Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital

Main Article Content

Chanpong Tangkanakul, MD

Abstract

OBJECTIVE:
To examine the prevalence of carotid artery disease and to determine risk factors for carotid duplex abnormalities among asymptomatic Thai subjects.

MATERIALS AND METHODS:
The cross-sectional observation study was conducted in a sample of patients (Thai population) who took an annual health check-up at the Bangkok Medical Center (BMC) over a 10 month period from June 1, 2011 to March 31, 2012. A total of 2,105 subjects were enrolled and underwent a carotid duplex examination using the standard procedure. The results from the carotid duplex ultrasonography and risk factors that contribute to carotid artery abnormalities were recorded and analyzed using a multiple logistic regression method and a prevalence rate ratio.

RESULTS:
The study enrolled 2,105 Thai participants aged 25-79 years old with a mean of age of 54 ± 10.4 years. The population was equally divided by gender, and 44% of subjects were current smokers and 25% of the patients were overweight. Approximately 30.5% of participants had hypertension (HT) and 9.3% had diabetes mellitus (DM). Abnormal carotid duplex examinations were found in 912 cases accounting for 45.7% of the participants.

Atheromatous plaque and thickening of the intimal media thickness was observed in 784 cases (37.2%) and 314 cases (14.9%) respectively. Internal carotid stenosis results were detected including 11 mild, 9 moderate and 2 severe stenotic cases; however, no carotid occlusion reported. Underlying HT and DM were related to abnormal duplex results. Factors including increasing age (p < 0.001), male gender (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-2.0), and HT associated (OR 2.4, 95% CI 1.8-3.1) were associated with carotid atherosclerotic disease observed by the duplex examination.

CONCLUSION:
The prevalence of atherosclerotic carotid arteries detected by duplex ultrasonography was approximately 45% among asymptomatic Thai population who took an annual health check at the BMC. Atheromatous plaque is the most common finding and significant (moderate to severe) internal carotid artery (ICA) stenosis was observed in 0.5% of participants. Factors including age, male gender, DM, and HT were associated with atherosclerotic carotid disease. High fasting plasma glucose (FPG) and low-density lipoprotein (LDL) were also related to abnormal carotid duplex results. The carotid duplex examination provided health information to the participants to help control risk factors and to raise awareness of cerebrovascular disease.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Tangkanakul C. Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital. BKK Med J [Internet]. 2014Sep.20 [cited 2020Jul.15];8(1):1. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/219717
Section
Original Article

References

1. Sobieszczyk P1, Beckman J. Carotid Artery Disease. Circulation 2006;114:e244-7.
2. Naylor AR. Carotid artery disease. Vascular, The Medicine Publishing Company Ltd, 2004; 285-7.
3. De Weerd M, Greving JP, de Jong AW, et al. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke 2009;40:1105-13.
4. Chaisinanunkul N, Chutinet A, Suwanwela NC. Prevalence and risk factors of extracranial internal carotid and intracranial artery stenosis in asymptomatic Thai subjects.19th World Congress of Neurology:Free Paper Abstracts. J Neurological Sciences 2009;S57-S154.
5. U.S. Preventive Services Task Force. Screening for carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2007;147:854-9.
6. Dharmasaroja PA, Intharakham K Risk factors for carotid stenosis in Thai patients with ischemic stroke/TIA. Angiology 2010;61:789-92.
7. Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid- artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 2000;342:1693-700.
8. Johnsen SH, Mathiesen EB. Carotid plaque compared with intima-media thickness as a predictor of coronary and cerebrovascular disease. Curr Cardiol Rep 2009;11:21-7.
9. O’Leary DH1, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardio-vascular Health Study Collaborative Research Group. N Engl J Med 1999;340:14-22.
10. Brott TG, Halperin JL, Abbara S, et al. 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 Neuro Interventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011;124:489-532.
11. Jahromi AS, Cinà CS, Liu Y, et al. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg 2005;41:962-72.
12. Buskens E, Nederkoorn PJ, Buijs-Van Der Woude T, et al. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology 2004;233:101-12.
13. AHA; ACC; National Heart, Lung, and Blood Institute, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease:2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006;47:2130-9.
14. Lovrencic-Huzjan A, Rundek T, Katsnelson M. Recommendations for management of patients with carotid stenosis. Stroke Res Treat 2012;2012:175869.
15. Meier P, Knapp G, Tamhane U, et al. Short-term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ 2010;340:c467.
16. Alexandrov AV. Cerebrovascular Ultrasound in Stroke Prevention and Treatment. 1st ed. Blackwell Publishing Inc, New York 2004;81-93.
17. Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42:517-84.
18. Venkatachalam S, Gray BH, Mukherjee D, et al. Contem-porary management of concomitant carotid and coronary artery disease. Heart 2011;97:175-80.
19. Davies KJ, Thapar A, Kasivisvanathan V, et al. Review of trans-atlantic cardiovascular best medical therapy guide-lines-recommendations for asymptomatic carotid athero-sclerosis. Curr Vasc Pharmacol 2013;11:514-23.
20. Goldstein LB, Bushnell CD, Adams RJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:517-84.