title: The relation between carotid atherosclerotic plaques and ischemic stroke is critically conditioned by the role of arterial hypertension as an effect modifier.
abstract: BACKGROUND
  Hypertension is a recognized risk factor for ischemic stroke (IS) along with diabetes, smoking, and hypercholesterolemia. Any uncertainty remains about other putative risk factors, ultrasound-derived, such as carotid soft plaques.
  
  
  METHODS
  A case-control study was carried out concerning cases of IS or transient ischemic attack (TIA) found in an outpatient population from February 2000 to March 2008. For every patient with documented IS or TIA, 1 to 2 controls without previous cerebrovascular event were recruited. The variables analyzed were: hypertension, defined as mild hypertension (140-160 mm Hg) or moderate-to-severe hypertension (>160 mm Hg); age, divided into 3 classes: 60 to 70, 70 to 80, and 80 to 90 years; diabetes and carotid plaques, categorized as "soft" or "hard" plaques, and as plaques achieving mild (<50%) or moderate (50%-70%) luminal narrowing.
  
  
  RESULTS
  Fourty-six cases and 60 controls were analyzed. In univariate analysis, moderate-to-severe hypertension, age between 80 and 90 years, carotid soft plaques and 50% to 70% stenoses predicted ischemic cerebral events. In multivariable analysis, only moderate-to-severe hypertension (odds ratio [OR]: 15.536; 95% confidence interval [CI]: 4.142-58.271; P = 0.0000) and oldest age class (OR: 15.862; 95% CI: 3.836-65.592; P = 0.0001) proved to predict IS or TIA. Soft plaques were found to predict risk of IS (OR: 13.50; 95% CI: 2.9788-61.1821) in hypertensive, but not in patients whose hypertension had been controlled by therapy (OR: 0.2308; 95% CI: 0.0270-1.9720) (qualitative interaction).
  
  
  CONCLUSIONS
  Moderate-to-severe hypertension and very old age predicted IS and TIA, whereas carotid soft plaques did not, in the presence of normotensive blood pressure.
authors: Presidio Sanitario Intermedio Elena d'Aosta, Naples, Italy.
authors: Renato
authors: R
authors: De Vecchis
authors: Antonio
authors: A
authors: Ciccarelli
authors: Carmelina
authors: C
authors: Ariano
authors: Carmela
authors: C
authors: Cioppa
authors: Anna
authors: A
authors: Giasi
authors: Armando
authors: A
authors: Pucciarelli
authors: Salvatore
authors: S
authors: Cantatrione
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D020520:Brain Infarction / Q000453:epidemiology / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018608:Ultrasonography, Doppler