title: Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study.
abstract: BACKGROUND
  Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults.
  
  
  METHODS
  Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993), 5,107 participants without a prior history of carotid endarterectomy (CEA) or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization.
  
  
  RESULTS
  Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23), peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93), and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46). Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77) and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86).
  
  
  CONCLUSIONS
  Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.
authors.affiliation: Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Parveen K
authors.initials: PK
authors.lastname: Garg
authors.forename: Willam J H
authors.initials: WJH
authors.lastname: Koh
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.forename: William T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Lesley
authors.initials: L
authors.lastname: Curtis
keywords: Cardiovascular risk factors; Carotid artery disease; Carotid duplex; Carotid endarterectomy; Gender