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Background: The coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis ≥50% in the carotid or vertebrobasilar territories (Groupathero) and a control group (Groupcontrol). Methods: In this cross-sectional study, Groupathero included two subgroups: GroupExtraorIntra, with stenoses in either cervical or intracranial arteries, and GroupExtra&Intra, with stenoses in at least one cervical and one intracranial artery. Groupcontrol had no history of prior stroke/transient ischemic attacks and no stenoses ≥50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC ≥100 and CAC > 0 were compared between Groupathero and Groupcontrol, as well as between GroupExtraorIntr, GroupExtra&Intra, and Groupcontrol, with bivariate logistic regressions. Multivariate analyses were also performed. Results: A total of 120 patients were included: 80 in Groupathero and 40 in Groupcontrol. CAC >0 was significantly more frequent in Groupathero (85%) than Groupcontrol (OR, 4.19; 1.74-10.07; p = 0.001). Rates of CAC ≥100 were not significantly different between Groupathero and Groupcontrol but were significantly greater in GroupExtra&Intra (n = 13) when compared to Groupcontrol (OR 4.67; 1.21-18.04; p = 0.025). In multivariate-adjusted analyses, "Groupathero" and "GroupExtra&Intra" were significantly associated with CAC. Conclusion: The frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.
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BACKGROUND: COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19. METHODS: Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity. RESULTS: Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers (P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis (P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant. CONCLUSIONS: Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.
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Aterosclerosis , COVID-19 , Aterosclerosis/epidemiología , Aterosclerosis/etiología , Grosor Intima-Media Carotídeo , Estudios de Cohortes , Humanos , SARS-CoV-2RESUMEN
AIM: Cervicocephalic atherosclerosis (AS) of patients with large-artery atherosclerotic (LAA) stroke might be more closely correlated to the functional outcome than patients with stroke of other etiologies. We aimed to investigate whether a whole-scope evaluation of cervicocephalic AS condition was better at predicting the 90-day functional outcome of LAA stroke than evaluation of intracranial or cervical AS condition alone. METHODS: Patients with LAA stroke were consecutively enrolled in this study. Computed tomography angiography was performed to evaluate AS condition of various cervicocephalic arterial segments. AS conditions ranging from no AS plaque to complete arterial occlusion scored 0-4 points. Intracranial atherosclerotic burden (IAB) and cervical atherosclerotic burden (CAB) were in respective the sums of AS scores of all intracranial arterial segments and all cervical arterial segments. And the sum of them was intracranial and cervical atherosclerotic burden (ICAB). Relationships of these three scores with the 90-day unfavorable functional outcome (modified Rankin Scale[mRS] score ï¼2 points) were compared. RESULTS: Of 172 patients who finished 90-day follow-up, only ICAB (adjusted odds ratio[OR]=1.10, 95% confidence interval[CI]:1.00-1.21, p=0.044) predicted 90-day unfavorable functional outcome independently of clinical factors, National Institutes of Health Stroke Scale (NIHSS) and mRS scores at admission. ICAB (adjusted hazard ratio[HR]=1.16, 95%CI:1.02-1.32, p=0.029) was related to 90-day recurrent ischemic stroke/death independently of clinical factors and was independently, positively correlated with NIHSS score at admission (r=0.16, p=0.047), whereas IAB and CAB were not. CONCLUSION: A whole-scope evaluation of cervicocephalic AS condition using ICAB outperformed evaluation of intracranial or cervical AS condition alone in predicting 90-day functional outcome of patients with LAA stroke.
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Aterosclerosis , Placa Aterosclerótica , Accidente Cerebrovascular , Arterias , Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico , Humanos , Oportunidad Relativa , Placa Aterosclerótica/complicaciones , Accidente Cerebrovascular/etiología , Resultado del TratamientoRESUMEN
AIM: Coronary artery stenosis (CAS) ≥ 50% frequently coexists in patients with acute ischemic cerebrovascular disease (AICVD), which portends unfavorable outcomes. We sought to examine whether patients with AICVD with CAS had more severe and more diffused cervicocephalic atherosclerosis (CA). METHODS: Patients with AICVD were consecutively enrolled and underwent simultaneous computed tomography angiography (CTA) of the coronary and cervicocephalic arteries. A total of 140 patients were divided into "AICVDï¼CAS" and "AICVD only" groups according to whether CTA showed stenosis of ≥ 50% in at least one coronary arterial segment. The relationship of the presence of CAS with the severity and extent of CA were examined. RESULTS: The CA severity characteristics, including the presence of stenosis ≥ 50% and the grade of the most severe stenotic segment, were not significantly different between the two groups. Regarding the extent of CA, the presence of stenosis ≥ 50% in both sides (adjusted odds ratio [OR]: 4.29, 95% confidence interval [CI]: 1.67-10.98), both extracranial and intracranial (adjusted OR: 5.26, 95% CI: 2.24-12.35), both anterior and posterior circulation (adjusted OR: 5.29, 95% CI: 2.22-12.64), and the number of stenotic segments ≥ 50% in cervicocephalic arteries (adjusted OR: 1.58, 95% CI: 1.28-1.96) were associated with CAS in patients with AICVD, independently of clinical demographics and CA severity characteristics. CONCLUSION: CA was similarly severe in patients with AICVD with and without CAS, but those with CAS had significantly more diffused CA. The extent of CA and CAS were mutual indicators in patients with AICVD, irrespective of CA severity.
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Aterosclerosis/etiología , Isquemia Encefálica/complicaciones , Trastornos Cerebrovasculares/complicaciones , Estenosis Coronaria/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aterosclerosis/patología , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Adulto JovenRESUMEN
The atherosclerotic origin of abdominal aorta (AA) aneurysms is controversial. Using the Atahualpa Project Cohort, we aimed to assess the relationship between the AA diameter and two surrogates of cervicocephalic atherosclerosis, including the carotid intima-media thickness (cIMT) and the presence of carotid siphon calcifications (CSC). Atahualpa residents aged ≥60 years undergoing ultrasound examinations of the abdominal aorta and the carotid arteries (to calculate the AA diameter and the cIMT), and head CT (to assess CSC severity) were included. Associations between AA diameter and cIMT and CSC severity were assessed by generalized linear models, after adjusting for relevant confounders. Of 256 participants, 64 (25%) had an increased cIMT and 85 (33%) had high calcium content in the carotid siphons. In univariate analysis, being male (p < 0.001) and having total cholesterol blood levels <240 mg/dL (p = 0.022) were associated with a higher AA diameter. Also in univariate analysis, the mean AA diameter was higher in individuals with an increased cIMT (p = 0.021), but such association disappeared in adjusted models. The AA diameter was not associated with high calcium content in the carotid siphons in either univariate or multivariate analyses. This population study shows no association between the AA diameter and cervicocephalic atherosclerosis in community-dwelling older adults, suggesting a non-atherosclerotic origin of AA aneurysms.