Kazum Shirit, Eisen Alon, Lev Eli I, Iakobishvili Zaza, Solodky Alejandro, Hasdai David, Kornowski Ran, Mager Aviv
Isr Med Assoc J. 2016 Feb;18(2):100-3.
Concomitant carotid artery disease (CaAD) in patients with coronary artery disease (CAD) is associated with worse cardiac and neurologic outcomes. The reported prevalence and risk factors for concomitant CaAD in CAD patients varied among previous studies.
To examine these factors in ambulatory patients with CAD and well-documented cholesterol levels treated with cholesterol-lowering medications.
We retrospectively analyzed prospectively collected data from 325 unselected patients with CAD (89 women, mean age 68.8 ± 9.9 years) undergoing routine evaluation at the coronary clinic of our hospital.
The low density lipoprotein-cholesterol (LDL-C) was < 100 mg/dl in 292 patients (90%). Age at onset of CAD symptoms was 59.4 ± 10.8 years. Carotid stenosis ≥ 50% was seen in 83 patients (25.5%) and between 30% and 49% in 55 patients (17%) (duplex method). Carotid stenosis was significantly associated with hypertension (P = 0.032), peripheral arterial disease (P = 0.002) and number of coronary arteries with ≥ 50% stenosis (P = 0.002), and showed a borderline association with age at CAD onset (P = 0.062) and diabetes mellitus (P = 0.053). On linear regression analysis, independent predictors of CaAD were peripheral vascular disease (OR 3.186, 95% CI 1.403-7.236, P = 0.006), number of coronary arteries with ≥ 50% stenosis (OR 1.543, 95% CI 1.136-2.095, P = 0.005), and age at CAD onset (OR 1.028, 95% CI 1.002-1.054, P = 0.003). None of the variables studied predicted freedom from CaAD.
Carotid atherosclerosis is very common in stable ambulatory patients with CAD regularly taking statins. The risk is higher in patients with peripheral arterial disease, a greater number of involved coronary arteries, and older age at onset of CAD.
冠状动脉疾病（CAD）患者合并颈动脉疾病（CaAD）与更差的心脏和神经学预后相关。既往研究中，CAD患者合并CaAD的报道患病率及危险因素各不相同。
在接受降胆固醇药物治疗且胆固醇水平记录良好的门诊CAD患者中研究这些因素。
我们回顾性分析了前瞻性收集的来自我院冠心病门诊325例未经选择的CAD患者（89例女性，平均年龄68.8±9.9岁）的数据。
292例患者（90%）的低密度脂蛋白胆固醇（LDL-C）<100mg/dl。CAD症状发作时的年龄为59.4±10.8岁。83例患者（25.5%）出现颈动脉狭窄≥50%，55例患者（17%）出现30%至49%的狭窄（采用双功超声法）。颈动脉狭窄与高血压（P=0.032）、外周动脉疾病（P=0.002）以及≥50%狭窄的冠状动脉数量（P=0.002）显著相关，与CAD发病年龄（P=0.062）和糖尿病（P=0.053）呈临界相关。在线性回归分析中，CaAD的独立预测因素为外周血管疾病（OR 3.186，95%CI 1.403-7.236，P=0.006）、≥50%狭窄的冠状动脉数量（OR 1.543，95%CI 1.136-2.095，P=0.005）以及CAD发病年龄（OR 1.028，95%CI 1.002-1.054，P=0.003）。所研究的变量均未预测无CaAD情况。
在规律服用他汀类药物的稳定门诊CAD患者中，颈动脉粥样硬化非常常见。在外周动脉疾病患者、累及冠状动脉数量较多的患者以及CAD发病年龄较大的患者中风险更高。
