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(Stroke. 2002;33:930.)
© 2002 American Heart Association, Inc.

Original Contributions

Risk Factors for Progression of Aortic Atheroma in Stroke and Transient Ischemic Attack Patients

Souvik Sen, MD, MS; Stephen M. Oppenheimer, DM; Joao Lima, MD Barry Cohen, PhD

From the Cerebrovascular Program (S.S., S.M.O.), Department of Neurology and Cardiology, and the Division of Cardiology (S.M.O., J.L.), Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md; the Cerebrovascular Program (S.M.O.), NJ Neuroscience Institute at JFK Medical Center, Seton Hall University School of Medicine, Edison, NJ; and the Department of Psychology (B.C.), New York University, New York, NY.

Correspondence to Dr Stephen M. Oppenheimer, Professor of Neuroscience, Seton Hall University School of Medicine, Associate Professor of Neurology and Medicine, Johns Hopkins University School of Medicine, Pharmanet Inc, 504 Carnegie Center, Princeton, NJ 08540. E-mail soppenheimer@ pharmanet-cro.com

Background and Purpose— Aortic atheroma is an independent risk factor for stroke and undergoes temporal progression. Clinical and risk factor associations of such progression are unknown. Hyperhomocysteinemia has been linked with atherosclerosis, including that in the cerebral vasculature. This study investigated associations between elevated homocysteine levels and other stroke vascular risk factors and the risk of aortic atheroma progression in patients with cerebrovascular disease.

Methods— Fifty-seven stroke and 21 transient ischemic attack patients underwent multiplanar transesophageal echocardiograms within 1 month of symptom onset and again at 9 months. Aortic atheroma was graded and stratified by use of existing criteria. Stroke risk factors; use of anticoagulant, antiplatelet, and hypolipidemic drugs; and clinical and etiological subtypes of stroke were recorded and compared in patients stratified for the presence or absence of aortic atheroma progression.

Results— Of the 78, 29 (37%) progressed, 32 (41%) remained unchanged, and 17 (22%) regressed. Progression was most marked at the aortic arch (P=0.005), followed by the ascending segment (P<0.04). In nearly two thirds of the patients in whom aortic atheroma remained unchanged over 9 months, no atheroma was evident on baseline transesophageal echocardiogram. Only homocysteine levels 14.0 µ mol/L (P=0.02), total anterior cerebral infarct (P=0.02), and large-artery atherosclerosis (P=0.005) significantly correlated with progression.

Conclusions— Among vascular risk factors, elevated homocysteine levels are associated with aortic atheroma progression. Stroke and transient ischemic attack patients with aortic atheroma should undergo assessment of homocysteine levels, which, if elevated, may be treated with vitamins in an effort to arrest aortic atheroma progression.

Key Words: atherosclerosis • echocardiography, transesophageal • hyperhomocysteinemia • ischemic attack, transient • risk factors • stroke

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