Atherosclerotic vascular disease conference - Writing group I: Epidemiology
Atherosclerotic vascular disease conference - Writing group I: Epidemiology
复制标题
DOI：
10.1161/01.cir.0000128518.26834.93
复制
发表时间：
2004-06-01
期刊：
影响因子：
37.8
通讯作者：
Zheng, ZJ
中科院分区：
文献类型：
--
作者：
Pasternak, RC;Criqui, MH;Zheng, ZJ
Stroke is one of the leading health problems in the United States today, with 600 000 new or recurrent strokes occurring annually. Stroke is the third leading cause of death and the principal cause of long-term disability. 4 Approximately 85% of all strokes are ischemic; of these, most (60% of all strokes) are attributable to atherothrombotic disease. The number of strokes related to carotid atherosclerosis is less certain but probably approaches 20% of all strokes. The absolute United States stroke mortality rate has declined for many years, reaching a low of 144 000 deaths from 1990 to 1992. 5 Since then, the absolute number of deaths attributed to stroke has begun to increase, probably because of a leveling off of the decline in stroke death rate as well as the aging of the United States population. As a consequence, in the United States, stroke deaths seem to have increased slightly to 167 000 per year.Although it was recognized as early as 1914 that stroke could be caused by extracranial arterial occlusion, 6 it was not until the early 1950s and the work of C. Miller Fisher7 that the role of carotid artery atherosclerosis as a more common cause of stroke began to be clarified. There is a predilection for clinical atherosclerosis in the internal carotid arteries as well as in the vertebrobasilar arteries. The prevalence of carotid artery stenosis has been estimated from high-resolution B-mode carotid ultrasonography. In the Framingham Heart Study cohort, 1000 subjects were studied, including 441 men and 675 women. The mean age of the sample studied was 75 years (range, 66 to 93). In this elderly communitybased sample, 47% percent of women and 37% of men had carotid stenoses of 0% to 10%; 34% of women and 37% of men had carotid stenoses of 11% to 30%. Slightly more than 10% of the cohort had stenoses 40%, and most of these had lesions in the range of 41% to 60%. In this cohort, traditional risk factors were associated with carotid atherosclerosis, with age being the most powerful, followed by cigarette smoking, elevated systolic blood pressure, elevated cholesterol level, and alcohol consumption. Age-adjusted, mean systolic blood pressure was 40 mm Hg higher in patients with carotid stenosis 50% compared with those who had stenosis of 0% to 4%. Overall data from Framingham suggest that at the mean age of 75 years, 9% of men and 7% of women have a carotid stenosis 50%, whereas at age 50 years, 1% have carotid stenosis 50%. 8
