Background: It is unclear why atherosclerosis remains restricted to one arterial tree in some patients whereas it is more generalized in others. Few studies have addressed the role that systemic risk factors play in the progression of atherosclerosis from one arterial tree to another.
Methods: We studied 344 consecutive patients with suggested coronary artery disease (CAD) who underwent combined coronary and carotid angiography during a 7-month period. Coronary and carotid disease was graded as absent-mild or moderate-severe based on the degree of stenosis of these vessels. Traditional vascular risk factors were compared for patients with moderate-severe CAD alone versus patients with moderate-severe CAD and carotid disease.
Results: Moderate-severe CAD alone was found in 162 patients and moderate-severe CAD and carotid disease was found in 100 patients. Multivariate analysis showed that hypertension (P = .007, odds ratio 2.2, 95% confidence interval 1.2-3.9), history of smoking (P = .06, odds ratio 1.8, 95% confidence interval 1.0-3.4), and diabetes (P = .09, odds ratio 1.6, 95% confidence interval 0.9-2.8) were associated with combined moderate-severe CAD and carotid disease. Patients with combined moderate-severe CAD and carotid disease were significantly more likely to have at least 2 of these 3 risk factors (P < .001) than patients with moderate-severe CAD alone.
Conclusion: An accumulating burden of hypertension, diabetes, and smoking are important in the progression of atherosclerosis from the coronary to the carotid circulation.