Calcifications in the carotid siphon correlate with silent cerebral small vessel disease in community-dwelling older adults: A population-based study in rural Ecuador.
OBJECTIVE
Using a population-based, cross-sectional design, we aimed to assess whether the presence of calcifications in the carotid siphon (as seen on computed tomography) is associated with silent markers of cerebral small vessel disease (on magnetic resonance imaging) in apparently healthy older adults living in Atahualpa, a rural Ecuadorian village.


METHODS
Stroke-free Atahualpa residents aged ≥60 years identified during a door-to-door survey underwent head computed tomography for assessment of carotid siphon calcifications, and brain magnetic resonance imaging for identification of white matter hyperintensities and silent lacunar infarcts. We evaluated the association between calcifications and markers of small vessel disease using logistic regression models adjusted for demographics and cardiovascular risk factors.


RESULTS
The mean age of the 236 participants was 71 ± 8 years, and 139 (59%) were women. Computed tomography readings showed high calcium content in the carotid siphon in 64 individuals (27%), and magnetic resonance imaging showed moderate-to-severe white matter hyperintensities in 51 (30%) and lacunar infarcts in 28 (12%). In the univariate analysis, individuals with high calcium content were older and were more likely to have high fasting glucose levels than those with low calcium content. After adjusting for confounding variables, we found an independent association between high calcium content in the carotid siphon and moderate-to-severe white matter hyperintensities (OR 2.3, 95% CI 1.1-4.9, P = 0.035) as well as lacunar infarcts (OR 3.1, 95% CI 1.3-7.6, P = 0.013).


CONCLUSIONS
The present study shows a direct relationship between calcium content in the carotid siphon and silent small vessel disease in an indigenous Latin American population. Geriatr Gerontol Int 2016; 16: 1063-1067.
School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador.|Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
Oscar H
OH
Del Brutto
Gastroenterology Department, Vanderbilt University, Nashville, Tennessee, USA.
Robertino M
RM
Mera
Langone Medical Center, School of Medicine, New York University, New York, New York, USA.
Jennifer
J
Gillman
Langone Medical Center, School of Medicine, New York University, New York, New York, USA.
Jung-Eun
JE
Ha
The Atahualpa Project, Community Center, Atahualpa, Ecuador.
Mauricio
M
Zambrano
D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D059345:Cerebral Small Vessel Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004484:Ecuador; D005260:Female; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000706:statistics & numerical data; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate
carotid siphon calcification; cerebral small vessel disease; intracranial arterial calcification; lacunar infarcts; white matter hyperintensities