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Thursday, April 30, 2009
Sadrivaan A and B (The Hilton Istanbul Hotel )
Purpose
Hollenhorst plaques (HP) are retinal cholesterol emboli. They are associated with systemic atherosclerosis. Recent studies suggested an incidence of 5% in the general population. The goal of this study is to examine the utility of Hollenhorst plaques in predicting significant carotid disease and long term vascular events in patient diagnosed with Hollenhorst plaques.
Design
Retrospective chart review.
Participants
237 patients diagnosed with Hollenhorst plaques by staff ophthalmologist between 1996 and 2004.
Methods
Baseline cardiovascular risk profile, medications, and carotid ultrasound findings were documented. Carotid stenosis >70% on carotid duplex ultrasound was classified as significant.
Main Outcome Measure
During follow up we documented the incidence of retinal ischemia, myocardial ischemia, and cerebrovascular events.
Results
Eighty one percent of the Hollenhorst plaque patient population underwent carotid ultrasound evaluation. Significant stenosis was found in 13.5 %. The incidence of significant carotid stenosis was higher in patients who presented with symptoms of retinal ischemia (25% vs. 9%; p=0.008). Among asymptomatic patients, those with a carotid bruit had higher incidence of significant carotid stenosis (37%vs. 4%; p=0.001). The mean followup was 41±22 months. Among HP patients, those with symptoms of retinal ischemia on presentation did not have a higher rate of recurrent retinal ischemia (9% vs. 8%; p=0.727), TIA (13% vs. 7%; p=0.461), myocardial infarction (9% vs. 13%; p=0.760), stroke (6% vs. 7%; p=1), cardiac mortality (6% vs. 8%; p=1), or all cause mortality (15.6% vs. 18%; p=1).
Conclusions
In patients with Hollenhorst plaques, symptoms of retinal ischemia and a carotid bruit increase the likelihood of finding surgical carotid disease and the eventual need for carotid endarterectomy. Symptomatic retinal ischemia on presentation was not associated with an increased risk for vascular events during the followup period. These results underscore the importance of aggressive cardiovascular risk profile modification in HP patients even in the absence of retinal ischemic symptoms at the time
Hollenhorst plaques (HP) are retinal cholesterol emboli. They are associated with systemic atherosclerosis. Recent studies suggested an incidence of 5% in the general population. The goal of this study is to examine the utility of Hollenhorst plaques in predicting significant carotid disease and long term vascular events in patient diagnosed with Hollenhorst plaques.
Design
Retrospective chart review.
Participants
237 patients diagnosed with Hollenhorst plaques by staff ophthalmologist between 1996 and 2004.
Methods
Baseline cardiovascular risk profile, medications, and carotid ultrasound findings were documented. Carotid stenosis >70% on carotid duplex ultrasound was classified as significant.
Main Outcome Measure
During follow up we documented the incidence of retinal ischemia, myocardial ischemia, and cerebrovascular events.
Results
Eighty one percent of the Hollenhorst plaque patient population underwent carotid ultrasound evaluation. Significant stenosis was found in 13.5 %. The incidence of significant carotid stenosis was higher in patients who presented with symptoms of retinal ischemia (25% vs. 9%; p=0.008). Among asymptomatic patients, those with a carotid bruit had higher incidence of significant carotid stenosis (37%vs. 4%; p=0.001). The mean followup was 41±22 months. Among HP patients, those with symptoms of retinal ischemia on presentation did not have a higher rate of recurrent retinal ischemia (9% vs. 8%; p=0.727), TIA (13% vs. 7%; p=0.461), myocardial infarction (9% vs. 13%; p=0.760), stroke (6% vs. 7%; p=1), cardiac mortality (6% vs. 8%; p=1), or all cause mortality (15.6% vs. 18%; p=1).
Conclusions
In patients with Hollenhorst plaques, symptoms of retinal ischemia and a carotid bruit increase the likelihood of finding surgical carotid disease and the eventual need for carotid endarterectomy. Symptomatic retinal ischemia on presentation was not associated with an increased risk for vascular events during the followup period. These results underscore the importance of aggressive cardiovascular risk profile modification in HP patients even in the absence of retinal ischemic symptoms at the time
Learning Objectives: 1-Describe Hollenhorst plaques 2-Present the relationship between Hollenhorst plaques and carotid disease 3-Describe the relationship between Hollenhorst plaques and the risk of stroke and cardiovascular disease
Sub-Theme: Revisiting primary health care in the 21st century
See more of: Poster: Revisiting Primary Health Care in the 21st Century
See more of: Public Health Practices Around the Globe
See more of: Public Health Practices Around the Globe