Asymptomatic carotid bruit and risk of stroke. The Framingham study

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Abstract
Carotid bruit was routinely sought in the Framingham cohort and during 8 yr appeared in 66 men and 105 women, all of whom were asymptomatic. The incidence increased with age equally in the 2 sexes from 3.5% at 44-54 yr, to 7.0% at 65-79 yr. The 8 yr incidence was greater in diabetics and hypertensive subjects. Transient ischemic attacks appeared in 8 (2 alone) and stroke in 21 of the 171, a stroke rate more than twice expected for age and sex. More often than not, cerebral infarction occurred in a vascular territory different from that of the carotid bruit, often in the posterior circulation. Ruptured aneurysm, embolism from the heart and lacunar infarction was the mechanism of stroke in nearly half the cases. Incidence of myocardial infarction was increased two-fold in those with asymptomatic carotid bruit. General mortality was also increased; 1.7-fold in men and 1.9-fold in women, with 79% of the deaths owing to cardiovascular disease, including stroke. Carotid bruit is clearly an indicator of increased stroke risk but chiefly as a general and nonfocal sign of advanced atherosclerotic disease and not necessarily as an indicator of local arterial stenosis preceding cerebral infarction.