Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases.
OBJECTIVE
The objective was to assess the prevalence of subclavian artery stenosis (SS) in four cohorts (two free-living and two clinical populations) and determine both risk factors for this condition and the association with other cardiovascular conditions.


BACKGROUND
The prevalence of SS in the general population is unknown, and its association with risk factors and other cardiovascular diseases is not well-established.


METHODS
A total of 4,223 subjects (2,975 from two free-living cohorts and 1,248 from two clinical cohorts) were included in this cross-sectional analysis. Subclavian artery stenosis was defined as > or =15 mm Hg interarm pressure difference.


RESULTS
The prevalence of SS was 1.9% in the free-living cohorts and 7.1% in the clinical cohorts; SS was significantly (p < 0.05) associated with past smoking (odds ratio [OR] = 1.80), current smoking (OR = 2.61), and higher levels of systolic blood pressure (OR = 1.90 per 20 mm Hg). Higher levels of high-density lipoprotein (HDL) cholesterol were inversely and significantly associated with SS (OR = 0.87 per 10 mg/dl). In regression analyses relating SS to other cardiovascular diseases, the only significant finding was with peripheral arterial disease (PAD) (OR = 5.11, p < 0.001).


CONCLUSIONS
Significant SS is present in approximately 2% of the free-living population and 7% of the clinical population. Additionally, SS is correlated with current and past smoking histories, systolic blood pressure, HDL levels (inversely), and the presence of PAD. These findings suggest that bilateral brachial blood pressure measurements should routinely be performed in patients with an elevated risk profile, both to screen for SS, and to avoid missing a hypertension or PAD diagnosis because of unilateral pressure measurement in an obstructed arm.
Shadman
Ramin
R
University of California-San Diego, School of Medicine, San Diego, California 92093-0607, USA.
Criqui
Michael H
MH
Bundens
Warner P
WP
Fronek
Arnost
A
Denenberg
Julie O
JO
Gamst
Anthony C
AC
McDermott
Mary M
MM
D000368:Aged; D001794:Blood Pressure; D001916:Brachial Artery; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013349:Subclavian Steal Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology
D008076:Cholesterol, HDL