Comparison Between Measures of Atherosclerosis and Risk of Stroke

Abstract

Background and Purpose-Several measures of atherosclerosis predict the risk of stroke. However, a comparison between various measures of atherosclerosis is lacking, and limited information exists on the added value of individual measures of atherosclerosis to cardiovascular risk factors. We compared different measures of atherosclerosis in relation to stroke. Methods-The study was based on the prospective cohort of the Rotterdam Study and included 6913 participants who did not suffer from previous stroke. At baseline, carotid intima-media thickness and plaques, ankle-arm index, and aortic calcifications were assessed; 3996 participants (53%) had measures of all studied markers of atherosclerosis. After a mean follow-up of 6.1 years, 378 strokes occurred. Data were analyzed with Cox proportional-hazards regression and Akaike information criteria scores. Results-Carotid intima-media thickness and aortic calcifications were related most strongly to the risk of stroke (relative risk, 2.23 and 1.89; 95% confidence interval, 1.48 to 3.36 and 1.28 to 2.80 for highest versus lowest tertile, respectively).The relations between intima-media thickness, aortic calcifications, and carotid plaques and stroke remained after adjustment for cardiovascular risk factors. Intima-media thickness and aortic calcifications were related to the risk of stroke independently of each other. The relation between ankle-arm index and stroke disappeared after adjustment for cardiovascular risk factors. Conclusions-Carotid intima-media thickness and aortic calcifications are stronger predictors of incident stroke than carotid plaque or ankle-arm indexes. They have additional value to each other and to classic risk factors and may reflect different processes.

The Prevalence and Quantification of Atherosclerosis in an Elderly Population Assessed by Whole-Body Magnetic Resonance Angiography

“…1 The prevalence of the renal artery stenosis in the present study was 3%, This is the first time to our knowledge that this prevalence has been reported in a free-living population sample. In a previous autopsy study, this figure ranged from 4.3% to 12%.…”

“…1 Magnetic resonance angiography (MRA) has advantages over conventional angiography in that it lacks ionizing radiation, there are no risks otherwise associated with arterial cannulation, and there is less nephrotoxicity than with iodinated contrast agents on the account of the smaller volumes of contrast agents administered in MRA. Recently the concept of imaging of the whole arterial system, except the coronary arteries, with one intravenous injection of gadolinium contrast and a moving table, ie, whole-body magnetic resonance angiography (WBMRA), 2 has been introduced.…”

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

“…(16)(17)(18)(19)(20)(21) Recently, we and others have reported that AAC can be measured on vertebral morphometric images obtained by dual-energy X-ray absorptiometry (DXA) and that the presence of AAC independently predicted incident MI, stroke, and cardiovascular events, even after adjusting for traditional cardiovascular risk factors. (22)(23)(24)(25) AAC also has been inversely associated with BMD in many studies.…”

The role of preclinical atherosclerosis in the explanation of educational differences in incidence of coronary events

“…Non-invasive imaging of the carotid arteries has been suggested to be a valid "window" or indicator site for general atherosclerosis in epidemiological studies (17,18Salonen 1993 (20), the relation between IMT and stroke was independent of plaque. Taken together, these data provide supportive evidence for the use of IMT measurements as a marker of generalized atherosclerosis.…”