title: Life-threatening coronary disease is prevalent in patients with stenosing carotid artery disease.
abstract: BACKGROUND
  Atherosclerosis affects several vascular trees systemically and though surgical plaque removal diminishes the risk of stroke in patients with carotid stenosis, they still face a risk of other atherothrombotic complications like myocardial infarction and premature death.
  
  
  OBJECTIVE
  This study was designed to reveal the long-term risk of death and atherothrombotic events following carotid endarterectomy.
  
  
  METHODS
  Eighty-nine previously (1997-2000) endarterectomized carotid patients (56-92 years) were followed up to 15·2 years. Causes of death, cardiovascular events (stroke, transient ischemic attack, acute myocardial infarction), comorbidities, and medications were recorded and analyzed by Cox regression analysis. Four population controls and four controls with coronary disease (n = 712) were selected for each case from a population cohort for age- and gender-matched analysis.
  
  
  RESULTS
  At the end of follow-up, 41 (44·6%) patients had died and 48 were alive. Ten patients (24,4%) died due to acute myocardial infarction and one (2,4%) due to stroke. Nineteen (21%) patients had an acute myocardial infarction, 12 (13%) had a stroke, 13 (15%) had a transient ischemic attack, and 5 (6%) had other atherothrombotic events. The risk of death was 5·7-fold in diabetics (P < 0·001) and 3·9-fold in smokers (P < 0·001). Patients who did not use statins had 5·0-fold, and irregular users 3·3-fold risk of death compared with active users (P = 0·005 and P = 0·001, respectively). The major factors associated with acute myocardial infarction were diabetes (6·0-fold risk, P = 0·004), bilateral carotid disease (3·5-fold risk, P = 0·014), and lack of statin use (4·4-fold risk, P = 0·038). Compared with population controls, carotid patients had a 4·4-fold risk of acute myocardial infarction (P = 0·002).
  
  
  CONCLUSIONS
  Endarterectomized carotid patients have a high risk of acute myocardial infarction and death, and need an intensified cardiovascular disease-risk-lowering treatment. Although asymptomatic, the evaluation of prognostically significant myocardial ischemia should be considered in these high-risk patients. Eventually, a clinical trial is needed to address whether carotid patients would benefit from early intervention.
authors: Molecular Neurology, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.|Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland, Helsinki, Finland.
authors: Krista
authors: K
authors: Nuotio
authors: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland, Helsinki, Finland.
authors: Lauri
authors: L
authors: Soinne
authors: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Helena
authors: H
authors: Hänninen
authors: Molecular Neurology, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.
authors: Jani
authors: J
authors: Saksi
authors: Individual Taxation Unit, Finnish Tax Administration, Helsinki, Finland.
authors: Jarno
authors: J
authors: Tuimala
authors: Department of Chronic Disease Prevention, National Institute of Health and Welfare, Helsinki, Finland.
authors: Antti
authors: A
authors: Jula
authors: Wihuri Research Institute, Helsinki, Finland.
authors: Petri T
authors: PT
authors: Kovanen
authors: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland, Helsinki, Finland.
authors: Markku
authors: M
authors: Kaste
authors: Molecular Neurology, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.|Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland, Helsinki, Finland.
authors: Petra
authors: P
authors: Ijäs
authors: Molecular Neurology, Research Programs Unit, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.|Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland, Helsinki, Finland.
authors: Perttu J
authors: PJ
authors: Lindsberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications* / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality*; D016894:Endarterectomy, Carotid; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D015995:Prevalence; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: atherosclerosis; carotid; carotid stenosis; endarterectomy; myocardial infarction; statins