Association between abdominal aortic atherosclerosis and carotid artery atherosclerosis: A prospective cross-sectional study

Öz

Atherosclerosis is a prevalent systemic disease, responsible for the greatest number of deaths in developed countries. Clinical events and appropriate treatment depend on the sites involved. Both aortic and carotid atherosclerotic disease may result in grave clinical outcomes; however, the association between these two entities has not been clearly demonstrated yet. We developed a study to look at the association between Abdominal aortic Atherosclerotic Plaque (AAP) and Carotid artery Atherosclerotic Plaque (CAP). A prospective cross-sectional study was performed from March 2011 to April 2012. Consecutive patients who underwent total abdominal Computed Tomography (CT) for several reasons and Ultrasonography (US) of the carotid arteries were included. The independent association between the incidental finding of both AAP and CAP was sought using uni and multivariate analyses. One hundred and eighteen patients were evaluated. AAP was present in 53/118 (44.9%) patients and CAP in 69/118 (58.4%). After performing adjustment by multiple logistic regression with covariables such as sex, smoking, diet, abdominal circumference, Systemic Arterial Hypertension (SAH), diabetes and history of ischemic stroke, we observed that AAP and SAH were associated with CAP, with an OR of 10.75 (CI: 3.95-29.3 and p=0.0001) and 5.65 (CI: 2.06-12.5 and p=0.001), respectively. The presence of AAP at CT scan is strongly associated with CAP at US. In the future, such incidental finding at routine abdominal CT may probably recommend carotid US performance. SAH is also strongly associated with the presence of CAP.

Anahtar Kelimeler

• Abdominal aorta, carotid artery, atherosclerosis, computed tomography

Association between abdominal aortic atherosclerosis and carotid artery atherosclerosis: A prospective cross-sectional study

Öz

Ateroskleroz gelşmiş ülkelerde ölümlerin büyük çoğunluğundan sorumlu olan yaydın görülen sistemik bir hastalıktır. Klinik olaylar ve uygun tedavi tutulumun olduğu bölgeye göre değişir. Hem aortik hemde karotis aterosklerotik hastalığı ciddi sonuçlara yolaçabilir, bununla birlikte bu iki klinik antite arasındaki ilişki henüz net olarak gösterilmemiştir. Biz abdominal aortik aterosklerotik plak (AAP) ile karotis arter aterosklerotik plağı (CAP) arasındaki ilişkiyi gösterme amaçlı bir çalışma planladık. Mart 2011 den Nisan 2012 ye kadar süren prospektif kesitsel bir çalışma planladık. Çeşitli nedenlerle abdominal komputerize tomografi ve carotis arter ultrasonografisi yapılmış ardışık hastalar çalışmaya dahil edildi. AAP ve CAP arasındaki bağımsız ilişki univariate ve multivariate analizler ile araştırıldı.118 hasta değerlendirildi. AAP 53/118 (44.9%) hastada ve CAP 69/118 (58.4%) hastada mevcuttu. Cinsiyet, sigara içimi, diyet, abdomen çevresi, sistemik arteryel hipertansiyon (SAH), diyabet ve iskemik inme öyküsü gibi değişkenler için multiple logistic regresyon analizi ile düzeltme yapıldığında we AAP ve SAH CAP ile ilişkili bulundu (sırasıyla OR 10.75 (CI: 3.95-29.3 and p=0.0001) ve 5.65 (CI: 2.06-12.5 ve p=0.001). CT incelemesindeki AAP ile ultrasonda görülen CAP kuvvetli ilişki gösteriyordu. Gelecekte rutin abdominal CT de görülen böyle tesadüfi bulgular karotis arter ultasonu ile karotis plağına bakma açısından yönlendirici olabilir. SAH da CAP varlığı ile kuvvetli ilişki gösteriyordu

Anahtar Kelimeler

• Abdominal aorta, karotis arter, ateroskleroz, komputerize tomografi

Kaynakça

1. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/ AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010;56:e50-103
2. Iijima K, Hashimoto H, Hashimoto M, et al. Aortic arch calcification detectable on chest X-ray is a strong inde- pendent predictor of cardiovascular events beyond tradi- tional risk factors. Atherosclerosis 2010;210:137-44
3. Witteman JC, Kannel WB, Wolf PA, et al. Aortic calci- fied plaques and cardiovascular disease (the Framingham Study). Am J Cardiol 1990;66:1060-4
4. Iribarren C, Sidney S, Sternfeld B, et al. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 2000;283:2810-5
5. Nandalur KR, Baskurt E, Hagspiel KD, et al. Carotid artery calcification on CT may independently predict stroke risk. AJR Am J Roentgenol 2006;186:547-52
6. Kallikazaros IE, Tsioufis CP, Stefanadis CI, et al. Closed relation between carotid and ascending aortic atheroscle- rosis in cardiac patients. Circulation 2000;102:263-8
7. Reaven PD, Sacks J, Investigators for the VADT. Coronary artery and abdominal aortic calcification are associ- ated with cardiovascular disease in type 2 diabetes. Diabetologia 2005;48:379-85
8. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary ar- tery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease inci- dence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 2008;168:1333-9

9. Takasu J, Budoff MJ, Katz R, et al. Relationship between common carotid intima-media thickness and thoracic aor- tic calcification: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2010;209:142-6
10. Takasu J, Budoff MJ, O'Brien KD, et al. Relationship be- tween coronary artery and descending thoracic aortic calcification as detected by computed tomography: the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2009;204:440-6
11. Wofford JL, Kahl FR, Howard GR, et al. Relation of extent of extracranial carotid artery atherosclerosis as mea- sured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb 1991;11:1786-94
12. O'Donnell CJ, Chazaro I, Wilson PW, et al. Evidence for heritability of abdominal aortic calcific deposits in the Framingham Heart Study. Circulation 2002;106:337-41
13. Hollander M, Hak AE, Koudstaal PJ, et al. Comparison be- tween measures of atherosclerosis and risk of stroke: the Rotterdam Study. Stroke 2003;34:2367-72
14. Eisen A, Tenenbaum A, Koren-Morag N, et al. Calcification of the thoracic aorta as detected by spiral computed to- mography among stable angina pectoris patients: asso- ciation with cardiovascular events and death. Circulation 2008;118:1328-34
15. Gondrie MJ, Mali WP, Jacobs PC, et al. Cardiovascular dis- ease: prediction with ancillary aortic findings on chest CT scans in routine practice. Radiology 2010;257:549-59
16. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/ AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/ SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Vasc Med 2011;16:35-77
17. Tintut Y, Demer LL. Recent advances in multifactorial regulation of vascular calcification. Curr Opin Lipidol 2001;12:555-60
18. Stary HC, Chandler AB, Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a his- tological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 1995;92:1355-74
19. Kardys I, Vliegenthart R, Oudkerk M, et al. The female advantage in cardiovascular disease: do vascular beds contribute equally? Am J Epidemiol 2007;166:403-12
20. Allison MA, Criqui MH, Wright CM. Patterns and risk fac- tors for systemic calcified atherosclerosis. Arterioscler Thromb Vasc Biol 2004;24:331-6