Winter 2006

Vascular Disease Goes Beyond the Heart

Patients often ask what their risk is of developing coronary heart disease. Although coronary heart disease is prevalent and is the leading cause of death in industrialized countries, new research shows that the risk of developing atherosclerotic vascular disease in arteries outside the heart is equally common.

The Oxford Vascular Study was reported in the Nov. 19-25, 2005, issue of the medical journal Lancet. This study assessed all patients who sought medical attention for a vascular disease event in any arterial territory in Oxfordshire, UK (population 91,100), between 2002 and 2005. Of the 2,024 acute vascular events that occurred in 1,657 patients, 918 (45 percent) were cerebrovascular events (618 stroke, 300 transient ischemic attack); 856 (42 percent) were coronary vascular events; and 188 (9 percent) were peripheral vascular events. Sixty-two patients (4 percent) died suddenly of a presumed vascular event. Thus, vascular events were more frequent in arterial territories outside the heart, especially in the brain.

Other findings in this study were that the event rate rose steeply with advancing age in all arterial territories and that the number of fatal events increased with age. Also, coronary events were more common in men, especially at ages younger than 65 years, as were events involving the abdominal aorta. The only event that was more common in women was subarachnoid hemorrhage, which was an infrequent event. Stroke rates were the same for men and women at all ages. Thus, the conventional wisdom that men are more likely than women to have a coronary event is supported by this study, but not the notion that women are more likely to have a stroke.

The strength of this study is that it is based upon a large, unselected adult population living in one location. The exact results may not be the same in populations with a different ethnic or racial mix, but the general trends would be expected to be the same. What it tells me is that although coronary heart disease is important, stroke and other vascular events in aggregate are actually more prevalent. Thus, our prevention efforts, therapies, research and education need to focus on the entire vascular system. This is the objective of the UCSF Heart and Vascular Center.

Michael H. Crawford, M.D.
Chief of Clinical Cardiology
UCSF Medical Center

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