Elderly patients with minimal common carotid atherosclerosis not infrequently have severe coronary atherosclerosis and myocardial infarction.

Background: The presence of discordances between common carotid and coronary atherosclerosis in the same individual has not been previously reported.

Methods And Results: The subjects of the present study were 1,518 consecutive autopsy cases at a general geriatric hospital. All were aged 60 years or older (821 men, 697 women) with an average age of 80 years. The atherosclerotic index of the common carotid artery (CC-AI) and coronary stenotic index (CSI) were semi-quantitatively evaluated. The simple correlation coefficient between the CC-AI and CSI was 0.456 (p<0.0001). Among 689 cases with minimal common carotid atherosclerosis (CC-AI < or =2), 74 (11%) had severe coronary atherosclerosis (CSI > or =12), 68 (10%) had coronary heart disease, and 80 (12%) had pathologically-verified myocardial infarction (MI). Among those with minimal common carotid atherosclerosis, the serum total cholesterol level, diabetes mellitus, and history of smoking were significantly higher or more frequent in cases with a CSI > or =12 than in the patients with a CSI <12.

Conclusions: A considerable proportion of cases with minimal common carotid atherosclerosis had severe coronary atherosclerosis and MI. This discordance can potentially lead to an underestimation of coronary risks if normal common carotid morphology is obtained by ultrasound.