The prognostic significance of asymptomatic carotid bruits in the elderly.
The prognostic significance of asymptomatic carotid bruits in the elderly.
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老年人无症状颈动脉杂音的预后意义。
DOI：
10.1046/j.1525-1497.1998.00023.x
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发表时间：
1998
影响因子：
5.7
通讯作者：
Applegate,WB
中科院分区：
文献类型：
--
作者：
Shorr,RI;Johnson,KC;Wan,JY;Sutton-Tyrrell,K;Pahor,M;Bailey,JE;Applegate,WB
目的：确定无症状颈动脉损伤与老年孤立性收缩期高血压患者继发卒中之间的关系。设计：回顾性队列研究。背景：老年人收缩期高血压项目（SHEP）是一项为期5年的随机试验，旨在检测60岁及以上非住院患者治疗收缩期高血压的疗效。从最初的4,736名SHEP参与者中，我们确定了4,442人的队列，这些人在随机分组时没有中风、短暂性脑缺血发作或心肌梗死的病史。测量和主要结果：这项辅助研究的终点是卒中的发生。平均随访时间为4.2年。在基线时，284名（6.4%）参与者发现颈动脉硬化。有颈动脉硬块的人中有21人（7.4%）发生中风，没有颈动脉硬块的人中有210人（5.0%）发生中风。颈动脉硬块患者的未校正卒中风险为1.53（95%可信区间[CI] 0.98, 2.40）。调整年龄、性别、种族、血压、吸烟、血脂水平、自我报告的阿司匹林使用情况和治疗组分配等因素后，无症状颈动脉bruits患者卒中的相对风险为1.29 （95% CI 0.80, 2.06）。在60 - 69岁的SHEP参与者中，与没有颈动脉硬块的患者相比，颈动脉硬块患者后续卒中的风险有增加的趋势（p= 0.08）（相对风险[RR] 2.05; 95% CI 0.92, 4.68）。然而，在年龄在70岁或以上的受试者中，颈动脉损伤与随后的卒中没有关系（RR 0.98; 95% CI 0.55, 1.76）。在SHEP参与者的其他亚组中，颈动脉损伤的存在没有独立预测卒中。结论：虽然我们不能排除60 - 69岁无症状SHEP受试者与颈动脉硬块相关的卒中风险增加的可能性，但颈动脉硬块作为70岁及以上无症状老年孤立性收缩期高血压患者卒中风险增加的标志物的效用是有限的。
OBJECTIVE:To determine the association between asymptomatic carotid bruits and the development of subsequent stroke in older adults with isolated systolic hypertension.DESIGN:Retrospective cohort study.SETTING:The Systolic Hypertension in the Elderly Program (SHEP), a 5-year randomized trial testing the efficacy of treating systolic hypertension in noninstitutionalized persons aged 60 years or older. From the original 4,736 SHEP participants, we identified a cohort of 4,442 persons who had no prior history of stroke, transient ischemic attack, or myocardial infarction at randomization.MEASUREMENTS AND MAIN RESULTS:The end point for this ancillary study was the development of a stroke. The average follow-up was 4.2 years. Carotid bruits were found in 284 (6.4%) of the participants at baseline. Strokes developed in 21 (7.4%) of those with carotid bruits and in 210 (5.0%) of those without carotid bruits. The unadjusted risk of stroke among persons with carotid bruits was 1.53 (95% confidence interval [CI] 0.98, 2.40). Adjusting for age, gender, race, blood pressure, smoking, lipid levels, self-reported aspirin use, and treatment group assignment, the relative risk of stroke among persons with asymptomatic carotid bruits was 1.29 (95% CI 0.80, 2.06). Among SHEP enrollees aged 60 to 69 years, there was a trend (p=.08) toward increased risk (relative risk [RR] 2.05; 95% CI 0.92, 4.68) of subsequent stroke in persons with, compared to those without, carotid bruits. However, among enrollees aged 70 years or over, there was no relation between carotid bruit and subsequent stroke (RR 0.98; 95% CI 0.55, 1.76). In no other subgroup of SHEP enrollees did the presence of carotid bruit independently predict stroke.CONCLUSIONS:Although we cannot rule out a small increased risk of stroke associated with bruits in asymptomatic SHEP enrollees aged 60 to 69 years, the utility of carotid bruits as a marker for increased risk of stroke among asymptomatic elderly with isolated systolic hypertension aged 70 years or older is limited.