Carotid bruits detected by auscultation might serve as markers for heart disease, rather than detect carotid lesions and the subsequent risk of stroke, and could help select patients who would benefit from an aggressive treatment strategy for cardiovascular risk, according to the results of new study . Investigators report that those with carotid bruits have twice the risk of MI and cardiovascular death than those without carotid bruits.

“Our study has shown that the presence of a carotid bruit significantly increased the likelihood of a cardiovascular death or myocardial infarction,” write lead investigator Dr Christopher Pickett (Walter Reed Army Medical Center, Washington, DC) and colleagues in the May 10, 2008 issue of the Lancet. “Our findings accord with the notion that these atherosclerotic changes might be indicative of systemwide vascular pathological change to include the coronary bed.”

According to the authors, since auscultation of the carotid is a quick and inexpensive test, it could be used to aid clinicians in the assessment of coronary heart disease risk in certain patients. The group points out that the prognostic implications of a carotid bruit have focused primarily on the risk of cerebrovascular events, but carotid bruits are a weak predictor of cerebrovascular events in asymptomatic individuals. For those with symptoms, including nondisabling stroke or transient ischemia in the ipsilateral carotid, prognosis depends more of the severity of stenosis than the presence of a carotid bruit, they write.

Because of these uncertainties, the United States Preventive Services Task Force and the Canadian Task Force recommend against routine auscultation of carotid bruits. However, as Pickett and colleagues note, the turbulent flow in the lumen might serve as a better marker for generalized atherosclerosis and, to test this hypothesis, performed a meta-analysis to assess whether carotid bruits could be used as a prognostic tool in determining in cardiovascular risk.