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The prevalence of carotid artery stenosis varies significantly by race
Rockman, Caron B; Hoang, Han; Guo, Yu; Maldonado, Thomas S; Jacobowitz, Glenn R; Talishinskiy, Toghrul; Riles, Thomas S; Berger, Jeffrey S
OBJECTIVE: Certain races are known to be at increased risk for stroke, and the prevalence of carotid artery stenosis (CAS) is thought to vary by race. The goal of this report was to study the prevalence of CAS in different races by analyzing a population of subjects who underwent vascular screening examinations. METHODS: The study data were provided by Life Line Screening. The cohort consists of self-referred individuals who paid for vascular screening tests. Subjects <40 and >100 years of age and those who reported a prior stroke or carotid artery intervention were excluded. Of the remaining 3,291,382 subjects, 3.7% did not self-identify a race. CAS was defined as stenosis in either internal carotid artery >/=50% by duplex ultrasound velocity criteria. RESULTS: The 3,291,382 subjects available for analysis consisted of Caucasian (2,845,936 [90%]), African American (97,502 [3.1%]), Hispanic (75,240 [2.4%]), Asian (60,982 [1.9%]), and Native American (87,757 [2.8%]) individuals. The prevalence of CAS was 3.4% in females and 4.2% in males (P = .001). Controlling for gender and age, there was marked variation in the prevalence of CAS (P < .001) by race. Native American subjects had the highest prevalence of CAS across all age categories and in both sexes. Caucasian subjects had the second highest prevalence of CAS across most age decades and in both sexes. Among males, African American individuals had the lowest prevalence of CAS in nearly all age categories. In contrast to males, Asian females had the lowest prevalence of CAS compared with females of other races in most age groups. Multivariate analysis adjusting for atherosclerotic risk factors in addition to age confirmed race as a significant independent predictor of CAS. Compared with Caucasian subjects, African American (odds ratio [OR], 0.65), Asian (OR, 0.69), and Hispanic (OR, 0.74) subjects had a significantly lower risk of CAS, whereas Native American (OR, 1.3) subjects had a significantly higher risk of CAS. CONCLUSIONS: The prevalence of clinically significant CAS varies significantly by race. Native American and Caucasian individuals have the highest prevalence of CAS, whereas African American males and Asian females appear to have the lowest prevalence. This information adds evidence to the hypothesis that the increased stroke rate in African American subjects is likely not related to extracranial cerebrovascular disease. Furthermore, this is a novel report of an extremely high prevalence of CAS in the Native American population.
PMID: 23177534
ISSN: 0741-5214
CID: 213612
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography
Brott, Thomas G; Halperin, Jonathan L; Abbara, Suhny; Bacharach, J Michael; Barr, John D; Bush, Ruth L; Cates, Christopher U; Creager, Mark A; Fowler, Susan B; Friday, Gary; Hertzberg, Vicki S; McIff, E Bruce; Moore, Wesley S; Panagos, Peter D; Riles, Thomas S; Rosenwasser, Robert H; Taylor, Allen J; Jacobs, Alice K; Smith, Sidney C Jr; Anderson, Jeffery L; Adams, Cynthia D; Albert, Nancy; Buller, Christopher E; Creager, Mark A; Ettinger, Steven M; Guyton, Robert A; Halperin, Jonathan L; Hochman, Judith S; Hunt, Sharon Ann; Krumholz, Harlan M; Kushner, Frederick G; Lytle, Bruce W; Nishimura, Rick A; Ohman, E Magnus; Page, Richard L; Riegel, Barbara; Stevenson, William G; Tarkington, Lynn G; Yancy, Clyde W
PMID: 23281092
ISSN: 1522-1946
CID: 386902
ASSOCIATION BETWEEN DIABETES MELLITUS AND PREVALENCE OF VASCULAR DISEASE IN DIFFERENT ARTERIAL TERRITORIES [Meeting Abstract]
Shah, Binita; Rockman, Caron; Chesner, Jaclyn; Guo, Yu; Schwartzbard, Arthur; Weintraub, Howard; Adelman, Mark; Riles, Thomas; Berger, Jeffrey
ISI:000316555202254
ISSN: 0735-1097
CID: 1795282
Why the US Center for Medicare and Medicaid Services Should Not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting
Abbott, Anne L; Adelman, Mark A; Alexandrov, Andrei V; Barnett C C, Henry J M; Beard, Jonathan; Bell, Peter; Bjorck, Martin; Blacker, David; Buckley, Clifford J; Cambria, Richard P; Comerota, Anthony J; Connolly, E Sander Jr; Davies, Alun H; Eckstein, Hans-Henning; Faruqi, Rishad; Fraedrich, Gustav; Gloviczki, Peter; Hankey, Graeme J; Harbaugh, Robert E; Heldenberg, Eitan; Kittner, Steven J; Kleinig, Timothy J; Mikhailidis, Dimitri P; Moore, Wesley S; Naylor, Ross; Nicolaides, Andrew; Paraskevas, Kosmas I; Pelz, David M; Prichard, James W; Purdie, Grant; Ricco, Jean-Baptiste; Riles, Thomas; Rothwell, Peter; Sandercock, Peter; Sillesen, Henrik; Spence, J David; Spinelli, Francesco; Tan, Aaron; Thapar, Ankur; Veith, Frank J; Zhou, Wei
PMID: 22495879
ISSN: 0003-3197
CID: 174056
Hormone Replacement Therapy is Associated With a Decreased Prevalence of Peripheral Arterial Disease in Postmenopausal Women
Rockman, Caron B; Maldonado, Thomas S; Jacobowitz, Glenn R; Adelman, Mark A; Riles, Thomas S
BACKGROUND: The effect of hormone replacement therapy (HRT) in postmenopausal women on the development of peripheral atherosclerosis remains in question. The goal of this study was to analyze the use of HRT in a large population of postmenopausal women and to determine its association with the prevalence of peripheral arterial disease (PAD). METHODS: A prospective database of patients who underwent voluntary vascular screening was used. Identification of patients as postmenopausal, and their use of HRT, was based on patient questionnaires. PAD was defined to be present if either lower extremity ankle-brachial index was =0.9. RESULTS: Analysis was performed on data from 847,982 postmenopausal women; 433,178 (51.1%) reported having used HRT. HRT subjects were slightly older than patients who had not used HRT (64.5 years vs. 63.6 years). Caucasian women were significantly more likely to have used HRT than non-Caucasian women (52.4% vs. 47.6%). HRT subjects were significantly more likely to have smoked cigarettes (42.8% vs. 40.6%), to have hypertension (47.9% vs. 45.1%), and to have hypercholesterolemia (55% vs. 51.5%) than women who had not used HRT (all P < 0.001). However, HRT subjects were significantly less likely to have diabetes mellitus (8.6% vs. 10.2%, P < 0.001). Despite the increased prevalence of several atherosclerotic risk factors among women who used HRT, they were significantly less likely to have PAD (3.3% vs. 4.1%, P < 0.001). Multivariate analysis adjusting for age, race, and medical comorbidities that predispose toward the development of atherosclerosis confirmed that HRT was independently associated with a decreased risk of PAD (odds ratio: 0.8, 95% confidence interval: 0.78-0.82). In subsets of postmenopausal women with known atherosclerotic risk factors, the significant effect of HRT on the prevalence of PAD was maintained; in women with either a smoking history, hypertension, hypercholesterolemia, diabetes, or age of >/=70 years, the odds ratio of HRT use with regard to PAD remained approximately 0.8. CONCLUSIONS: The use of HRT in postmenopausal women appears to be associated with a significant reduction in the prevalence of PAD in this population-based study. This association appeared to be significant even in postmenopausal women with known atherosclerotic risk factors. These observational data may suggest a relationship between HRT and the prevalence of PAD that has not been the specific subject of previous randomized prospective studies.
PMID: 22285341
ISSN: 0890-5096
CID: 162029
Peripheral vascular disease prevalence increases dramatically with advanced age: a population database of over 3.6 million people [Meeting Abstract]
Savji, Nazir; Rockman, Caron; Skolnick, Adam; Adelman, Mark A.; Riles, Thomas; Berger, Jeffrey
ISI:000302326702318
ISSN: 0735-1097
CID: 167535
Why the United States Center for Medicare and Medicaid Services (CMS) should not extend reimbursement indications for carotid artery angioplasty/stenting [Letter]
Abbott, A L; Adelman, M A; Alexandrov, A V; Barnett, H J M; Beard, J; Bell, P; Bjorck, M; Blacker, D; Buckley, C J; Cambria, R P; Comerota, A J; Connolly, E S Jr; Davies, A H; Eckstein, H H; Faruqi, R; Fraedrich, G; Gloviczki, P; Hankey, G J; Harbaugh, R E; Heldenberg, E; Kittner, S J; Kleinig, T J; Mikhailidis, D P; Moore, W S; Naylor, R; Nicolaides, A; Paraskevas, K I; Pelz, D M; Prichard, J W; Purdie, G; Ricco, J B; Riles, T; Rothwell, P; Sandercock, P; Sillesen, H; Spence, J D; Spinelli, F; Tan, A; Thapar, A; Veith, F J; Zhou, W
PMID: 22226698
ISSN: 1078-5884
CID: 165441
Why the United States Center for Medicare and Medicaid Services (CMS) should not extend reimbursement indications for carotid artery angioplasty/stenting [Letter]
Abbott, A L; Adelman, M A; Alexandrov, A B; Barnett, H J M; Beard, J; Bell, P; Bjorck, M; Blacker, D; Buckley, C J; Cambria, R P; Comerota, A J; Sander, E; Davies, A H; Eckstein, H H; Fraedrich, G; Gloviczki, P; Hankey, G J; Harbaugh, R E; Heldenberg, E; Kittner, S J; Kleinig, T J; Mikhailidis, D P; Moore, W S; Naylor, R; Nicolaides, A; Paraskevas, K I; Pelz, D M; Prichard, J W; Purdie, G; Ricco, J B; Riles, T; Rothwell, P; Sandercock, P; Sillesen, H; Spence, J D; Spinelli, F; Tan, A; Thapar, A; Veith, F J; Zhou, W
PMID: 22330629
ISSN: 0392-9590
CID: 164276
Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting
Abbott, Anne L; Adelman, Mark A; Alexandrov, Andrei V; Barnett, Henry Jm; Beard, Jonathan; Bell, Peter; Bjorck, Martin; Blacker, David; Buckley, Clifford J; Cambria, Richard P; Comerota, Anthony J; Sander Connolly, E; Davies, Alun H; Eckstein, Hans-Henning; Faruqi, Rishad; Fraedrich, Gustav; Gloviczki, Peter; Hankey, Graeme J; Harbaugh, Robert E; Heldenberg, Eitan; Kittner, Steven J; Kleinig, Timothy J; Mikhailidis, Dimitri P; Moore, Wesley S; Naylor, Ross; Nicolaides, Andrew; Paraskevas, Kosmas I; Pelz, David M; Prichard, James W; Purdie, Grant; Ricco, Jean-Baptiste; Riles, Thomas; Rothwell, Peter; Sandercock, Peter; Sillesen, Henrik; David Spence, J; Spinelli, Francesco; Tan, Aaron; Thapar, Ankur; Veith, Frank J; Zhou, Wei
PMID: 22271806
ISSN: 1708-5381
CID: 174057
Differences in Prevalence of Peripheral Vascular Disease: An age-sex interaction [Meeting Abstract]
Savji, Nazir; Rockman, Caron B.; Skolnick, Adam; Reynolds, Harmony; Guo, Yu; Adelman, Mark A.; Riles, Thomas; Berger, Jeffrey S.
ISI:000208885002196
ISSN: 0009-7322
CID: 4630832