Article

Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands.
Stroke (Impact Factor: 6.02). 02/2009; 40(4):1105-13. DOI: 10.1161/STROKEAHA.108.532218
Source: PubMed

ABSTRACT In the discussion on the value of population-wide screening for asymptomatic carotid artery stenosis (ACAS), reliable prevalence estimates are crucial. We set out to provide reliable age- and sex-specific prevalence estimates of ACAS through a systematic literature review and meta-regression analysis.
We searched PubMed and EmBase until December 2007 for studies that reported the prevalence of ACAS in a population free of symptomatic carotid artery disease. Data were extracted with use of a standardized form on participants' characteristics, assessment method, study quality, and prevalence estimates for moderate (>or=50% stenosis) and severe (>or=70% stenosis) ACAS. Metaregression was used to investigate sources of heterogeneity.
Forty studies fulfilled the inclusion criteria. There was considerable variation among studies with respect to demographics, methods of grading stenosis, and stenosis cutoff point used. The pooled prevalence of moderate stenosis was 4.2% (95% CI, 3.1% to 5.7%). Prevalence of moderate stenosis among people age <70 years was 4.8% (95% CI, 3.1% to 7.3%) in men and 2.2% (95% CI, 0.9% to 4.9%) in women. Among those >or=70 years, prevalence increased to 12.5% (95% CI, 7.4% to 20.3%) in men and to 6.9% (95% CI, 4.0% to 11.5%) in women. Metaregression showed that both age and sex significantly affected the prevalence of moderate stenosis. No contribution of study size, publication year, geographic region, assessment method, and study quality was found. The pooled prevalence of severe stenosis was 1.7% (95% CI, 0.7% to 3.9%).
Prevalence of moderate stenosis increases with age in both men and women, but men at all ages have the higher prevalence estimates. The number of studies that allowed meaningful data synthesis of severe stenosis was limited.

0 Bookmarks
 · 
104 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to review the recent literature regarding the neurocognitive consequences of carotid endarterectomy (CEA) and carotid stenting (CAS).
    Cerebrovascular diseases extra. 01/2014; 4(2):132-48.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Numerous population-based studies of age-related macular degeneration have been reported around the world, with the results of some studies suggesting racial or ethnic differences in disease prevalence. Integrating these resources to provide summarised data to establish worldwide prevalence and to project the number of people with age-related macular degeneration from 2020 to 2040 would be a useful guide for global strategies. Methods We did a systematic literature review to identify all population-based studies of age-related macular degeneration published before May, 2013. Only studies using retinal photographs and standardised grading classifications (the Wisconsin age-related maculopathy grading system, the international classification for age-related macular degeneration, or the Rotterdam staging system) were included. Hierarchical Bayesian approaches were used to estimate the pooled prevalence, the 95% credible intervals (CrI), and to examine the difference in prevalence by ethnicity (European, African, Hispanic, Asian) and region (Africa, Asia, Europe, Latin America and the Caribbean, North America, and Oceania). UN World Population Prospects were used to project the number of people affected in 2014 and 2040. Bayes factor was calculated as a measure of statistical evidence, with a score above three indicating substantial evidence. Findings Analysis of 129 664 individuals (aged 30–97 years), with 12 727 cases from 39 studies, showed the pooled prevalence (mapped to an age range of 45–85 years) of early, late, and any age-related macular degeneration to be 8·01% (95% CrI 3·98–15·49), 0·37% (0·18–0·77), and 8·69% (4·26–17·40), respectively. We found a higher prevalence of early and any age-related macular degeneration in Europeans than in Asians (early: 11·2% vs 6·8%, Bayes factor 3·9; any: 12·3% vs 7·4%, Bayes factor 4·3), and early, late, and any age-related macular degeneration to be more prevalent in Europeans than in Africans (early: 11·2% vs 7·1%, Bayes factor 12·2; late: 0·5% vs 0·3%, 3·7; any: 12·3% vs 7·5%, 31·3). There was no difference in prevalence between Asians and Africans (all Bayes factors <1). Europeans had a higher prevalence of geographic atrophy subtype (1·11%, 95% CrI 0·53–2·08) than Africans (0·14%, 0·04–0·45), Asians (0·21%, 0·04–0·87), and Hispanics (0·16%, 0·05–0·46). Between geographical regions, cases of early and any age-related macular degeneration were less prevalent in Asia than in Europe and North America (early: 6·3% vs 14.3% and 12·8% [Bayes factor 2·3 and 7·6]; any: 6·9% vs 18·3% and 14·3% [3·0 and 3·8]). No significant gender effect was noted in prevalence (Bayes factor <1·0). The projected number of people with age-related macular degeneration in 2020 is 196 million (95% CrI 140–261), increasing to 288 million in 2040 (205–399). Interpretation These estimates indicate the substantial global burden of age-related macular degeneration. Summarised data provide information for understanding the effect of the condition and provide data towards designing eye-care strategies and health services around the world. Funding National Medical Research Council, Singapore.
    The Lancet Global Health. 02/2014; 2(2):e106–e116.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and Purpose: Cerebral artery stenosis is known as an important cause of stroke, and elevated fasting glucose level is also considered as a risk factor for stroke. Our aim was to exam whether elevated fasting glucose is associated with cerebral artery stenosis, especially asymptomatic cerebral artery stenosis. Methods: The current study included 5309 participants who were age of 40 years or older, and free of stroke, transient ischemic attack, and coronary artery disease. Cerebral artery stenosis was assessed by Doppler ultrasound. Participants were classified into four subtypes: no cerebral artery stenosis (NCS), intracranial artery stenosis (ICAS), extracranial carotid artery stenosis (ECCS) and combined intracranial artery and extracranial carotid artery stenosis (IECS). Fasting blood glucose concentrations were grouped into: normal fasting glucose (<5.60 mmol/l), impaired fasting glucose 1 (IFG1) (5.60-6.09 mmol/l), IFG2 (6.10-6.99 mmol/l) and diabetes (≥7.00 mmol/l). A multinomial logistic regression was used to examine the association between fasting glucose and cerebral artery stenosis, after adjusting for potential confounders. Results: Fasting glucose level was significantly higher in ICAS and IECS groups than the other two groups. In the multinomial logistic regression analysis, IFG2 was the risk factor for ICAS (odds ratio (OR) 1.53, 95% confidential interval (CI), 1.12-2.10), and diabetes was a strong predictor for both ICAS (OR 1.75, 95% CI, 1.38-2.22) and IECS (OR 2.14, 95% CI 1.31-3.49). However, fasting glucose level was not significantly associated with ECCS. Conclusions: Our results showed that elevated fasting glucose levels are associated with asymptomatic cerebral artery stenosis, especially ICAS and IECS. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 10/2014; 237(2):661-665. · 3.71 Impact Factor