Coronary Artery Calcification, Intima-Media Thickness, and Ankle-Brachial Index Are Complementary Stroke Predictors

Gronewold, Janine; Bauer, Marcus; Lehmann, Nils; Mahabadi, Amir A.; Kälsch, Hagen; Weimar, Christian; Berger, Klaus; Moebus, Susanne; Jöckel, Karl‐Heinz; Erbel, Raimund

doi:10.1161/strokeaha.114.005626

Cited by 22 publications

(14 citation statements)

References 32 publications

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“…It has also been identified as a risk factor for coronary heart disease ( 2 ). Large vessel disease biomarkers such as atherosclerosis are linked to cerebrovascular disease ( 6 , 7 ) and have been extensively studied in migraine ( 8 – 10 ), but have not yet elucidated common mechanisms. Increasing evidence shows that microvascular pathology also contributes to stroke and coronary heart disease ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

The retinal microcirculation in migraine: The Rotterdam Study

et al. 2017

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BackgroundTo explore the role of microvascular pathology in migraine, we investigated the association between migraine and retinal microvascular damage.MethodsWe included 3270 participants (age ≥ 45 years, 63% women) from the population-based Rotterdam Study (2006–2009). Participants with migraine were identified using a validated questionnaire based on ICHD-II criteria (n = 562). Retinopathy signs were graded on fundus photographs. Retinal arteriolar and venular caliber were measured by semi-automatic assessment of fundus photographs. Associations of migraine with retinopathy and retinal microvascular calibers were examined using logistic and linear regression models, respectively, adjusting for age, sex, and cardiovascular risk factors.ResultsMigraine was not associated with the presence of retinopathy (odds ratio (OR): 1.09, 95% confidence interval (CI) 0.62; 1.92). In the fully adjusted model, adjusting for the companion vessel, persons with migraine did not differ in retinal arteriolar or venular caliber compared to persons without migraine (mean difference in standardized arteriolar caliber −0.05 (95%CI −0.13; 0.03); in standardized venular caliber −0.00 (95%CI −0.09; 0.08)). Migraine subtypes, including migraine with aura, were also not associated with retinal microvascular damage.ConclusionsOur findings suggest that migraine is not associated with retinopathy or difference in retinal microvascular caliber. Further studies are needed to confirm these results.

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Section: Introductionmentioning

confidence: 99%

The retinal microcirculation in migraine: The Rotterdam Study

et al. 2017

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“… 27 Another study conducted in the same population revealed that although coronary artery calcification scoring, CCA IMT and ankle‐brachial index provided complementary information, the ankle‐brachial index had the greatest predictive value on stroke risk. 28 In both studies, the overall predictive ability of the IMT was lower than that of the other 2 measures. 27 , 28 Similarly, the Multi‐Ethnic Study of Atherosclerosis showed that coronary artery calcification and carotid plaque improved predictions of coronary heart disease and stroke to a greater degree than did a large CCA IMT.…”

Section: Discussionmentioning

confidence: 73%

Diameter Reduction Determined Through Carotid Ultrasound Associated With Cardiovascular and All‐Cause Mortality: A Single‐Center Experience of 38 201 Consecutive Patients in Taiwan

Chen

Lin

Huang

et al. 2021

JAHA

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Background Few studies have evaluated the prognostic significance of diameter‐based carotid sonographic measurements for mortality. We investigated whether a reduction in diameter of different carotid anatomical segments is associated with cardiovascular and all‐cause mortality in a hospital‐based cohort with universal health care. Methods and Results We conducted a retrospective cohort study of 38 201 patients who underwent carotid duplex ultrasound at a medical center in Taiwan. Carotid sonographic parameters were the diameter reduction percentage in carotid bifurcation, the internal carotid artery, the common carotid artery, and the external carotid artery and the overall carotid atherosclerotic burden score, determined by summing the scores from all segments. The vital status was ascertained by linking data to National Death Registry until 2017. During a median follow‐up of 4.2 years, 5644 participants died, with 1719 deaths attributable to cardiovascular diseases. The multivariable‐adjusted hazard ratios (HRs; 95% CIs) for cardiovascular mortality were 1.33 (1.16‒1.53), 1.58 (1.361.84), and 1.89 (1.58, 2.26) for participants with 30% to <40%, 40% to <50%, and ≥50% reduction in carotid bifurcation diameter, respectively, compared with participants with <30% diameter reduction ( P for trend <0.001). The corresponding HRs (95% CIs) for all‐cause mortality were 1.25 (1.16‒1.34), 1.42 (1.31‒1.54), and 1.60 (1.45‒1.77), respectively. Diameter reduction at other carotid sites and the carotid atherosclerotic burden score exhibited the same dose–response relationship. Conclusions This study suggests that reduction in carotid artery diameter, which can be determined through routinely available sonography, is an independent risk factor for all‐cause and cardiovascular mortality.

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“…Combining CAC with other measures of subclinical atherosclerosis such as carotid IMT or plaque presence may be more promising for discriminating ischemic stroke/TIA. 3435, 36 Potentially, increased carotid artery IMT and the presence of carotid plaque are associated with intracranial atherosclerosis 37 , which is strongly associated with ischemic stroke/TIA. 38 However, carotid artery IMT has not been routinely recommended for atherosclerotic cardiovascular disease risk assessment due to a lack of sufficient evidence in the current guidelines.…”

Section: Discussionmentioning

confidence: 99%

Ischemic stroke/transient ischemic attack events and carotid artery disease in the absence of or with minimal coronary artery calcification: Results from the Multi-Ethnic Study of Atherosclerosis

et al. 2018

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Background and aims The association between minimally elevated coronary artery calcification (CAC) and cerebrovascular disease is not well known. We assessed whether individuals with minimal CAC (Agatston scores of 1–10) have higher ischemic stroke or transient ischemic attack (TIA) frequencies compared with those with no CAC. We also investigated the relative prevalence of carotid atherosclerosis in these two groups. Methods A total of 3924 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) without previous cardiovascular events, including stroke, and with baseline CAC scores of 0–10 were followed for the occurrence of incident ischemic stroke/TIA. We used carotid ultrasound to detect carotid artery plaques and to measure the intima-media thickness (IMT). Results During a median follow-up of 13.2 years, 130 participants developed incident ischemic stroke/TIA. There was no significant difference in the ischemic stroke/TIA incidence between those with minimal CAC and no CAC (3.7 versus 2.7 per 1000 person-years). In participants with minimal CAC, we observed a significant association of the condition with an internal carotid artery (ICA) that had a greater-than-average IMT (ICA-IMT; β = 0.071, p = 0.001) and a higher odds ratio (OR) for carotid artery plaques (OR 1.46; with a 95% confidence interval [CI] of 1.18–1.80; p < 0.001). Conclusions A CAC score of 0–10 is associated with a low rate of ischemic stroke/TIA, and thus a minimal CAC score is not a valuable predictive marker for ischemic stroke/TIA. A minimal CAC score may, however, provide an early and asymptomatic sign of carotid artery disease.

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Coronary Artery Calcification, Intima-Media Thickness, and Ankle-Brachial Index Are Complementary Stroke Predictors

Cited by 22 publications

References 32 publications

The retinal microcirculation in migraine: The Rotterdam Study

The retinal microcirculation in migraine: The Rotterdam Study

Diameter Reduction Determined Through Carotid Ultrasound Associated With Cardiovascular and All‐Cause Mortality: A Single‐Center Experience of 38 201 Consecutive Patients in Taiwan

Ischemic stroke/transient ischemic attack events and carotid artery disease in the absence of or with minimal coronary artery calcification: Results from the Multi-Ethnic Study of Atherosclerosis

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