Cardiovascular risk factors in patients with carotid stenosis

Aim of the study to determine the prevalence of vascular risk factors in a population of patients with carotid stenosis, the correlation with cerebral ischemic events and the effects of treatment on the clinical outcomes. Methods Preliminary results are presented, regarding a selected population of 63 patients (43M, 20F) with > 50% carotid stenosis, 71 ± 6.6 y.o. Beyond clinical examination and blood analysis, self-reported non diabetic patients underwent OGTT. In all patients ultrasound carotid examination, angioCT, brain CT and neurological evaluation were performed before indication for revascularization. Patients were analyzed according to presence of clinical symptoms, brain ischemic lesions, cardiovascular risk factors. Results Clinical symptoms or brain infarction were reported in 27 patients (43%, 17 major strokes), 36 patients (54%) were asymptomatic. On clinical evaluation, the main risk factors were hypertension (88.8%), smoke (74.6%) and diabetes (33%). OGTT revealed an higher prevalence of patients with impaired glucose metabolism (diabetes in 44.5%, IGT in 17.4% of patients). 77.5% of patients had more than 4 risk factors. Mean systolic pressure at baseline was 164 ± 29 mmHg, although all hypertensive patients were treated (64.2% with > 2 drugs). Symptoms occurred in 55.8% of males vs. 15% of females; in 44.6% of smokers vs. 37.5% non smokers; in 44.6% of patients with hypertension vs 28.5 % normotensive; in 59.8 % of patients with diabetes vs 46.6 % non diabetic. BMI was 26 ± 0.4 Kg/m2, 27.5 ± 0.5 Kg/m2 in symptomatic patients (p=0.029). Discussion and conclusions In subjects with carotid stenosis, mainly in symptomatic patients, the prevalence of cardiovascular risk factors is very high. Even if hypertension is the most important risk factor, systolic values at baseline appeared higher with respect to targets indicated on current guidelines. After screening with OGTT, we found a larger number of patients with overt abnormality of glucose metabolism, often unknown before. We suggest that in patients with assessed carotid stenosis a better antihypertensive treatment and a skilled evaluation of abnormalities of glucose metabolism are very important milestones for a better prevention of stroke.