Asymptomatic Carotid Stenosis is Associated With Mobility Dysfunction: Results From the InChianti Study

Abstract

BackgroundOlder adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunction when compared to individuals without ACAS. We tested whether carotid stenosis affected mobility function in a larger community-dwelling cohort using the Invecchaire in Chianti (InCHIANTI) database.MethodsWe analyzed data from participants in the InCHIANTI study who completed a medical history, carotid duplex testing, and mobility function testing (Short Physical Performance Battery- SPPB). Participants with a history of stroke, transient ischemic attack, or carotid endarterectomy were excluded. 709 participants met inclusion criteria (116 ACAS, 593 no ACAS). Our analytic approach sought to evaluate the impact of stenosis on mobility after accounting for age, sex and cardiovascular risk factors. Age was stratified into 2 age-groups (65-74 and 75-84 years). Two-way ANOVA was used to test the effect of stenosis-group, age-group, and their interactions on SPPB score with sex as a covariate.ResultsStenosis-group (P = 0.0002), age-group (P < 0.0001), and the interaction between stenosis-group and age-group (P = 0.0008) significantly affected SPPB. Post-hoc testing showed that participants with ACAS demonstrated worse performance on the SPPB (9.81 ± 0.37) compared to those with no ACAS (11.10 ± 0.11) in the 65-74 years age-group (P < 0.0001).Conclusions65-74-year-old adults with ACAS performed significantly worse on the SPPB than those without ACAS. These results lend further support that ACAS may be associated with mobility dysfunction in older adults.

Keywords: asymptomatic carotid stenosis; balance; carotid stenosis; mobility function.

Figure 1.

Flow diagram of participant inclusion. Participants were classified as having asymptomatic carotid artery stenosis (ACAS) or no ACAS at cycles 1, 2, 3, or 4. Of 1453 participants, 709 were identified as either having (116) or not having ACAS (593). Abbreviations: carotid endarterectomy (CEA), transient ischemic attack (TIA), Short Physical Performance Battery (SPPB).

Figure 2.

Estimated marginal mean (EMM) and standard error of the mean (SEM) for Short Physical Performance Battery (SPPB) score for the younger (65-74 years) and older (75-84 years) age groups with and without ACAS. Scores are adjusted for sex using the reduced model.