Patients with a carotid bruit are at increased risk for myocardial infarction (MI) and cardiovascular death, meta-analysis results indicate.

"Auscultation for carotid bruits in patients at risk for heart disease could help select those who might benefit the most from an aggressive modification strategy for cardiovascular risk," the authors write in The Lancet.

Carotid bruits are weak predictors of cerebrovascular events, but they are probably better indicators of generalized atherosclerotic disease and cardiovascular risk, the team explains.

Christopher Pickett (Walter Reed Army Medical Center, Washington, DC, USA) and colleagues carried out a meta-analysis of 22 studies that included data for cardiovascular outcomes in individuals with carotid bruits. Of these, 14 studies were of patients with asymptomatic bruits.

The analysis included 17,295 patients followed-up for 62,413.5 patient-years, with a median sample size of 273 patients followed-up for 4 years.

Patients with carotid bruits were more likely to have MI than those without bruits, at a rate of 3.69 versus 1.86 per 100 patient-years. Patients with bruits also had higher yearly rates of cardiovascular death than those without carotid bruits, at 2.85 versus 1.11 per 100 patient-years.

In the four trials in which direct comparisons of patients with and without bruits were possible, patients with carotid bruits were 2.15 and 2.27 times more likely than those without bruits to have MI and cardiovascular death, respectively.

Pickett and co-workers conclude: "Our study has shown that the presence of a carotid bruit significantly increased the likelihood of a cardiovascular death or MI."

They suggest: "The presence of a carotid bruit alone should be regarded as an equivalent of coronary heart disease and would warrant the same aggressive modification of cardiac risk factors that are recommended for diabetes or peripheral artery disease."

Victor Aboyans and Philippe Lacroix, from the Dupuytren University Hospital in Limoges, France, wrote in an accompanying comment:

"These data illustrate the major importance of clinical signs to guide the physician for individual primary prevention focused on those at a higher level of risk."

Lancet 2008; 371: 1587-1594