Incidence and progression of carotid artery stenosis in elderly men: Thirteen-year follow-up of the population cohort ‘men born in 1914’

 

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Abstract

‘Men born in 1914’ is a population-based cohort study of the epidemiology of cardiovascular disease. Twenty-five percent of the men had moderate or severe (> 30%) carotid artery stenosis (CAS) at 68 years of age. The objective of this study was to study the incidence and progression of disease from 68 to 81 years of age in relation to major risk factors for atherosclerotic disease. Five hundred men, born 1914, were examined at the age of 68, and 185 of them were re-examined at 81 years of age. Examination included ultrasonographic measurement of carotid arteries and cardiovascular risk factors. The ultrasonographic examinations of the carotid arteries were made with the continuous-wave doppler method at 68 years of age and with the duplex method at 81 years of age. Two hundred and nineteen men died and 95 were unwilling to participate in the follow-up. Twenty-three percent of these men had been treated for stroke and 13.7% died from ischaemic heart disease. Of the 185 men who were re-examined, 148 had normal carotid artery blood flow at the age of 68, while 37 men had CAS. At follow-up, only 12 of the 148 men still had no signs of CAS, while 136 men (91.2%) had developed CAS by the age of 81 and the incidence of stroke was 8.0/1000 person years. Less than 10% of the 37 men with CAS at 68 years of age developed a high degree of stenosis (> 70%). A higher proportion of hypertension was noted in men who developed bilateral CAS, 64.8% (n = 105), compared to the others, 39.5% (n = 43), p <0.005. Less hypertension was noted in men with unilateral CAS (n = 31) than in men with bilateral CAS (n = 105), the figures being 35% and 65%, respectively, p <0.013. No significant differences were noted for other cardiovascular risk factors. The development of CAS increases with age and hypertension emerges as a potential risk factor.