Enfermedad carotídea aterosclerosa y enfermedad de sustancia blanca en sujetos sin historia de infarto cerebral o isquemia cerebral transitoria

espanolIntroduccion: La enfermedad carotidea aterosclerosa (ECA) es un factor de riesgo importante para enfermedad vascular cerebral. Objetivo: Analizar la asociacion entre factores de riesgo vascular mayores con ECA y leucopatia cerebral en pacientes sin historia de ictus isquemico. Metodo: Se evaluaron factores de riesgo en sujetos con exploracion de carotidas mediante ultrasonografia Doppler duplex. No se incluyeron casos con historia de infarto cerebral o ataque isquemico transitorio. Los sujetos contaron con resonancia magnetica cerebral y se excluyeron aquellos con lesiones isquemicas de grandes vasos. Se construyeron modelos multivariable para la prediccion de ECA, estenosis carotidea significativa, carga de ateromas y leucopatia cerebral. Resultados: Se estudiaron 145 sujetos (60.7 % mujeres, edad de 73 anos). Se documento ECA en 54.5 %, estenosis carotidea ≥ 50 % en 9 %, carga de placas de ateroma > 6 en 7.6 % y leucopatia periventricular o subcortical en 28.3 % (20.6 % tenian concurrentemente ECA y leucopatia). Los factores asociados independientemente con ECA fueron edad e hipertension; con estenosis ≥ 50 %, hipertension; con cargas de ateromas > 6 placas, edad; con leucopatia, edad, diabetes e hipertension. La obesidad no se asocio con las variables independientes analizadas. Conclusiones: En los sujetos asintomaticos sin historia de ictus isquemico, la edad y la hipertension fueron los factores de riesgo mas importantes para enfermedad macrovascular. La diabetes mellitus se asocio con enfermedad microvascular. La obesidad por si sola no fue un determinante mayor de ECA o leucopatia cerebral. EnglishIntroduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.