Prevalence and risk factors for atherosclerotic carotid stenosis and plaque A population-based screening study

Atherosclerotic carotid stenosis (ACS) is a major cause of ischemic stroke. Screening for asymptomatic ACS is important to identify the patients who require longitudinal surveillance, medication, or endovascular surgery. The aim of this study was to assess the prevalence and risk factors for ACS and carotid plaque (CP) in Korea using a population-based screening study. We recruited participants during visits to several community welfare centers in Korea. The baseline characteristics of the study population were collected. All patients underwent duplex ultrasonography to examine their bilateral carotid arteries. ACS was defined as the presence of plaque with >= 50% vessel diameter reduction and peak systolic velocity (PSV) >= 125cm/s or PSV ratio >= 2.0. CP was defined as the presence of plaque with <50% vessel diameter reduction. The Mann-Whitney test, chi(2) test, Fisher exact test, and logistic regression were used in the statistical analysis. A total of 3030 participants were enrolled in this study (male 43.7% and female 56.3%). The prevalence of ACS and CP was 1.1% and 5.7%, respectively. Significant risk factors for CP included age >= 80 years (odds ratio [OR], 8.11; 95% confidence interval [CI], 3.45-18.93), male sex (OR, 2.16; 95% CI, 1.29-3.61), hypertension (OR, 1.72; 95% CI, 1.21-2.45), and hyperlipidemia (OR, 1.84; 95% CI, 1.30-2.62). The presence of ACS was significantly associated with age (OR, 1.07; 95% CI, 1.03-1.12), hypertension (OR, 3.16; 95% CI, 1.34-7.46), and being an ex-smoker (OR, 6.81; 95% CI, 1.66-27.93) or current smoker (OR, 6.97; 95% CI, 1.78-27.31) after adjusting for confounding factors. This population-based screening study revealed that ACS was uncommon and had a prevalence of 1.1% in the study population. Age, hypertension, and smoking were risk factors for ACS. Further investigations into the prevalence and risk factors of ACS are required, as are studies on the cost-effectiveness of a national screening program. Abbreviations: ACS = atherosclerotic carotid stenosis, BMI = body mass index CCA = common carotid artery, CDUS = carotid duplex ultrasound, CI = confidence interval, CP = carotid plaque, CVD = cerebrovascular disease, DM = diabetes mellitus, ECA = external carotid artery, ICA = internal carotid artery, OR = odd ratio, PSV = peak systolic velocity, RPVI = Registered Physician in Vascular Interpretation, RVT = Registered Vascular Technologist.