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The relation between carotid atherosclerotic plaques and ischemic stroke is critically conditioned by the role of arterial hypertension as an effect modifier.
MedLine Citation:
PMID:  21459262     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Hypertension is a recognized risk factor for ischemic stroke (IS) along with diabetes, smoking, and hypercholesterolemia. Any uncertainty remains about other putative risk factors, ultrasound-derived, such as carotid soft plaques.
METHODS: A case-control study was carried out concerning cases of IS or transient ischemic attack (TIA) found in an outpatient population from February 2000 to March 2008. For every patient with documented IS or TIA, 1 to 2 controls without previous cerebrovascular event were recruited. The variables analyzed were: hypertension, defined as mild hypertension (140-160 mm Hg) or moderate-to-severe hypertension (>160 mm Hg); age, divided into 3 classes: 60 to 70, 70 to 80, and 80 to 90 years; diabetes and carotid plaques, categorized as "soft" or "hard" plaques, and as plaques achieving mild (<50%) or moderate (50%-70%) luminal narrowing.
RESULTS: Fourty-six cases and 60 controls were analyzed. In univariate analysis, moderate-to-severe hypertension, age between 80 and 90 years, carotid soft plaques and 50% to 70% stenoses predicted ischemic cerebral events. In multivariable analysis, only moderate-to-severe hypertension (odds ratio [OR]: 15.536; 95% confidence interval [CI]: 4.142-58.271; P = 0.0000) and oldest age class (OR: 15.862; 95% CI: 3.836-65.592; P = 0.0001) proved to predict IS or TIA. Soft plaques were found to predict risk of IS (OR: 13.50; 95% CI: 2.9788-61.1821) in hypertensive, but not in patients whose hypertension had been controlled by therapy (OR: 0.2308; 95% CI: 0.0270-1.9720) (qualitative interaction).
CONCLUSIONS: Moderate-to-severe hypertension and very old age predicted IS and TIA, whereas carotid soft plaques did not, in the presence of normotensive blood pressure.
Authors:
Renato De Vecchis; Antonio Ciccarelli; Carmelina Ariano; Carmela Cioppa; Anna Giasi; Armando Pucciarelli; Salvatore Cantatrione
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  27     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:    2011 Mar-Apr
Date Detail:
Created Date:  2011-04-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  152-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", Naples, Italy.
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