title: Atherosclerotic disease of the proximal aorta and the risk of vascular events in a population-based cohort: the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study.
abstract: OBJECTIVE
  Proximal aortic plaques are a risk factor for vascular embolic events. However, this association in the general population is unclear. We sought to assess whether proximal aortic plaques are associated with vascular events in a community-based cohort.
  
  
  METHODS
  Stroke-free subjects from the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study were evaluated. Aortic arch and proximal descending aortic plaques were assessed by transesophageal echocardiography (TEE). Vascular events (myocardial infarction, ischemic stroke, vascular death) were prospectively recorded, and their association with aortic plaques was assessed.
  
  
  RESULTS
  209 subjects were studied (age 67.0+/-8.6 years). Aortic arch plaques were present in 130 subjects (62.2%), large plaques (>or=4 mm) in 50 (23.9%). Descending aortic plaques were present in 126 subjects (60.9%), large plaques in 41 (19.8%). During a follow-up of 74.4+/-26.3 months, 29 events occurred (12 myocardial infarctions, 11 ischemic strokes, 6 vascular deaths). After adjustment for risk factors, large aortic arch plaques were not associated with combined vascular events (hazard ratio [HR] 1.03, 95% confidence intervals [CI] 0.35 to 3.02) or ischemic stroke (HR 0.59, 95% CI 0.10 to 3.39). Large descending aortic plaques were also not independently associated with vascular events (HR 1.99, 95% CI 0.52 to 7.69) or ischemic stroke (HR 1.43, 95% CI 0.27 to 7.48).
  
  
  CONCLUSIONS
  In a population-based cohort, the incidental detection of plaques in the aortic arch or proximal descending aorta was not associated with future vascular events. Associated cofactors may affect the previously reported association between proximal aortic plaques and vascular events.
authors.affiliation: Departments of Medicine, Columbia University, New York, NY 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014652:Vascular Diseases / Q000453:epidemiology*