The presence of a carotid bruit — a ‘sound’ over the carotid artery (which supplies the head and neck with blood) indicating blockage — substantially increases the risk of cardiovascular death and heart attack. This is the conclusion of authors of an Article in this week’s edition of the Lancet.
The prognostic implications of a carotid bruit have been mostly focused on bleeding events in the brain, yet uncertainty about these prognostic implications has led some organisations, including the US Preventive Services Taskforce and the Canadian Task Force, to recommend against routine listening (auscultation) for carotid bruits.
Dr Christopher Pickett, Walter Reed Army Medical Centre, Washington, DC, USA, and colleagues did a meta-analysis of 22 previous studies with 17 295 patients followed up for an average of four years. They found that patients with carotid bruits were around twice as likely to suffer a heart attack as those without; and more than two-and-a-half times as likely to die from cardiovascular causes. In the four studies in which direct comparisons of patients with and without bruits was possible, again those with bruits were more than twice as likely to have a heart attack or die from cardiovascular causes.
The authors conclude: “Our study has shown that the presence of a carotid bruit significantly increased the likelihood of cardiovascular death or heart attack…Auscultation for carotid bruits in patients at high risk for heart disease could help select those that might benefit the most from an aggressive cardiovascular risk modification strategy.”
In an accompanying Comment, Dr Victor Aboyans and Dr Philippe Lacroix, Dupuytren University Hospital, Limoges, France, discuss the effectiveness of carotid bruit for prognosis in general practitioners’ offices, as well as in poorer countries where complex diagnostic methods are not available. But they note that other clinical signs of cardiovascular disease exist in patients without carotid bruit. They conclude: "Prospective studies on asymptomatic patients are needed to study the prognostic value of a combination of simple clinical signs such as neck and groin auscultation and pulse palpation."
Dr Christopher Pickett, Walter Reed Army Medical Centre, Washington, DC, USA T) +1 202-782 1774 E) Christopher.pickett1@us.army.mil
Dr Victor Aboyans, Dupuytren University Hospital, France T) +33 555 056 371 E) victor.aboyans@unilim.fr
http://multimedia.thelancet.com/pdf/press/Carotid.pdf
Journal
The Lancet