Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population

doi:10.1016/S0002-9149(01)02225-1

The American Journal of Cardiology

Volume 89, Issue 3, 1 February 2002, Pages 262-267

https://doi.org/10.1016/S0002-9149(01)02225-1 Get rights and content

Abstract

The association between clinical coronary artery disease, cerebrovascular disease, and aortic atherosclerosis has not been examined in the general population. Transesophageal echocardiography was performed in 581 subjects, a random sample of the Olmsted County (Minnesota) population aged ≥45 years, participating in the Stroke Prevention: Assessment of Risk in a Community (SPARC) study. The frequency and severity of atherosclerosis of the thoracic aorta were determined in the population and the association between clinical coronary artery disease, cerebrovascular disease, and aortic atherosclerosis was examined. Previous myocardial infarction, angina pectoris, and coronary artery bypass surgery were significantly associated with aortic atherosclerosis, adjusting for age and gender (p ≤0.01). Among subjects with atherosclerosis, these manifestations were associated with complex atherosclerosis (plaques >4-mm thick, ulcerated plaques, or mobile debris), adjusting for age and gender (p <0.05). Age, smoking, pulse pressure, previous myocardial infarction (odds ratio [OR] 4.67; 95% confidence interval [CI] 1.42 to 15.40), and coronary artery bypass surgery (OR 5.12; 95% CI 1.01 to 26.01) were independently associated with aortic atherosclerosis. Among subjects with atherosclerosis, age, smoking, pulse pressure, hypertension treatment, and coronary artery disease (OR 2.50; 95% CI 1.18 to 5.30) were independently associated with complex atherosclerosis. Weak associations were observed between previous ischemic stroke, transient ischemic attack, and aortic atherosclerosis, associations that were not significant after age- and gender-adjustment (p >0.2). Thus, coronary artery disease is strongly associated with aortic atherosclerosis and complex atherosclerosis in the general population. Cerebrovascular disease is weakly associated with aortic atherosclerosis, thereby questioning the overall importance of aortic atherosclerosis in the pathogenesis of cerebrovascular events in the general population.

Section snippets

SPARC study:

The study design and initial results of the SPARC study were presented recently in detail.1, 2, 3, 4 In brief, the SPARC population consisted of 581 subjects, an age- and gender-stratified random sample of the Olmsted County (Minnesota) population aged ≥45 years. Study participants (47% of eligible sampled subjects2) were evaluated by multiple modalities including clinical evaluation (interviews and abstracting of medical records), multiple blood pressure measurements,2, 4 carotid

Results

The age and gender distribution of the SPARC population and the frequency of aortic atherosclerosis and complex atherosclerosis by age are shown in Figure 2. Atherosclerosis (of any degree) was identified in the ascending aorta, aortic arch, and descending aorta in 8.4%, 31.0%, and 44.9% of subjects, respectively. Complex atherosclerosis was identified in these segments in 0.2%, 2.2%, and 6.0%, respectively. Overall, aortic atherosclerosis (of any degree in any aortic segment) and complex

Discussion

Atherosclerotic vascular disease is a diffuse process, thus explaining the association between coronary artery and aortic atherosclerosis. Multiple studies have demonstrated an association between aortic atherosclerosis and angiographically defined CAD in highly selected patient groups undergoing TEE and coronary angiography for clinical indications.8, 9, 10, 11, 12, 13 Aortic atherosclerosis correlated with the angiographic extent of CAD and was predictive of obstructive CAD even after

References (28)

I Meissner et al.
Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonographythe SPARC Study
Mayo Clin Proc
(1999)
L.J Melton
History of the Rochester Epidemiology Project
Mayo Clin Proc
(1996)
G.P Fazio et al.
Transesophageal echocardiographically detected atherosclerotic aortic plaque is a marker for coronary artery disease
J Am Coll Cardiol
(1993)
P Nihoyannopoulos et al.
Detection of atherosclerotic lesions in the aorta by transesophageal echocardiography
Am J Cardiol
(1993)
F Parthenakis et al.
Absence of atherosclerotic lesions in the thoracic aorta indicates absence of significant coronary artery disease
Am J Cardiol
(1996)
Z Khoury et al.
Frequency and distribution of atherosclerotic plaques in the thoracic aorta as determined by transesophageal echocardiography in patients with coronary artery disease
Am J Cardiol
(1997)
Y Matsumura et al.
Atherosclerotic aortic plaque detected by transesophageal echocardiographyits significance and limitation as a marker for coronary artery disease in the elderly
Chest
(1997)
M Khatibzadeh et al.
Aortic atherosclerotic plaques as a source of systemic embolism
J Am Coll Cardiol
(1996)
P.A Tunick et al.
High risk for vascular events in patients with protruding aortic atheromaa prospective study
J Am Coll Cardiol
(1994)
C Tribouilloy et al.
Correlation of thoracic atherosclerotic plaque detected by multiplane transesophageal echocardiography and cardiovascular risk factors
Am J Med
(1998)

L.A Demopoulos et al.

Protruding atheromas of the aortic arch in symptomatic patients with carotid artery disease

Am Heart J

(1995)

Z Khoury et al.

Relation of coronary artery disease to atherosclerotic disease in the aorta, carotid, and femoral arteries evaluated by ultrasound

Am J Cardiol

(1997)

I Meissner et al.

Detection and control of high blood pressure in the communitydo we need a wake-up call?

Hypertension

(1999)

Y Agmon et al.

Frequency of atrial septal aneurysms in patients with cerebral ischemic events

Circulation

(1999)

Cited by (97)

Threats of per- and poly-fluoroalkyl pollutants to susceptible populations
2024, Science of the Total Environment
Environmental exposure to per- and poly-fluoroalkyl substances (PFAS) has raised significant global health concerns due to potential hazards in healthy adults. However, the impact of PFAS on susceptible populations, including pregnant individuals, newborns, the older people, and those with underlying health conditions, has been overlooked. These susceptible groups often have physiological changes that make them less resilient to the same exposures. Consequently, there is an urgent need for a comprehensive understanding of the health risks posed by PFAS exposure to these populations. In this review, we delve into the potential health risks of PFAS exposure in these susceptible populations. Equally important, we also examine and discuss the molecular mechanisms that underlie this susceptibility. These mechanisms include the induction of oxidative stress, disruption of the immune system, impairment of cellular metabolism, and alterations in gut microbiota, all of which contribute to the enhanced toxicity of PFAS in susceptible populations. Finally, we address the primary research challenges and unresolved issues that require further investigation. This discussion aims to foster research for a better understanding of how PFAS affect susceptible populations and to pave the way for strategies to minimize their adverse effects.
2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2023, Journal of Thoracic and Cardiovascular Surgery
The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).
A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.
Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2022, Journal of the American College of Cardiology
The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).
A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.
Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Comparison of vegan and non-vegan diets on memory and sleep quality
2022, Clinical Nutrition Open Science
It is widely acknowledged that the quality of nutrition affects many aspects of physical and mental performance. A vegan diet is associated with superior cardiovascular and cerebrovascular conditions. Mediterranean diets (high fruit and vegetable content) are linked with reduced risk of neurodegenerative diseases and improved performance on cognitive. The aim of the present study was to evaluate the effects of diet on memory and sleep quality.
Verbal memory and sleep quality were assessed in a cohort of 62 adults aged 40 and above. Using a modified Mediterranean Diet Adherence Screener, the participants were divided into the categories of vegan, vegetarian, pescatarian, omnivores with low meat/fish consumption, and omnivores with high meat/fish consumption. The California Verbal Learning Test was used to assess verbal learning memory, and the Pittsburg Sleep Quality Index was used to assess sleep quality.
The diet group with the best performance was pescatarian (M = 118.2), followed by vegetarian (M = 117.6) and vegan (M =116.0). The group with the lowest performance was omnivore high (M = 104.7). Females performed better than males in every diet group except vegetarian. Analysis of variance showed a main effect of diet on delayed recall, F(4, 57) = 2.823, P = .033, ηp 2 = .165. There was a significant difference among the diet groups on the delayed recall, where vegetarians had the highest scores (116.43) followed by pescatarians (116.20), vegans (115.21), omnivore lows (105.41) and lastly omnivore highs (99.43).
Diet was found to have a significant effect on memory but no significant effect on sleep quality. The sample size may have been insufficient to capture the effects of diet on sleep. To definitively establish the relationships between diet patterns and quality of cognitive functioning and sleep, further research is required. The results of this study cast doubt on the hypothesis that the consumption of animal products boosts memory performance.
Atherosclerotic Disease of the Proximal Aorta
2021, Stroke: Pathophysiology, Diagnosis, and Management
Large and/or complex atherosclerotic plaques in the proximal segment of the aorta have been identified as a cause of ischemic stroke in individuals older than age 60, initially in autopsy studies and then in vivo, using transesophageal echocardiography (TEE); TEE remains the most widely used diagnostic technique for their detection, although magnetic resonance imaging (MRI), computerized tomography (CT), and positron emission tomography (PET) are also used. The stroke risk depends on the morphologic characteristics of the plaque, which can be accurately assessed by TEE. Plaque thickness of 4 mm or greater is commonly used for risk stratification, although plaque complexity (i.e., presence of surface ulcerations and/or superimposed mobile components/thrombus) may be more directly related to the stroke mechanism. Unsuspected proximal aortic plaques increase the stroke risk during cardiac catheterization procedures and cardiac surgery due to the possibility of atheroembolism; screening for proximal aortic plaques is recommended in patients who have a high risk of significant aortic atherosclerotic disease, such as elderly patients and those with multiple atherosclerotic risk factors. Embolic protection during cardiac catheterization procedures and modification of the surgical approach may reduce the risk of embolic complications in these patients. The optimal preventive treatment to decrease embolic events in patients with proximal aortic plaques is controversial; statins and antiplatelet agents are currently recommended and are usually prescribed in patients with a recent stroke or transient ischemic attack; systemic anticoagulation appears indicated in the case of documented superimposed thrombus. Surgical aortic endarterectomy carries a great risk of embolization and should be reserved to highly selected cases. Advances in noninvasive imaging of plaques at higher risk of rupture and embolization (vulnerable plaque), along with newer potential medical treatment options, may further refine the approach to stroke prevention in patients with proximal aortic plaques.
The comparison of zinc, copper and iron levels in serum, aorta and left internal mammarian artery tissues in coronary by-pass graft surgery patients
2019, Journal of Trace Elements in Medicine and Biology
Trace elements are crucial for vital enzymatic reactions in all metabolic processes. Zinc (Zn) acts as a co-factor for many enzymes. Copper (Cu) and iron (Fe) have pro-atherogenic effects resulting in atherosclerosis. Aorta exposing high pulsatile pressure is sensitive for atherosclerosis because of its fast metabolism and poor nutrition by diffusion from vasa vasorum. We aimed to determine the relationship between serum Zn, Cu and Fe levels with aortic and left internal mammary artery (LIMA) tissues in 33 atherosclerotic individuals who inevitably underwent coronary artery by-pass graft (CBAG) surgery that is an end-point treatment for atherosclerosis. Trace elements in serum and tissues were measured using inductively coupled plasma-optical emission spectrophotometer. Pre-operative (Pre-op) serum Fe levels were statistically 46% higher than post-operative (Post-op) values (p = 0.009). Aortic Fe level was 49.8% higher than LIMA Fe (p = 0.0001). Our study points out the tendency of aortic tissue to atherosclerosis via pro- atherogenic effect of Fe. LIMA, being a potential graft for CBAG, is resistant to atherosclerosis with its intimal specialty of graft patency. In conclusion, serum Zn, Cu and Fe levels in atherosclerotic CBAG patients might be monitored to reveal minor alterations pre-operatively and post-operatively for ameliorating the treatment and life quality.

View all citing articles on Scopus

^☆: This study was supported by research Grant NS06663 from the National Institute of Neurologic Disorders, National Institutes of Health, Bethesda, Maryland.

^∗: Current Address: Rambam Medical Center, Haifa, Israel.

View full text

Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population☆

Abstract

Section snippets

SPARC study:

Results

Discussion

Mayo Clin Proc

Mayo Clin Proc

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Chest

J Am Coll Cardiol

J Am Coll Cardiol

Am J Med

Am Heart J

Am J Cardiol

Detection and control of high blood pressure in the communitydo we need a wake-up call?

Hypertension

Frequency of atrial septal aneurysms in patients with cerebral ischemic events

Circulation