Decline in the Severity of Carotid Atherosclerosis and Associated Risk Factors From 2002 to 2014

Background and Purpose— Several recent studies suggest declining rates of carotid revascularization for patients with carotid stenosis. We investigated whether carotid atherosclerosis severity has declined in recent years. Methods— We used carotid ultrasound to evaluate stenosis and plaque area in 6039 patients presenting to vascular medicine clinics in 3 eras: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Results— The total plaque area at the time of referral to the clinics declined by 24% between 2002 and 2014; the percentage of patients presenting with carotid stenosis >60% declined by 29.9%, and the number presenting with >80% stenosis declined by 36.4%. There were significant reductions in plasma lipids and blood pressure during the same interval. Conclusions— Atherosclerosis severity seems to be declining over time. Better treatment of risk factors in the community may be responsible.