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Effect of Carotid E...
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Halliday, AlisonUniversity of Oxford,Univ Oxford, Nuffield Dept Surg Sci, Oxford OX3 9DU, England.
(author)
Effect of Carotid Endarterectomy on 20 Year Incidence of Recorded Dementia : A Randomised Trial
- Article/chapterEnglish2022
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LIBRIS-ID:oai:lup.lub.lu.se:87c58f7b-01d8-4c7c-be50-75248a1e81a2
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https://lup.lub.lu.se/record/87c58f7b-01d8-4c7c-be50-75248a1e81a2URI
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https://doi.org/10.1016/j.ejvs.2021.12.041DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-475597URI
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
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Editor's Choice
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Objective: Stroke and carotid atherosclerosis are associated with dementia. Carotid endarterectomy (CEA) reduces stroke risk, although its effect on later dementia is uncertain. Participants in the Asymptomatic Carotid Surgery Trial (ACST-1), randomly allocated to immediate vs. deferral of CEA (i.e., no intervention unless or until triggered by ipsilateral transient ischaemic attack or stroke), were followed, to study effects on dementia. Methods: From 1993 to 2003, ACST-1 included 3 120 participants with asymptomatic tight carotid stenosis. All UK and Swedish patients (n = 1 601; 796 immediate vs. 805 deferral) were followed with trial records, national electronic health record linkage, and (UK only) by post and telephone. Cumulative incidence and competing risk analyses were used to measure the effects of risk factors and CEA on dementia risk. Intention to treat analyses yielded hazard ratios (HRs; immediate vs. deferral) of dementia. Results: The median follow up was 19.4 years (interquartile range 16.9 – 21.7). Dementia was recorded in 107 immediate CEA patients and 115 allocated delayed surgery; 1 290 patients died (1 091 [538 vs. 536] before any dementia diagnosis). Dementia incidence rose with age and with female sex (men: 8.3% aged < 70 years at trial entry vs. 15.1% aged ≥ 70; women: 15.1% aged < 70 years at trial entry vs. 22.4% aged ≥ 70 years) and was higher in those with pre-existing cerebral infarction (silent or with prior symptoms; 20.2% vs. 13.6%). Dementia risk was similar in both randomised groups: 6.7% vs. 6.6% at 10 years and 14.3% vs. 15.5% at 20 years, respectively. The dementia HR was 0.98 (95% confidence interval [CI] 0.75 – 1.28; p =.89), with no heterogeneity in the neutral effect of immediate CEA on dementia related to age, carotid stenosis, blood pressure, diabetes, country of residence, or medical treatments at trial entry (heterogeneity values p >.05). Conclusion: CEA was not associated with significant reductions in the long term hazards of dementia, but the CI did not exclude a proportional benefit or hazard of about 25%.
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Sneade, MaryUniversity of Oxford,Univ Oxford, Nuffield Dept Surg Sci, Oxford OX3 9DU, England.
(author)
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Björck, MartinUppsala universitet,Uppsala University,Kärlkirurgi(Swepub:uu)mabjo425
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Pendlebury, Sarah T.University of Oxford,Univ Oxford, Oxford Univ Hosp NHS Fdn Trust, Wolfson Ctr Prevent Stroke & Dementia, NIHR Oxford Biomed Res Ctr,Nuffield Dept Clin Neu, Oxford, England.
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Bulbulia, RichardUniversity of Oxford,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Parish, SarahUniversity of Oxford,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Llewellyn-Bennett, RebeccaUniversity of Oxford,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Pan, HollyUniversity of Oxford,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Whiteley, WilliamUniversity of Oxford,University of Edinburgh,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.;Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland.
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Pan, HongchaoUniversity of Oxford,Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Gottsäter, AndersLund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups,Lund Univ, Dept Vasc Dis, Lund, Sweden.(Swepub:lu)medf-ago
(author)
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University of OxfordUniv Oxford, Nuffield Dept Surg Sci, Oxford OX3 9DU, England.
(creator_code:org_t)
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ACST-1 Trial Investigators
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In:European journal of vascular and endovascular surgery: Elsevier BV63:4, s. 535-5451078-58841532-2165
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Halliday, Alison
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Sneade, Mary
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Björck, Martin
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Parish, Sarah
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- MEDICAL AND HEALTH SCIENCES
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