THURSDAY, May 8 (HealthDay News) -- That unusual, harsh sound a
doctor can hear when passing a stethoscope over a main artery to
the brain could indicate an increased risk of heart attack and
death from heart disease and stroke, a new study finds.
The sound -- called a carotid bruit (pronounced brew-ee) -- is
caused by turbulent blood flow due to buildup of fatty deposits in
one of the two arteries that carry blood to the front and middle
part of the brain. It is usually regarded as a possible indicator
of increased risk of stroke.
Now an analysis of 22 studies finds that people with carotid
bruits are more than twice as likely to have heart attacks or to
die of cardiovascular disease. "The presence of a carotid bruit
should heighten clinician concern for coronary heart disease," said
the report by physicians at Walter Reed Army Medical Center in
Washington, D.C.
The studies included 17,295 people who were followed for an
average of four years. "In the four studies in which direct
comparison of patients with and without bruits were possible, the
odds ratio for myocardial infarction [heart attack] was 2.15 and
for cardiovascular death 2.27," the report said.
The findings are published in the May 10 issue of
The Lancet.
Using the presence of a bruit as an indicator of cardiovascular
risk could be helpful, but "there are some unresolved questions
about the usefulness of carotid bruit and prognosis," said Dr.
Victor Aboyans, a cardiologist at Dupuytren University Hospital in
Limoges, France, and co-author of an accompanying editorial in the
journal.
"First, many of the patients who were studied already had
cardiovascular disease, so what is the additional value of carotid
bruit in such a case?" Aboyans asked. "The second issue is that
some patients who don't have carotid bruit may have other evidence
of cardiovascular disease."
Several studies have shown that starting preventive measures for
stroke on the basis of screening for carotid bruit aren't useful,
Aboyans said. Nevertheless, presence of carotid bruit could prompt
physicians to be more aggressive in recommending measures to reduce
the risk of cardiovascular disease, such as cholesterol reduction,
he said.
Dr. Deepak Bhatt, associate director of the Cleveland Clinic
Cardiovascular Coordinating Center, said, "The [study authors']
recommendation that they be even more aggressive with risk
modification, that is good clinical judgment."
Physicians routinely listen for possible carotid bruits when
doing a physical examination of people who are middle-aged or
older, Bhatt noted.
Studies have shown that there's a link between the risk of
stroke and of coronary heart disease, Bhatt said. "The core
knowledge already exists," he said. "This study helps put a number
on how high the risk is."
But the study raises some practical issues, Bhatt added. "One is
whether, if a carotid bruit is found, to go ahead and do an
ultrasound examination," he said. "I would say yes, but it is
controversial. The U.S. Preventive Task Force recommends against
routine ultrasound in general."
More information
Learn what a carotid bruit is and what it might mean from the
American Heart Association.
