P. Mineva 1, D. Hadjiev 2, V. Tsoneva 1, Zh. Andreev 2
1 Medical Faculty, Trakia University – Stara Zagora,
2 Medical Faculty, Medical University – Sofia, Bulgaria
Objective: The aim of this population-based study was to analyze the prevalence and correlations between the well-documented vascular risk factors (VRF) – asymptomatic carotid stenosis (ACS) and dyslipidemia, and their significance for the incidence of cerebral ischemic events.
Materials and Methods: A total of 500 randomly selected volunteers, 200 men and 300 women, without signs or symptoms of cerebrovascular disease, aged 50-79 years, were enrolled in the study in the University town of Stara Zagora. All participants underwent Duplex scanning of internal carotid arteries, structured questionnaires, a physical and neurological examination and a battery of laboratory tests.
Results: The most frequent single VRFs in this population were elevated LDL cholesterol level (61.5%) – (LDL-C), arterial hypertension (44.2%) – (AH) and ACS (61%). The prevalence of ACS<50% was 54.6%, 6.4% for ACS≥50%, from which 0.4% was severe ACS – 80%-99%. Three and more VRFs (multiple VRFs – MVRFs) were found in 52% of the participants. This selected group revealed an increased frequency of elevated LDL-C level (78.1%), AH (65.8%) and ACS≥50% (8.8%). The volunteers with MVRFs who reached to the end points of the study (TIA and ischemic strokes - IS) were with markedly elevated frequency of AH (85.7%), increased LDL-C level (71.4%), ACS≥50% (28.6%) and especially of ACS – 80%-99% (100%). Logistic regression analyses have revealed that only ACS≥50% as a single VRF, as well as the combination of ACS≥50% and elevated LDL-C level (OR=11.11; 95% CI, 1.58-78.29; p=0.0156) were significantly relate to the end points (OR=4.74; 95% CI, 1.24-18.16; p=0.008).
Discussion: ACS and elevated LDL-C level are treatable, well-documented VRFs for TIA and first IS and their prevalence differs among various populations. Our study has shown that for patients with MVRFs, screening for ACS is well-grounded. The management of all VRFs may contribute to decreasing TIA and IS incidence.
Key words: asymptomatic carotid stenosis, dyslipidemia, multiple vascular risk factors, ischemic stroke.