jurnal carolin sidharta
TRANSCRIPT
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CAROTID BRUITS AND
CEBROVASCULAR DISEASE RISK A
META- ANALYSIS
Karolin D S Sidharta
2009 061 - 252
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BACKGROUND
The physical examination of the patient is afundamental medical skill and one cornerstone isauscultation.
In a recent meta-analysis, has found that thepresence of a carotid bruit significantly increasedthe risk of myocardial infarction andcardiovascular death.
Is there a relationship between the presence of acarotid bruits and the subsequent occurrence ofTIA, Stroke and death from stroke?
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METHOD
Data Sources and SearchesReview the reference list of retrieved articles and review
articles and personal fles of the authors.
Study Selection Identify all published studies that include prognostic
information based on identification of the presence ofcarotid bruit.
To be included in the analysis, studies hd to be onprospective cohorts of asymptomatic adults, englishlanguage, and have extractable cerebrovascular outcomedata.
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Quality Assessment
Studies were assessed with 31 questions that assessed
quality in 7 domains:
Description of patient population characteristic
Completeness of follow-up
Measurement of prognostic factors
Measurement of outcomes
Measurement and adjusment for potentialconfounders
Approprites of the analytic methods
Measurement of a carotid bruits.
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Data Extraction
From each included study were abstracted study
design, year, country, number of included patients,
length of follow up, sex, race, prevalence of
diabetes, hypertension, tobacoo use,
hyperlipidemia, CHF,AF< coronary or peripheral
vascular disease, and the percentage of patients
with carotid stenosis >50%.
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Data synthesis and Analysis
All analyses were performed using STATA 112 (
STATA corportion,college station ,Texas)
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RESULTS
785 potential articles
757 articles exlcuded
28 articles analysis
total patients: 17. 913
The mean Age was 64, 8 years, 56,3% of patients were male
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OUTCOMES
Transient Ischemic Attack
the pooled risk ratio for a TIA in patients withcarotid bruit was 4.00 ( 95% CI, 1.77 to 9.03 )
Stroke The pooled risk ratio for stroke in patients with
carotid bruit was 2.49 ( 95%CI, 1.77 to 3.52)
Death from strokethe pooled risk ratio for death from stroke in patientswith carotid bruit was 2,71 (95% CI,1,33 to 5,53)
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DISCUSSION
CBV , serious medical problem
Caroid bruit may be a candidate for such a tool
for primary preventive. Presence of carotid bruits significantly
increased the likelihood of CBV events.
TIAs, stroke and death 2- 4 fold.
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There are a number of limitations to thefindings:
most of the studies did not collect important
prognostic information such as the incidence ofdiabetes, hypertension , or other vascular risk.
The changes in medical care could influence theprognosis of patients with bruits.
Many of the result were heterogeneity, make itdifficult to now how accurate the pooled outcomesare.
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This test chracteristic describe the relationship
between detection of a carotid bruit and finding
significant stenosis of the carotid artery , not
attempting to assess degree of stenosis by
auscultation, but rather predict risk for future
atherosclerotic CBV outcomes.
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CONCLUSION
1. Patients with carotid bruit have over 4 timesthr risk ofTIA, over twice the risk of stroke,and an increased risk of death from stroke
when compared with defined patient controlswithout carotid bruits.
2. It would be tempting to recommend cliniciansauscultate for carotid bruits and, when found,consider aggressive modifications of CBV riskfactors.
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3. Although it is possible that such a strategy
may reduce TIAs, stroke and death, such a
conclusion awaits prospective interventional
trials, in which the effects of auscultation and
aggressive modification of CBV risk factors
such as aggressive cholesterol reduction are
compared with standard management