Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population

M. R. Di Tullio, Ralph L Sacco, M. T. Savoia, R. R. Sciacca, S. Homma

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background: Protruding atheromas in the aortic arch are an independent risk factor for ischemic stroke in the elderly. However, the role of atheroma morphologic characteristics (ulceration and mobility) has been less well characterized. Moreover, data have been obtained in predominantly white populations, and little is known about the association between atheromas and stroke n minorities. Methods and Results: We performed transesophageal echocardiography in 152 elderly patients with stroke (58 white, 45 black, 49 Hispanic) and in 152 age-and race/ethnicity-matched control patients. Atheromas were classified as small (<4 mm in thickness), large noncomplex (≥4 mm, no ulceration or mobility), and complex (ulcerated or mobile). Logistic regression analysis was performed to assess the risk of stroke associated with different definitions of atheroma in the overall group and in the race-ethnic strata after adjusting for the presence of other stroke risk factors. Complex atheromas were strongly associated with stroke in the overall group (22.4% in cases, 2.6% in control patients; adjusted odds ratio [OR] 17.1, 95% confidence intervals [CI] 5.1 to 57.3), whereas large noncomplex atheromas conferred a mildly increased stroke risk (22.4% vs 16.5%; adjusted OR 2.4, 95% CI 1.1 to 5.1). Complex atheromas also were strongly associated with stroke in whites (adjusted OR 24.3, 95% CI 3.9 to 150.6) and Hispanics (adjusted OR 13.9, 95% CI 1.4 to 136). In blacks, complex atheromas were significantly more frequent in cases (15.6% vs 0%; P = .006), but their absence in control patients precluded the calculation of the OR. Complex atheromas were twice as frequent in white patients with stroke (32.3%) than in black or Hispanic patients (15.6% and 16.3%, respectively; P = .05). Conclusions: Aortic atheroma complexity rather than size is strongly associated with ischemic stroke in the elderly. Complex atheromas are significantly associated with stroke in all 3 race-ethnic subgroups.

Original languageEnglish
Pages (from-to)329-336
Number of pages8
JournalAmerican Heart Journal
Volume139
Issue number2 I
StatePublished - Feb 23 2000
Externally publishedYes

Fingerprint

Atherosclerotic Plaques
Stroke
Population
Odds Ratio
Hispanic Americans
Confidence Intervals
Transesophageal Echocardiography
Thoracic Aorta
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Di Tullio, M. R., Sacco, R. L., Savoia, M. T., Sciacca, R. R., & Homma, S. (2000). Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. American Heart Journal, 139(2 I), 329-336.

Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. / Di Tullio, M. R.; Sacco, Ralph L; Savoia, M. T.; Sciacca, R. R.; Homma, S.

In: American Heart Journal, Vol. 139, No. 2 I, 23.02.2000, p. 329-336.

Research output: Contribution to journalArticle

Di Tullio, MR, Sacco, RL, Savoia, MT, Sciacca, RR & Homma, S 2000, 'Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population', American Heart Journal, vol. 139, no. 2 I, pp. 329-336.
Di Tullio MR, Sacco RL, Savoia MT, Sciacca RR, Homma S. Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. American Heart Journal. 2000 Feb 23;139(2 I):329-336.
Di Tullio, M. R. ; Sacco, Ralph L ; Savoia, M. T. ; Sciacca, R. R. ; Homma, S. / Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population. In: American Heart Journal. 2000 ; Vol. 139, No. 2 I. pp. 329-336.
@article{58568ff19f5c435d88468f7c41db8838,
title = "Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population",
abstract = "Background: Protruding atheromas in the aortic arch are an independent risk factor for ischemic stroke in the elderly. However, the role of atheroma morphologic characteristics (ulceration and mobility) has been less well characterized. Moreover, data have been obtained in predominantly white populations, and little is known about the association between atheromas and stroke n minorities. Methods and Results: We performed transesophageal echocardiography in 152 elderly patients with stroke (58 white, 45 black, 49 Hispanic) and in 152 age-and race/ethnicity-matched control patients. Atheromas were classified as small (<4 mm in thickness), large noncomplex (≥4 mm, no ulceration or mobility), and complex (ulcerated or mobile). Logistic regression analysis was performed to assess the risk of stroke associated with different definitions of atheroma in the overall group and in the race-ethnic strata after adjusting for the presence of other stroke risk factors. Complex atheromas were strongly associated with stroke in the overall group (22.4{\%} in cases, 2.6{\%} in control patients; adjusted odds ratio [OR] 17.1, 95{\%} confidence intervals [CI] 5.1 to 57.3), whereas large noncomplex atheromas conferred a mildly increased stroke risk (22.4{\%} vs 16.5{\%}; adjusted OR 2.4, 95{\%} CI 1.1 to 5.1). Complex atheromas also were strongly associated with stroke in whites (adjusted OR 24.3, 95{\%} CI 3.9 to 150.6) and Hispanics (adjusted OR 13.9, 95{\%} CI 1.4 to 136). In blacks, complex atheromas were significantly more frequent in cases (15.6{\%} vs 0{\%}; P = .006), but their absence in control patients precluded the calculation of the OR. Complex atheromas were twice as frequent in white patients with stroke (32.3{\%}) than in black or Hispanic patients (15.6{\%} and 16.3{\%}, respectively; P = .05). Conclusions: Aortic atheroma complexity rather than size is strongly associated with ischemic stroke in the elderly. Complex atheromas are significantly associated with stroke in all 3 race-ethnic subgroups.",
author = "{Di Tullio}, {M. R.} and Sacco, {Ralph L} and Savoia, {M. T.} and Sciacca, {R. R.} and S. Homma",
year = "2000",
month = "2",
day = "23",
language = "English",
volume = "139",
pages = "329--336",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "2 I",

}

TY - JOUR

T1 - Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population

AU - Di Tullio, M. R.

AU - Sacco, Ralph L

AU - Savoia, M. T.

AU - Sciacca, R. R.

AU - Homma, S.

PY - 2000/2/23

Y1 - 2000/2/23

N2 - Background: Protruding atheromas in the aortic arch are an independent risk factor for ischemic stroke in the elderly. However, the role of atheroma morphologic characteristics (ulceration and mobility) has been less well characterized. Moreover, data have been obtained in predominantly white populations, and little is known about the association between atheromas and stroke n minorities. Methods and Results: We performed transesophageal echocardiography in 152 elderly patients with stroke (58 white, 45 black, 49 Hispanic) and in 152 age-and race/ethnicity-matched control patients. Atheromas were classified as small (<4 mm in thickness), large noncomplex (≥4 mm, no ulceration or mobility), and complex (ulcerated or mobile). Logistic regression analysis was performed to assess the risk of stroke associated with different definitions of atheroma in the overall group and in the race-ethnic strata after adjusting for the presence of other stroke risk factors. Complex atheromas were strongly associated with stroke in the overall group (22.4% in cases, 2.6% in control patients; adjusted odds ratio [OR] 17.1, 95% confidence intervals [CI] 5.1 to 57.3), whereas large noncomplex atheromas conferred a mildly increased stroke risk (22.4% vs 16.5%; adjusted OR 2.4, 95% CI 1.1 to 5.1). Complex atheromas also were strongly associated with stroke in whites (adjusted OR 24.3, 95% CI 3.9 to 150.6) and Hispanics (adjusted OR 13.9, 95% CI 1.4 to 136). In blacks, complex atheromas were significantly more frequent in cases (15.6% vs 0%; P = .006), but their absence in control patients precluded the calculation of the OR. Complex atheromas were twice as frequent in white patients with stroke (32.3%) than in black or Hispanic patients (15.6% and 16.3%, respectively; P = .05). Conclusions: Aortic atheroma complexity rather than size is strongly associated with ischemic stroke in the elderly. Complex atheromas are significantly associated with stroke in all 3 race-ethnic subgroups.

AB - Background: Protruding atheromas in the aortic arch are an independent risk factor for ischemic stroke in the elderly. However, the role of atheroma morphologic characteristics (ulceration and mobility) has been less well characterized. Moreover, data have been obtained in predominantly white populations, and little is known about the association between atheromas and stroke n minorities. Methods and Results: We performed transesophageal echocardiography in 152 elderly patients with stroke (58 white, 45 black, 49 Hispanic) and in 152 age-and race/ethnicity-matched control patients. Atheromas were classified as small (<4 mm in thickness), large noncomplex (≥4 mm, no ulceration or mobility), and complex (ulcerated or mobile). Logistic regression analysis was performed to assess the risk of stroke associated with different definitions of atheroma in the overall group and in the race-ethnic strata after adjusting for the presence of other stroke risk factors. Complex atheromas were strongly associated with stroke in the overall group (22.4% in cases, 2.6% in control patients; adjusted odds ratio [OR] 17.1, 95% confidence intervals [CI] 5.1 to 57.3), whereas large noncomplex atheromas conferred a mildly increased stroke risk (22.4% vs 16.5%; adjusted OR 2.4, 95% CI 1.1 to 5.1). Complex atheromas also were strongly associated with stroke in whites (adjusted OR 24.3, 95% CI 3.9 to 150.6) and Hispanics (adjusted OR 13.9, 95% CI 1.4 to 136). In blacks, complex atheromas were significantly more frequent in cases (15.6% vs 0%; P = .006), but their absence in control patients precluded the calculation of the OR. Complex atheromas were twice as frequent in white patients with stroke (32.3%) than in black or Hispanic patients (15.6% and 16.3%, respectively; P = .05). Conclusions: Aortic atheroma complexity rather than size is strongly associated with ischemic stroke in the elderly. Complex atheromas are significantly associated with stroke in all 3 race-ethnic subgroups.

UR - http://www.scopus.com/inward/record.url?scp=0033952653&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033952653&partnerID=8YFLogxK

M3 - Article

C2 - 10650307

AN - SCOPUS:0033952653

VL - 139

SP - 329

EP - 336

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 2 I

ER -