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J Am Coll Cardiol, 2004; 44:618-623, doi:10.1016/j.jacc.2004.04.044
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Subclavian artery stenosis: Prevalence, risk factors, and association with cardiovascular diseases

Ramin Shadman, BA*, Michael H. Criqui, MD, MPH{dagger},*, Warner P. Bundens, MD{ddagger}, Arnost Fronek, MD, PhD{ddagger}, Julie O. Denenberg, MA{dagger}, Anthony C. Gamst, PhD{dagger} and Mary M. McDermott, MD§

* University of California-San Diego, School of Medicine, San Diego, California, USA
{dagger} Department of Family and Preventive Medicine, University of California-San Diego, San Diego, California, USA
{ddagger} Department of Surgery, University of California-San Diego, California, USA
§ Department of Medicine and Preventive Medicine, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA

Manuscript received February 18, 2004; revised manuscript received April 4, 2004, accepted April 16, 2004.

* Reprint requests and correspondence: Dr. Michael H. Criqui, Department of Family and Preventive Medicine, University of California San Diego, 9500 Gilman Drive, 352 SCRB, La Jolla, California 92093-0607, USA.
mcriqui{at}ucsd.edu

OBJECTIVES: The objective was to assess the prevalence of subclavian artery stenosis (SS) in four cohorts (two free-living and two clinical populations) and determine both risk factors for this condition and the association with other cardiovascular conditions.

BACKGROUND: The prevalence of SS in the general population is unknown, and its association with risk factors and other cardiovascular diseases is not well-established.

METHODS: A total of 4,223 subjects (2,975 from two free-living cohorts and 1,248 from two clinical cohorts) were included in this cross-sectional analysis. Subclavian artery stenosis was defined as ≥15 mm Hg interarm pressure difference.

RESULTS: The prevalence of SS was 1.9% in the free-living cohorts and 7.1% in the clinical cohorts; SS was significantly (p < 0.05) associated with past smoking (odds ratio [OR] = 1.80), current smoking (OR = 2.61), and higher levels of systolic blood pressure (OR = 1.90 per 20 mm Hg). Higher levels of high-density lipoprotein (HDL) cholesterol were inversely and significantly associated with SS (OR = 0.87 per 10 mg/dl). In regression analyses relating SS to other cardiovascular diseases, the only significant finding was with peripheral arterial disease (PAD) (OR = 5.11, p < 0.001).

CONCLUSIONS: Significant SS is present in approximately 2% of the free-living population and 7% of the clinical population. Additionally, SS is correlated with current and past smoking histories, systolic blood pressure, HDL levels (inversely), and the presence of PAD. These findings suggest that bilateral brachial blood pressure measurements should routinely be performed in patients with an elevated risk profile, both to screen for SS, and to avoid missing a hypertension or PAD diagnosis because of unilateral pressure measurement in an obstructed arm.

Abbreviations and Acronyms
  ABI = ankle brachial index
  CABG = coronary artery bypass graft
  CAD = coronary artery disease
  HDL = high-density lipoprotein
  MI = myocardial infarction
  NHW = non-Hispanic white
  PAD = peripheral arterial disease
  PTCA = percutaneous transluminal coronary angioplasty
  SBP = systolic blood pressure
  SS = subclavian artery stenosis




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