Carotid artery atheromas in postmenopausal women. Their prevalence on panoramic radiographs and their relationship to atherogenic risk factors.
BACKGROUND
More than 60 percent of the deaths in the United States attributed to stroke occur in postmenopausal women. As estrogen levels decline, atherosclerotic lesions (that is, atheromas) develop in the region of the carotid bifurcation and have been implicated as the precipitating cause in the majority of these strokes. Atheromas often are calcified and have been detected on the panoramic radiographs of neurologically asymptomatic male veterans; however, similar studies have not been conducted among female veterans.


METHODS
The authors assessed panoramic radiographs and medical records of 52 neurologically asymptomatic female veterans (mean age, 70.4 years), with a history of amenorrhea of more than 12 months' duration, for atheromas and risk factors associated with atherosclerosis.


RESULTS
The radiographs of 16 subjects (31 percent) exhibited atheromas located in the neck about 2.0 centimeters inferior and posterior to the angle of the mandible. These findings were confirmed in all instances by the presence of atheromas on anteroposterior cervical spine radiographs. The medical histories of these subjects were heavily laden with atherogenic risk factors (hypertension, 94 percent; body mass index of 27 to 29.9 [characterized as overweight], 25 percent; body mass index of 30 or higher [characterized as obese], 25 percent; smoking more than 15 pack-years, 38 percent; hyperlipidemia, 69 percent; type 2 diabetes mellitus, 21 percent). Hypertension was significantly associated with the presence of atheromas.


CONCLUSIONS
Some neurologically asymptomatic women at high risk of developing stroke can be identified in the dental office via panoramic radiography. Women whose X-rays show calcified carotid artery atheromas are almost always hypertensive and have medical histories heavily laden with other atherogenic risk factors.


CONCLUSIONS
Dentists should refer patients with such calcifications to an appropriate physician for further evaluation and treatment.
Friedlander
A H
AH
Hospital Dental Service, Medical Center, University of California Los Angeles, School of Dentistry, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, Calif., USA. arthur.friedlander@med.va.gov
Altman
L
L
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017698:Postmenopause; D011862:Radiography, Panoramic; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013223:Statistics as Topic
D008078:Cholesterol, LDL