and Purpose: Along with the recent changes in lifestyle in Japan, the incidence of coronary artery disease has increased while the incidence of stroke appears to be decreasing. We investigated the relation between the progression of carotid atherosclerosis and the severity of coronary artery disease in the Japanese population. Methods: The 2-year change in extracranial carotid atherosclerosis in 50 Japanese patients who underwent coronary angiography was evaluated using carotid echotomography.

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... o quantify the extent of carotid atherosclerosis, the maximal thickness measurements of all plaques were summed for an individual plaque score, except for new plaques found on reexamination. Carotid disease progression was evaluated by the sum of plaque score change and the thickness of the new plaque found on reexamination. Results: The plaque score changed by -3.2 to 10.1 mm (mean±SD, 1.06±2.42 mm). The extent of coronary atherosclerosis (p<0.02) and serum total cholesterol level (p<0.01) were different between the progressing (n=17) and the nonprogressing (n=30) groups of carotid atherosclerosis when the progressing group included the patients with a A plaque score of >1.0 mm. Neither age, serum triglyceride level, serum high-density lipoprotein cholesterol level, pack-years of smoking, percentage of smokers, percentage of hypertensive patients, nor percentage of diabetic patients was different between the two groups. Carotid disease progression was significantly higher in patients with three-vessel coronary disease than in patients without significant coronary artery disease (p<0.005). There was a significant positive linear correlation between carotid disease progression and Gensini's coronary artery disease score (R=0.4ll, p<0.005). Conclusions: Our data showed that severe coronary artery disease and a high serum total cholesterol level were strong predictors for carotid disease progression in Japanese patients with high rates of coronary artery disease. (Stroke 1992;23:946-951) KEY WORDS • cardiovascular diseases • carotid artery diseases • Japan • ultrasonics A therosclerosis at the carotid artery bifurcation has / \ been reported to be a source of cerebrovascular •J. A . events. 1 -2 A significantly higher incidence of cerebrovascular events with the progression of atherosclerotic plaque in the carotid artery has also been reported. 3 Several previous studies have proposed the predicting factors for carotid disease progression. 4 -8 A 30-month follow-up study of 38 patients suggested that coronary atherosclerosis and elevated low density lipoprotein (LDL) and fibrinogen may be predicting factors for carotid stenosis progression. 6 In another study, cigarette smoking, diabetes mellitus, and age were proposed as the major factors associated with disease progression. 7 A 2-year follow-up study using intimal-medial thickness measurement suggested that age, serum LDL cholesterol level, pack-years of smoking, blood leukocyte count, and platelet aggregability were strong predictors for atherosclerosis progression. 8