August 21, 1997New England Journal of Medicine
Cumulative Effects of High Cholesterol Levels, High Blood Pressure, and Cigarette Smoking on Carotid Stenosis
Key result
Long-term exposure to high systolic blood pressure (OR 2.11 per 20 mm Hg increase; 95% CI 1.51-2.97), high cholesterol, and smoking were associated with an increased risk of moderate carotid stenosis.
Why the study?
Are long-term cumulative exposures to high blood pressure, high cholesterol, and smoking associated with an increased risk of carotid stenosis in an elderly population?
Population
1,090 adults from the Framingham Heart Study, mean age 75 years, who underwent B-mode ultrasound…
Comparison
Time-integrated measurements of cardiovascular… vs Lower levels of cardiovascular risk factors.
Design
Cohort
Follow-up
34 years
Authors
Discussion
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Implication
Supports lifelong risk factor assessment in elderly patients; extends cumulative exposure data but requires prospective confirmation.
Key Points
- This research aims to explore the long-term impact of high cholesterol, high blood pressure, and smoking on the prevalence of carotid stenosis.
- Analyzed cross-sectional and longitudinal data from 429 men and 661 women in the Framingham Heart Study.
- Utilized B-mode ultrasound to measure carotid artery conditions at an average age of 75 over a span of 34 years.
- Implemented time-integrated assessments for evaluating associations between risk factors and carotid stenosis degrees.
- Moderate carotid stenosis was found in 189 men and 226 women.
- Each 20 mm Hg increase in systolic blood pressure related to an odds ratio of 2.11 (95% CI, 1.51 to 2.97) for moderate stenosis.
- Each 10 mg/dL increase in cholesterol level yielded an odds ratio of 1.10 (95% CI, 1.03 to 1.16), while each increase of five pack-years of smoking led to an odds ratio of 1.08 (95% CI, 1.03 to 1.13).
Study Design
Type
Observational (n=1,090)
Structured PICO
Are long-term cumulative exposures to high blood pressure, high cholesterol, and smoking associated with an increased risk of carotid stenosis in an elderly population?
P
Population
1,090 adults (429 men, 661 women) from the Framingham Heart Study, mean age 75 years, who underwent B-mode ultrasound measurements of the carotid artery.
I
Intervention
Time-integrated measurements of cardiovascular risk factors (systolic blood pressure, serum cholesterol, cigarette smoking) over 34 years.
C
Comparator
Lower levels of cardiovascular risk factors.
O
Outcome
Prevalence of moderate carotid stenosis (≥25 percent) compared with minimal stenosis (<25 percent).surrogate
Main Result
Effect estimate: OR 2.11 (95% CI 1.51 to 2.97)
Long-term cumulative exposure to high systolic blood pressure, elevated cholesterol, and smoking is significantly associated with an increased risk of carotid stenosis in older adults.
Cite This Study
Wilson et al. (1997) conducted an observational in Carotid Stenosis (n=1,090). High systolic blood pressure, high cholesterol levels, and cigarette smoking vs. Lower levels of cardiovascular risk factors was evaluated on Moderate carotid stenosis (≥25 percent) compared with minimal stenosis (<25 percent) (OR 2.11, 95% CI 1.51 to 2.97). Long-term exposure to high systolic blood pressure (OR 2.11 per 20 mm Hg increase; 95% CI 1.51-2.97), high cholesterol, and smoking were associated with an increased risk of moderate carotid stenosis.