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Asymptomatic Carotid Bruit and Risk of Stroke: Title and subTitle BreakThe Framingham Study FREE

Philip A. Wolf, MD; William B. Kannel, MD, MPH; Paul Sorlie, MS
[+] Author Affiliations

Presented in part at the Fourth Joint Meeting on Stroke and Cerebral Circulation, Phoenix, Ariz, Feb 9, 1980.

Reprint requests to Department of Neurology, Boston University School of Medicine, 80 E Concord St, Boston, MA 02118 (Dr Wolf).


JAMA. 1981;245(14):1442-1445. doi:10.1001/jama.1981.03310390042019
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Carotid bruit was routinely sought in the Framingham cohort and during eight years appeared in 66 men and 105 women, all of whom were asymptomatic. The incidence increased with age equally in the two sexes from 3.5% at 44 to 54 years, to 7.0% at 65 to 79 years. The eight-year incidence was greater in diabetics and hypertensive subjects. Transient ischemic attacks appeared in eight (two alone) and stroke in 21 of the 171, a stroke rate more than twice expected for age and sex. More often than not, cerebral infarction occurred in a vascular territory different from that of the carotid bruit, often in the posterior circulation, and ruptured aneurysm, embolism from the heart, and lacunar infarction was the mechanism of stroke in nearly half the cases. Incidence of myocardial infarction was also increased twofold in those with asymptomatic carotid bruit. General mortality was also increased; 1.7-fold in men, and 1.9-fold in women, with 79% of the deaths owing to cardiovascular disease, including stroke. Carotid bruit is clearly an indicator of increased stroke risk but chiefly as a general and nonfocal sign of advanced atherosclerotic disease and not necessarily as an indicator of local arterial stenosis preceding cerebral infarction.

(JAMA 1981;245:1442-1445)

REFERENCES

 Five-year findings of the hypertension detection and follow-up programs: I. Reduction in mortality of persons with high blood pressure, including mild hypertension, Hypertension Detection and Follow-up Program Cooperative Group . JAMA 1979;;242:2562-2571.
Kannel WB, Wolf PA, Dawber TR:  An evaluation of the epidemiology of atherothrombotic brain infarction . Milbank Mem Fund Q 1975;;53:405-447.
Whisnant JP, Cartlidge NEF, Elveback LR:  Carotid and vertebralbasilar transient ischemic attacks: Effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence . Ann Neurol 1978;;3:107-115.
Fields WS:  The asymptomatic carotid bruit—operate or not . Stroke 1978;;9:269-271.
Moore WS, Boren C, Malone JM, et al:  Asymptomatic carotid stenosis: Immediate and long-term results after prophylactic endarterectomy . Am J Surg 1979;;138:228-233.
Thompson JE, Patman RD, Talkington CM:  Asymptomatic carotid bruit: Long-term outcome of patients having endarterectomy compared with unoperated controls . Ann Surg 1978;; 188:308-316.
Shurtleff D: Some characteristics related to the incidence of cardiovascular disease and death: The Framingham 18-year follow-up study, in Kannel WB, Gordon T (eds): The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease. Government Printing Office, 1974.
Wolf PA, Kannel WB, Dawber TR:  Epidemiology of stroke: The Framingham Study , in Schoenberg B (ed): Neurological Epidemiology: Principles and Clinical Applications, vol 19: Advances in Neurology . New York, Raven Press, pp 107-120.
Kistler JP, Lees RS, Friedman J, et al:  The bruit of carotid stenosis vs radiated basal heart murmurs . Circulation 1978;;57:975-981.
Cutler JL:  Cerebrovascular disease in an elderly population . Circulation 1967;;36:394-399.
Heyman A, Wilkinson WE, Heyden S, et al:  Risk of stroke in asymptomatic persons with cervical arterial bruits . N Engl J Med 1980;; 302:838-841.

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 Five-year findings of the hypertension detection and follow-up programs: I. Reduction in mortality of persons with high blood pressure, including mild hypertension, Hypertension Detection and Follow-up Program Cooperative Group . JAMA 1979;;242:2562-2571.
Kannel WB, Wolf PA, Dawber TR:  An evaluation of the epidemiology of atherothrombotic brain infarction . Milbank Mem Fund Q 1975;;53:405-447.
Whisnant JP, Cartlidge NEF, Elveback LR:  Carotid and vertebralbasilar transient ischemic attacks: Effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence . Ann Neurol 1978;;3:107-115.
Fields WS:  The asymptomatic carotid bruit—operate or not . Stroke 1978;;9:269-271.
Moore WS, Boren C, Malone JM, et al:  Asymptomatic carotid stenosis: Immediate and long-term results after prophylactic endarterectomy . Am J Surg 1979;;138:228-233.
Thompson JE, Patman RD, Talkington CM:  Asymptomatic carotid bruit: Long-term outcome of patients having endarterectomy compared with unoperated controls . Ann Surg 1978;; 188:308-316.
Shurtleff D: Some characteristics related to the incidence of cardiovascular disease and death: The Framingham 18-year follow-up study, in Kannel WB, Gordon T (eds): The Framingham Study: An Epidemiological Investigation of Cardiovascular Disease. Government Printing Office, 1974.
Wolf PA, Kannel WB, Dawber TR:  Epidemiology of stroke: The Framingham Study , in Schoenberg B (ed): Neurological Epidemiology: Principles and Clinical Applications, vol 19: Advances in Neurology . New York, Raven Press, pp 107-120.
Kistler JP, Lees RS, Friedman J, et al:  The bruit of carotid stenosis vs radiated basal heart murmurs . Circulation 1978;;57:975-981.
Cutler JL:  Cerebrovascular disease in an elderly population . Circulation 1967;;36:394-399.
Heyman A, Wilkinson WE, Heyden S, et al:  Risk of stroke in asymptomatic persons with cervical arterial bruits . N Engl J Med 1980;; 302:838-841.
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