People who have a carotid bruit are at a significantly greater risk of cardiovascular death and heart attack, according to an article published in The Lancet. A carotid bruit is a sound that blood makes when it passes over an obstruction in the carotid artery, the main passageway for supplying blood to the head and neck. A bruit is usually detected with a stethoscope and is an indicator of arterial blockage.

To date, carotid bruits have mostly been associated with bleeding events in the brain. However, there is a great deal of uncertainty about prognoses deriving from bruits, leading many organizations (such as the US Preventive Services Taskforce and the Canadian Task Force) to stop recommending routine listening for carotid bruits.

Summarizing and evaluating the extant research related to carotid bruits, Dr. Christopher Pickett (Walter Reed Army Medical Centre, Washington, DC, USA) and colleagues conducted a meta-analysis. They analyzed 22 studies with a total of 17,295 patients who were followed up for about four years, on average. The researchers found that the presence of a carotid bruit was associated with a doubling in the risk of suffering a heart attack compared to those without a bruit. Additionally, patients with a carotid bruit were 2.5 times as likely to die because of a cardiovascular-related event. Four of the studies in the meta-analysis directly compared patients with and without bruits; in these analyses, similar findings held: those with bruits were more two times as likely to have a heart attack or die from cardiovascular causes.

“Our study has shown that the presence of a carotid bruit significantly increased the likelihood of cardiovascular death or heart attack…Auscultation for carotid bruits in patients at high risk for heart disease could help select those that might benefit the most from an aggressive cardiovascular risk modification strategy,” conclude the authors.

An accompanying Comment, written by Drs. Victor Aboyans and Philippe Lacroix (Dupuytren University Hospital, Limoges, France), includes a discussion of the efficacy of using the presence of carotid bruit for prognostic reasons in the offices of general practitioners and in poorer countries other methods of diagnosis are unavailable. They caution, however, that some patients will not express carotid bruit, but may have other clinical signs of cardiovascular disease. “Prospective studies on asymptomatic patients are needed to study the prognostic value of a combination of simple clinical signs such as neck and groin auscultation and pulse palpation,” they conclude.

Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis
C A Pickett et al.
The Lancet (2008): 371[9624]. pp. 1587-1594.
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Written by: Peter M Crosta