Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study.
OBJECTIVE
Studies on extracranial carotid atherosclerosis have predominately been undertaken on middle-aged subjects. This study examines the prevalence of extracranial carotid atherosclerosis, its relation to vascular risk factors and its significance for survival in elderly subjects.


METHODS
Population-based cross-sectional survey. Non-modifiable vascular risk factors examined were family history of atherosclerotic disease, sex and apolipoprotein E (apoE) genotype. Potentially modifiable risk factors assessed were smoking, fibrinogen, fasting lipids, body mass index, hypertension and diabetes.


METHODS
Two hundred and twenty-five functionally healthy volunteers of the Berlin Ageing Study, aged 70-100.


METHODS
Presence of carotid stenosis and plaque ascertained by ultrasound imaging; 5-year mortality.


RESULTS
At least one plaque was found in 144 (64%) of the volunteers; 34 (15%) had a stenosis over 50%; and nine (4%) had a stenosis over 75%. Total cholesterol > 6.5 mmol L-1, LDL cholesterol > 4.6 mmol L-1 and total cholesterol/HDL cholesterol ratio > 5 were significantly associated with presence of plaque in 70- to 80-year-old subjects, as was diabetes in subjects over 80 years. Log-linear analyses showed significant three-way interactions for high LDL cholesterol and diabetes with plaques and age. Family history, sex, apoE genotype, smoking and fibrinogen were not related to presence of plaque in the study population. Cox regression analysis revealed increased 5-year mortality rates for subjects with plaques (OR = 2. 88; 95% CI = 1.30-6.35), whereas the vascular risk profile was not associated with mortality.


CONCLUSIONS
In a population-based sample of functionally healthy elderly subjects, the significance of the vascular risk profile seemed to be diminished. It had no impact on survival and only modifiable risk factors showed an age-dependent association with carotid disease.
Hillen
T
T
Research Group on Geriatrics at the Evangelische Geriatriezentrum Berlin (EGZB), Medical Faculty of the Humboldt-University Berlin, Berlin, Germany. thomashillen@yahoo.com
Nieczaj
R
R
Münzberg
H
H
Schaub
R
R
Borchelt
M
M
Steinhagen-Thiessen
E
E
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001057:Apolipoproteins E / Q000235:genetics; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics / Q000401:mortality; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate; D014463:Ultrasonography
D001057:Apolipoproteins E; D008055:Lipids; D005340:Fibrinogen