title: Thoracic aortic calcification is associated with incident stroke in the general population in addition to established risk factors.
abstract: OBJECTIVE
  The aorta is a major source of cerebral thromboembolism, but its role in stroke pathogenesis is not well understood due to its poor accessibility for non-invasive imaging. We examined whether thoracic aortic calcification (TAC), a marker of aortic plaque load, is associated with stroke in addition to established risk factors.
  
  
  RESULTS
  A total of 3930 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.1% men) without previous stroke, coronary heart disease, or myocardial infarction were evaluated for incident stroke events over 109.0 ± 23.3 months. Cox proportional hazards regressions were used to examine associations with stroke of TAC in addition to established risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, and smoking) and coronary artery calcification (CAC). 101 incident strokes occurred during the follow-up period. Subjects suffering a stroke had significantly higher TAC values at baseline than the remaining subjects (median = 83.1 [Q1;Q3 = 4.7;472.9] vs. 15.7 [0.0;117.1]; P < 0.001). In a multivariable Cox proportional hazards regression, log(TAC + 1) (hazards ratio [HR] = 1.09 [95% confidence interval = 1.00-1.19]; P = 0.044) was associated with stroke in addition to established risk factors. Further analyses revealed that log(DTAC + 1), i.e. calcification of the descending aorta (1.11 [1.02-1.20]; P = 0.016), but not log(ATAC + 1), i.e. calcification of the ascending aorta (1.02 [0.93-1.11]; P = 0.713), was associated with stroke. The HR for log(TAC + 1) decreased to 1.06 (0.97-1.16; P = 0.202), when log(CAC + 1) was also inserted into multivariable analyses.
  
  
  CONCLUSIONS
  Calcification of the thoracic aorta, more specifically its descending segment, is associated with incident stroke in addition to established risk factors. CAC outperforms aortic calcification as a stroke predictor.
authors.affiliation: Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany dirk.hermann@uk-essen.de.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Hermann
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Gronewold
authors.affiliation: Department of Cardiology, University Hospital Essen, Essen, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, University Hospital Essen, Essen, Germany.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Department of Cardiology, University Hospital Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Department of Cardiology, University Hospital Essen, Essen, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Kälsch
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging*
keywords: Aortic plaque; Risk stratification; Stroke prediction; Subclinical atherosclerosis