21, Auditorium Minus, Museum Gustavianum, Akademig. 3, Uppsala, 13:00 (English)
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Screening for asymptomatic carotid atherosclerosis
Available from: 2017-09-29 Created: 2017-08-31 Last updated: 2017-10-18

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Högberg, DominikaKragsterman, BjörnBjörck, MartinWanhainen, Anders

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