(May 9, 2008 - Insidermedicine) The presence of a carotid bruit is associated with significantly increased risk for cardiovascular-related mortality and myocardial infarction, according to research published in the latest issue of The Lancet.

Here are some recommendations for managing patients in whom a bruit has been detected:

•    Further investigation is warranted after detecting a bruit, as a proportion of patients will have significant stenosis, even if asymptomatic.

•    While there are no internationally agreed guidelines regarding how to proceed, the consensus view of specialists is that less invasive imaging procedures should be tried first as these are less likely to precipitate a stroke.

•    The following types of carotid imaging can be used: duplex ultrasound, magnetic resonance imaging (MRI), or digital subtraction angiography.

Researchers out of Walter Reed Army Medical Center in Washington, DC conducted a meta-analysis of 22 previous studies exploring the clinical implications of carotid bruits. The studies involved 17, 295 patients who were followed-up for an average of four years.

Patients with carotid bruits were about twice as likely to suffer a myocardial infarction and more than two-and-a-half times as likely to die of a cardiovascular-related cause, compared with those without bruits. Four studies included in the meta-analysis directly compared patients with and without bruits, and data from these studies revealed, again, that bruits are associated with more than double the risk of myocardial infarction or cardiovascular mortality.

Today's research uncovers the cardiovascular risks associated with carotid bruits and suggests that the presence of a bruit may be an indication for a more aggressive approach to cardiovascular risk modification.