Prospective evaluation of carotid bruit as a predictor of first stroke in type 2 diabetes: the Fremantle Diabetes Study.
OBJECTIVE
We sought to examine prospectively the relationship between asymptomatic carotid bruit and stroke in type 2 diabetes.


METHODS
We studied 1181 (91.3%) of a community-based sample of 1294 patients with type 2 diabetes. These patients had no history of cerebrovascular disease at recruitment during 1993-1996 and were followed until the end of January 2002. Hospital morbidity and death register data relating to cerebrovascular events were also available. Cox proportional hazards models were used to determine whether carotid bruit status was an independent predictor of stroke and to identify other significant cerebrovascular risk factors.


RESULTS
One hundred thirty-four patients (11.3%) suffered a first stroke during 6.5+/-2.2 (mean+/-SD) years of follow-up. In the first 2 years after study entry, first stroke (n=45/1181; 3.8%) was strongly predicted by the presence of carotid bruit(s) after adjustment for known cardiovascular risk factors and other potentially confounding variables (hazard ratio, 6.7; 95% CI, 3.0 to 14.9; P<0.001). Between 2 years and census, first stroke (n=89/1083; 8.2%) was not associated with carotid bruit(s) (P=0.97). Age and diastolic blood pressure were other determinants of stroke in the first 2 years, while age, atrial fibrillation/flutter, and microalbuminuria were independent predictors of subsequent stroke.


CONCLUSIONS
Type 2 diabetic patients found to have incidental carotid bruits have >6 times the risk of first stroke in the first 2 years than patients without a bruit and should receive intensified management of vascular risk factors. Carotid imaging with a view to surgical intervention in these patients remains controversial.
Gillett
Melissa
M
University of Western Australia, Department of Medicine, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.
Davis
Wendy A
WA
Jackson
Denise
D
Bruce
David G
DG
Davis
Timothy M E
TM
D000368:Aged; D001314:Auscultation; D002339:Carotid Arteries / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000503:physiopathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D014904:Western Australia / Q000453:epidemiology