Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease
Ana Luíza Vieira de Araújo1, Raul D Santos2,3, Marcio Sommer Bittencourt4
1Hospital das Clinicas, Neurology Clinical Division, University of São Paulo, São Paulo, Brazil.
Insights
Individuals with stroke due to large-artery atherosclerosis show higher coronary artery calcification (CAC) scores. This indicates a link between cerebrovascular and coronary artery disease, highlighting CAC as a potential risk marker.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Coronary calcium score (CAC) on chest CT is a cardiac event risk marker.
- Study compares CAC in stroke patients (Groupathero) versus controls (Groupcontrol).
- Groupathero includes subgroups with cervical/intracranial stenoses (GroupExtraorIntra) or both (GroupExtra&Intra).
Purpose of the Study:
- To compare coronary calcification levels between patients with stroke from large-artery atherosclerosis and a control group.
- To investigate the association between the extent of cerebrovascular stenosis and coronary artery calcification.
Main Methods:
- Cross-sectional study comparing CAC scores in multiethnic groups.
- Logistic regression analyses (bivariate and multivariate) were used for comparisons.
- Included 120 patients: 80 in Groupathero and 40 in Groupcontrol.
Main Results:
- CAC > 0 was significantly more frequent in Groupathero (85%) than Groupcontrol (OR, 4.19; p=0.001).
- CAC ≥ 100 was significantly greater in GroupExtra&Intra compared to Groupcontrol (OR 4.67; p=0.025).
- Multivariate analyses confirmed significant associations between Groupathero, GroupExtra&Intra, and CAC.
Conclusions:
- Coronary calcification is more frequent in stroke patients with large-artery atherosclerosis.
- Findings suggest shared pathophysiology between cerebrovascular and coronary atherosclerosis.
- CAC may serve as a risk marker in patients with atherosclerotic stroke.
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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