Risk Factors of Asymptomatic Carotid Artery Disease in Geriatric Evaluated Using Carotid Intima-Media Thickness (IMT) Measurement, the First Indonesian Population Study

Abstract

Carotid artery disease in geriatric is one of the important etiologies of stroke, which topped the cause of mortality in Indonesia. Specific prevention should be done as early as asymptomatic disease occurred. Initial assessment can be performed using ultrasound by measuring the intima-media thickness (IMT) of carotid artery, which can evaluate earlier progression of the atherosclerosis process. Unfortunately, we do not have risk factors categorization that show us which geriatric population fall under high-risk stratification to be screened. Study was done to Indonesian geriatric population. Asymptomatic carotid disease was tested positive if IMT was > 0.9 mm without any previous neurological symptoms. Correlation of the result was statistically tested with risk factors of atherosclerotic process, such as sex, body mass index, presence of hypertension, diabetes mellitus, and hypercholesterolemia. Study obtained 104 subjects and showed the prevalence of asymptomatic carotid disease was 37.5%. Two risk factors: diabetes mellitus and hypercholesterolemia were statistically significant (p = 0.01) with odds ratio (OR) 3.56 (1.31–9.64, 95% confidence interval [CI]) and OR 2.85 (1.25–6.51, CI 95%), respectively. Logistic regression showed the risk was 69.2% by having two of these comorbidities, 47.2 or 42.5% if diabetes mellitus or hypercholesterolemia was present. As diabetes mellitus and hypercholesterolemia were proved to be significant risk factors for asymptomatic carotid artery disease, we recommend performing ultrasound screening to measure carotid artery IMT for geriatric population who had diabetes mellitus and/or hypercholesterolemia for asymptomatic carotid artery disease to be diagnosed and further treated.

Keywords

asymptomatic carotid artery disease - intima-media thickness evaluation - risk factors

Publication History

Article published online:
28 June 2022

• References

• 1 Marsh JD, Keyrouz SG. Stroke prevention and treatment. J Am Coll Cardiol 2010; 56 (09) 683-691
• 2 Mughal MM, Khan MK, DeMarco JK, Majid A, Shamoun F, Abela GS. Symptomatic and asymptomatic carotid artery plaque. Expert Rev Cardiovasc Ther 2011; 9 (10) 1315-1330
• 3 Harris S, Kurniawan M, Rasyid A, Mesiano T, Hidayat R. Cerebral small vessel disease in Indonesia: lacunar infarction study from Indonesian Stroke Registry 2012-2014. SAGE Open Med 2018; 6: 2050312118784312
• 4 Moeloek N. Indonesian Ministry of Health. Kebijakan pembangunan kesehatan 2015–2019. 2016 . Accessed September 23, 2021 at: https://www.kemkes.go.id/folder/view/01/structure-web-content-publikasi-data.html
• 5 Shiber JR, Fontane E, Adewale A. Stroke registry: hemorrhagic vs ischemic strokes. Am J Emerg Med 2010; 28 (03) 331-333
• 6 Simove I. Intima-media thickness: appropriate evaluation and proper measurement, described. Eur Soc Cardiol 2015; 13: 1-14
• 7 Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Erratum: stroke epidemiology in South, East, and South-East Asia: a review. J Stroke 2018; 20 (01) 142-142
• 8 Ghani L, Mihardja LK, Delima D. Faktor Risiko Dominan Penderita Stroke di Indonesia. Buletin Penelitian Kesehatan 2016; 44 (01) 49-58
• 9 Kitamura A, Iso H, Imano H. et al. Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke 2004; 35 (12) 2788-2794
• 10 Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurg 2011; 76 (6, Suppl): S85-S90
• 11 van den Oord SCH, Sijbrands EJG, ten Kate GL. et al. Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 2013; 228 (01) 1-11
• 12 Indonesian Ministry of Health. Situasi kesehatan jantung. Pusat Data dan Informasi Kementerian Kesehatan RI. 2014 3. . Accessed September 23, 2021 at: https://www.kemkes.go.id/folder/view/01/structure-web-content-publikasi-data.html
• 13 de Weerd M, Greving JP, Hedblad B. et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 2010; 41 (06) 1294-1297
• 14 Zaenurrohmah DH, Rachmayanti RD. Hubungan Pengetahuan Dan Riwayat Hipertensi Dengan Tindakan Pengendalian Tekanan Darah Pada Lansia. J Berk Epidemiol 2017; 2017 (05) 174-184
• 15 Indonesian Ministry of Health. Gambaran Kesehatan Lanjut Usia Di Indonesia. 2013 . Accessed September 23, 2021 at: https://www.kemkes.go.id/folder/view/01/structure-web-content-publikasi-data.html
• 16 Brott T, Halperin J, Abbara S. et al. Carotid stenosis: what is the high-risk population?. Eur J Vasc Endovasc Surg 2010; 161 (01) 356-362
• 17 Banerjee C, Chimowitz MI. Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res 2017; 120 (03) 502-513
• 18 Pratama D, Rahmaditya FS. Screening recommendations for asymptomatic carotid artery disease and role of carotid intima-media thickness evaluation: a literature review. J Indones Soc Vasc Endovasc Surg 2021; 2 (01) 34-40
• 19 Simons PCG, Algra A, van de Laak MF, Grobbee DE, van der Graaf Y. Second manifestations of ARTerial disease (SMART) study: rationale and design. Eur J Epidemiol 1999; 15 (09) 773-781