The risk factors associated with carotid artery disease

Abstract

Atherosclerosis plays a primary role in ischaemic heart disease, the most common cause of death in the developed world.  Inflammation, the fundamental pathological process in atherogenesis and formation of plaque, was investigated in a randomised controlled trial conducted on 189 patients awaiting carotid endarterectomy (CEA).  The main objective of this study was to compare the effect of n-3 polyunsaturated fatty acid (PUFA) supplements on the inflammatory process in carotid plaques compared with n-6 PUFA supplements and a placebo.  It was found that the number of macrophages in the plaque was significantly lower in patients taking n-3 PUFA supplements than in those of the other groups, which may make these plaques more stable and less likely to rupture.  The level of high sensitivity C-reactive protein was significantly higher in patients with symptomatic carotid stenosis than in those without symptoms, which may help to identify carotid stenosis patients at a high risk of developing neurological deficits.  Another objective of this study was to assess the extent to which physicians recognised the importance of control of hyperlipidaemia in patients with severe atherosclerosis.  It was found that 32.1% of these patients had higher levels of plasma cholesterol than the recommended value and 22% of them had never had any tests for blood lipids. 

Many large randomised controlled trials have found that CEA in patients with symptomatic severe carotid stenosis has clearly reduced the incidence of stroke, compared with medical treatment only.  From a systematic review of the literature of carotid endarterectomy in the period 1960 -  2000 and a meta-analysis, it was found that the risk of stroke and death in patients with symptomatic carotid stenosis was 4.6% and has not changed significantly over the last 15 years.  Presentation, such as stroke, transient ischaemic attacks and amaurosis fugax, strongly influences stroke/death rates and therefore, reports of the outcome of surgery should always be stratified accordingly. Furthermore, this figure for risk varied enormously and depended on research design and reporting.  One should take the quality of study design and reporting into account before judging the performance of the surgeons in these studies.

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