Carotid and femoral bruits as cardiovascular risk indicators in a middle-aged Finnish population

1. Patients with auscultated carotid and femoral bruits were found to have an elevated risk for cardiovascular (CV) mortality, but after excluding patients with a history of CV events, no association was found between bruits and CV events or all-cause mortality.

Evidence Rating Level: 2 (Good)

As the leading cause of death globally, predicting the risk of cardiovascular (CV) disease-related adverse events is pertinent. While there are risk calculators available and complex measurements such as carotid intima-media thickness, the utility of less complex clinical tests, such as assessing for carotid or femoral bruits, has not been rigorously studied. Therefore, this 20-year prospective study examined the association between carotid and femoral bruits and mortality from CV disease and all causes. The study population consisted of participants randomly chosen from the Social Insurance Institute of Finland: This included 600 patients with hypertension who were matched by age and sex to 600 other subjects. The auscultation for bruits was done in the early 1990s, and patients were followed for 20 years until 2014. In total, there were 1045 subjects, 49.8% of whom were male, and with a mean (SD) age of 51.3 (5.97) years at the beginning of the study. Also, 4.0% had carotid bruits, 11.9% had femoral bruits, 1.1% had both, and 85.2% had neither. The results found that 23.1% of participants died, and 34.0% of those deaths were CV related. Both carotid and femoral bruits were associated with higher risk of CV-related death (hazards ratio 4.15, 95% CI 2.39-8.52, p < 0.001; HR 2.55, 95% CI 1.54-4.22, p < 0.001 respectively). The incidence of mortality from CV events was 1.48% per person-year for those with carotid bruits, 0.81% per person-year for those with femoral bruits, and 0.82% per person-year for those with either. After adjustments for CV risk factors such as blood pressure, smoking, cholesterol levels, and history of coronary disease or stroke, the risk for CV deaths was increased by 69% for patients with a carotid or femoral bruit, compared to those without. However, when excluding patients with prior CV events, there was no association between carotid and femoral bruits with future CV event or all-cause mortality. Overall, this study found that there is an elevated risk of CV-related death for middle-age patients with carotid and femoral bruits, but without a history of a prior CV event, bruits were not associated with future CV events or all-cause mortality.

Click to read the study in PLOSONE

Image: PD

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