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(Stroke. 2009;40:2313.)
© 2009 American Heart Association, Inc.

Original Contributions

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

Cesare Russo, MD; Zhezhen Jin, PhD; Tatjana Rundek, MD, PhD; Shunichi Homma, MD; Ralph L. Sacco, MD, MS Marco R. Di Tullio, MD

From the Departments of Medicine (C.R., S.H., M.R.D.T.) and Biostatistics (Z.J.), Columbia University, New York; and the Departments of Neurology (T.R., R.L.S.) and Epidemiology and Human Genetics (R.L.S.), University of Miami, Fla.

Correspondence to Marco R. Di Tullio, MD, Division of Cardiology, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032. E-mail md42{at}columbia.edu

Background and Purpose— 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 (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.

Key Words: thoracic aorta • atherosclerosis • thromboembolism • prognosis • transesophageal echocardiography