2019, Number 4
Gac Med Mex 2019; 155 (4)
Enfermedad carotídea aterosclerosa y enfermedad de sustancia blanca en sujetos sin historia de infarto cerebral o isquemia cerebral transitoria
Chiquete E, Gómez-Piña JJ, Ramírez-García G, Ruiz-Ruiz E, Barrientos-Guerra JD, Toapanta-Yanchapaxi L, Flórez-Cardona JA, Flores-Silva F, Reyes-Melo I, García-Ramos G, Higuera-Calleja J, Cantú-Brito C
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Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective:
analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients
without a history of ischemic stroke. Method:
Risk factors were assessed with carotid examination using Doppler duplex ultrasound.
Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic
resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were
constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD.
One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic
CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, › 6 atheroma plaques in 7.6%, and periventricular or sub-cortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with
atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated
with › 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated
with any of the analyzed independent variables. Conclusions:
In asymptomatic subjects without a history of ischemic stroke,
age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with
microvascular disease. Obesity alone was not a major determinant of CAD or WMD.
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