title: Serum creatinine level is an independent risk factor for the angiographic severity of internal carotid artery stenosis in subjects who have previously had transient ischaemic attacks.
abstract: BACKGROUND
  Serum creatinine level has been reported to be related to the incidence of strokes.
  
  
  OBJECTIVE
  To examine the relationship between serum creatinine level and the severity of extracranial carotid artery atherosclerosis.
  
  
  METHODS
  This is a secondary analysis of data from 88 patients (59 men and 29 women) who had previously had transient ischaemic attacks or minor strokes and had been included in intervention trials of symptomatic carotid disease. Narrowing of internal carotid artery was estimated by angiography. Both internal carotid arteries were measured and the severity was expressed as the sum of percentage stenoses on both sides. The risk profiles of patients with moderate and severe internal carotid artery stenosis were compared.
  
  
  RESULTS
  The sex-adjusted mean serum creatinine concentration in those with severe carotid disease was significantly higher than that in those with moderate disease (106.3 +/- 3.3 versus 91.3 +/- 3.7 mumol/l, P = 0.003), but still within the normal range. The risk of having severe disease was compared with risk of having moderate disease for people ranked by their serum creatinine levels. Univariate logistic regression showed that the odds ratio (OR) for having severe involvement of internal carotid artery was greater for patients in mid-tertile of creatinine values than it was for those in the lowest tertile (OR 6.3, 95% confidence interval 2.0-20.4, P = 0.002). The creatinine levels of patients in these two tertiles were within the normal range. The OR was no greater for patients in the highest tertile of creatinine values, which were slightly elevated above the normal range. These OR did not change after adjustment for age, sex, hypertension or systolic blood pressure, diabetes, smoking and lipid levels.
  
  
  CONCLUSIONS
  Results of this study demonstrate for the first time that serum creatinine level, even within the range of upper normal or mildly elevated levels, is related to the angiographic severity of internal carotid artery disease in patients who have previously had transient ischaemic attacks and that this relationship is independent of classic cardiovascular risk factors.
authors.affiliation: Department of Medicine, WHO Collaborating Centre for Study of Atherosclerosis in Diabetes, Toronto Hospital, University of Toronto, Ontario, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Tkác
authors.forename: F
authors.initials: F
authors.lastname: Silver
authors.forename: B
authors.initials: B
authors.lastname: Lamarche
authors.forename: G F
authors.initials: GF
authors.lastname: Lewis
authors.forename: G
authors.initials: G
authors.lastname: Steiner
mesh_terms: D000368:Aged; D000792:Angiography; D015415:Biomarkers; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000145:classification / Q000209:etiology* / Q000503:physiopathology; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D003404:Creatinine