02829nas a2200397 4500008004100000022001400041245016100055210006900216260001300285300001100298490000800309520163400317653000901951653002201960653002901982653002102011653003002032653001902062653001102081653001102092653003402103653000902137653003202146653000902178653003702187653004302224100001602267700001702283700001702300700001702317700001602334700001702350700001602367700001202383856003602395 1998 eng d a0033-841900aHypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study.0 aHypoechoic plaque at US of the carotid artery an independent ris c1998 Sep a649-540 v2083 a

PURPOSE: To investigate the association between incident (first) stroke and the echogenicity of internal carotid arterial plaque at ultrasonography (US).

MATERIALS AND METHODS: A cohort of 4, 886 individuals who, at baseline, were 65 years of age or older and without symptoms of cerebrovascular disease was followed up for an average of 3.3 years. Baseline clinical findings were from color Doppler and duplex US studies of the carotid arteries and a record of traditional risk factors: age, sex, presence of diabetes mellitus, pack-years of cigarette smoking, presence of hypertension, elevated systolic and diastolic blood pressure, elevated low-density lipoprotein cholesterol level.

RESULTS: Incident strokes, excluding hemorrhagic strokes and strokes of cardiac origin, were seen in 104 individuals (2.1%) at risk. Age- and sex-adjusted odds ratios for incident stroke were significant for hypoechoic plaque (odds ratio, 2.53; 95% CI, 1,42,4.53). After controlling for risk factors in a Cox proportional hazards model, the relative risk (RR) of incident stroke was 1.72 (p = .015) for hypoechoic plaque and 2.32 (P = .004) for internal carotid arterial narrowing of at least 50%. In addition, hypoechoic plaque (RR, 2.78; CI, 1.36,5.69) and 50%-100% stenosis (RR, 3.08; CI, 1.28, 7.41) were associated with ipsilateral, nonfatal stroke.

CONCLUSION: In asymptomatic adults aged 65 years or older, that risk of incident stroke was associated with two US features: hypoechoic internal carotid arterial plaque and an estimated internal carotid arterial stenosis of 50%-100%.

10aAged10aAged, 80 and over10aCarotid Artery, Internal10aCarotid Stenosis10aCerebrovascular Disorders10aCohort Studies10aFemale10aHumans10aIntracranial Arteriosclerosis10aMale10aProportional Hazards Models10aRisk10aUltrasonography, Doppler, Duplex10aUltrasonography, Doppler, Transcranial1 aPolak, J, F1 aShemanski, L1 aO'Leary, D H1 aLefkowitz, D1 aPrice, T, R1 aSavage, P, J1 aBrant, W, E1 aReid, C uhttps://chs-nhlbi.org/node/151103636nas a2200397 4500008004100000022001400041245015700055210006900212260001600281300001200297490000800309520249400317653002102811653000902832653001102841653002202852653001102874653001402885653000902899653002602908653002602934653003002960653003202990653000903022653001703031653002103048100001503069700001703084700001603101700001503117700002103132700001603153700001403169700002003183856003503203 1999 eng d a0003-992600aTraditional risk factors and subclinical disease measures as predictors of first myocardial infarction in older adults: the Cardiovascular Health Study.0 aTraditional risk factors and subclinical disease measures as pre c1999 Jun 28 a1339-470 v1593 a

BACKGROUND: Risk factors for myocardial infarction (MI) have not been well characterized in older adults, and in estimating risk, we sought to assess the individual and joint contributions made by both traditional risk factors and measures of subclinical disease.

METHODS: In the Cardiovascular Health Study, we recruited 5888 adults aged 65 years and older from 4 US centers. At baseline in 1989-1990, participants underwent an extensive examination that included traditional risk factors such as blood pressure and fasting glucose level and measures of subclinical disease as assessed by electrocardiography, carotid ultrasonography, echocardiography, pulmonary function, and ankle-arm index. Participants were followed up with semiannual contacts, and all cardiovascular events were classified by the Morbidity and Mortality Committee. The main analytic technique was the Cox proportional hazards model.

RESULTS: At baseline, 1967 men and 2979 women had no history of an MI. After follow-up for an average of 4.8 years, there were 302 coronary events, which included 263 patients with MI and 39 with definite fatal coronary disease. The incidence was higher in men (20.7 per 1000 person-years) than women (7.9 per 1000 person-years). In all subjects, the incidence was strongly associated with age, increasing from 7.8 per 1000 person-years in subjects aged 65 to 69 years to 25.6 per 1000 person-years in subjects aged 85 years and older. Glucose level and systolic blood pressure were associated with the incidence of MI, but smoking and lipid measures were not. After adjustment for age and sex, the significant subclinical disease predictors of MI were borderline or abnormal ejection fraction by echocardiography, high levels of intimal-medial thickness of the internal carotid artery, and a low ankle-arm index. Forced vital capacity and electrocardiographic left ventricular mass did not enter the stepwise model. Excluding subjects with clinical cardiovascular diseases such as prior angina or congestive heart failure at baseline had little effect on these results. Risk factors were generally similar in men and women.

CONCLUSIONS: After follow-up of 4.8 years, systolic blood pressure, fasting glucose level, and selected subclinical disease measures were important predictors of the incidence of MI in older adults. Uncontrolled high blood pressure may explain about one quarter of the coronary events in this population.

10aAge Distribution10aAged10aFemale10aFollow-Up Studies10aHumans10aIncidence10aMale10aMultivariate Analysis10aMyocardial Infarction10aPredictive Value of Tests10aProportional Hazards Models10aRisk10aRisk Factors10aSex Distribution1 aPsaty, B M1 aFurberg, C D1 aKuller, L H1 aBild, D, E1 aRautaharju, P, M1 aPolak, J, F1 aBovill, E1 aGottdiener, J S uhttps://chs-nhlbi.org/node/593