Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study.
OBJECTIVE
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 > or =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.
Meissner
Irene
I
Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. imeissner@mayo.edu
Khandheria
Bijoy K
BK
Sheps
Sheldon G
SG
Schwartz
Gary L
GL
Wiebers
David O
DO
Whisnant
Jack P
JP
Covalt
Jody L
JL
Petterson
Tanya M
TM
Christianson
Teresa J H
TJ
Agmon
Yoram
Y
D000368:Aged; D001018:Aortic Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001161:Arteriosclerosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors