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ATHEROSCLEROSIS

Atherosclerosis of the aorta: Risk factor, risk marker, or innocent bystander?

A prospective population-based transesophageal echocardiography study

Irene Meissner, MD^*,*, Bijoy K. Khandheria, MD, Sheldon G. Sheps, MD, Gary L. Schwartz, MD, David O. Wiebers, MD^*, Jack P. Whisnant, MD, Jody L. Covalt, RN^||, Tanya M. Petterson, MS^¶, Teresa J.H. Christianson, BS^¶ and Yoram Agmon, MD

^* Department of Neurology
Division of Cardiovascular Diseases and Internal Medicine
Division of Hypertension and Internal Medicine
Division of Epidemiology
^|| Mayo Stroke Center
^¶ Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received February 18, 2004; revised manuscript received May 3, 2004, accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Irene Meissner, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: imeissner{at}mayo.edu).

OBJECTIVES: The goal of this study was to investigate whether complex aortic atherosclerosis is associated with increased risk of vascular events in a non-selected population.

BACKGROUND: In selected high-risk patients, aortic atherosclerosis is associated with increased risk of vascular events.

METHODS: We describe the relationship between simple versus complex (>4-mm thick or mobile debris) aortic atherosclerotic plaques and vascular events during follow-up in a random sample of 585 persons (age 45 years) using 1993 to 2000 data from the Stroke Prevention: Assessment of Risk in a Community (SPARC), a prospective population-based longitudinal study.

RESULTS: At five-year median follow-up (range, 0.5 to 6.5 years), cardiac events (death, non-fatal myocardial infarction, coronary revascularization, heart failure associated with coronary artery disease) and cerebrovascular events (ischemic fatal and non-fatal strokes, transient ischemic attacks) had occurred in 95 subjects and 41 subjects, respectively. Age, male gender, prior coronary artery disease, higher pulse pressure, and diabetes were significant cardiovascular predictors. Age, prior myocardial infarction, and a history of atrial fibrillation were significant cerebrovascular predictors. Simple aortic plaques (253 persons) were not independently associated with either cardiac or cerebrovascular events. Complex plaques (44 persons) were marginally associated with cardiac events, adjusting for age and gender (hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.11 to 4.68; p = 0.053 for two degrees of freedom [complex and simple plaques vs. no plaques]) but not after adjusting for additional clinical risk factors (HR, 1.22; 95% CI, 0.57 to 2.62; p = 0.64). Complex plaques were associated with cerebrovascular events only univariately.

CONCLUSIONS: Aortic atherosclerotic plaques are not associated with future cardiac or cerebrovascular events. Aortic atherosclerosis may not be an independent risk factor for vascular events in the general population.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   CVD = cerebrovascular disease   HR = hazard ratio   SPAF = Stroke Prevention in Atrial Fibrillation   SPARC = Stroke Prevention: Assessment of Risk in a Community   TEE = transesophageal echocardiography   TIA = transient ischemic attack

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