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High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study.
Saturday,2023-06-17 19:48 America/Los_Angeles — ecterry
| Title | High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2023 |
| Authors | Noubiap, JJacques, Thomas, G, Kamtchum-Tatuene, J, Middeldorp, ME, Sanders, P |
| Journal | Eur J Neurol |
| Volume | 30 |
| Issue | 7 |
| Pagination | 2042-2050 |
| Date Published | 2023 Jul |
| ISSN | 1468-1331 |
| Keywords | Atrial Fibrillation, Carotid Artery Diseases, Carotid Stenosis, Female, Humans, Ischemic Stroke, Male, Plaque, Atherosclerotic, Prospective Studies, Risk Factors, Stroke |
| Abstract | <p><b>BACKGROUND AND PURPOSE: </b>Whether carotid artery disease could improve stroke risk stratification tools in patients with atrial fibrillation (AF) remains uncertain. This study was undertaken to investigate the risk of ischemic stroke associated with occlusive and nonocclusive carotid atherosclerotic disease in patients with AF in the prospective population-based Cardiovascular Health Study.</p><p><b>METHODS: </b>We included participants aged ≥65 years with AF. We used multivariable Cox regression analysis to explore the risk of ischemic stroke associated with the percentage of carotid stenosis, plaque irregularity, echogenicity, and vulnerability (markedly irregular, ulcerated, or hypoechoic plaques).</p><p><b>RESULTS: </b>A total of 1398 participants were included (55.2% female, 61.7% aged 65-74 years). The maximum carotid stenosis was <50%, 50%-99%, and 100% in 94.5%, 5%, and 0.5% of participants, respectively. High-risk plaques based on echogenicity and plaque irregularity were found in 25.6% and 8.9% of participants, respectively. After a median follow-up of 10.9 years (interquartile range = 7.5-15.6), 298 ischemic strokes were recorded. There was no difference in the incidence of ischemic stroke according to the degree of carotid artery stenosis (p = 0.44), plaque echogenicity (low vs. high risk, p = 0.68), plaque irregularity (low vs. high risk, p = 0.55), and plaque vulnerability (p = 0.86). The CHA₂DS₂-VASc score was associated with an increased risk of ischemic stroke (adjusted hazard ratio = 1.28, 95% confidence interval = 1.18-1.40, p < 0.001). Both maximum grade of stenosis and plaque vulnerability were not associated with incident ischemic stroke (all p > 0.05).</p><p><b>CONCLUSIONS: </b>Neither the degree of carotid stenosis nor the presence of vulnerable plaques was associated with incident ischemic stroke in this cohort of individuals with AF. This suggests that carotid disease was probably not a significant contributor to ischemic stroke in this population.</p> |
| DOI | 10.1111/ene.15817 |
| Alternate Journal | Eur J Neurol |
| PubMed ID | 37038345 |
| PubMed Central ID | PMC10247465 |
| Grant List | U01HL080295 / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States U01 HL130114 / HL / NHLBI NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01HC45133 / HL / NHLBI NIH HHS / United States N01HC85085 / HL / NHLBI NIH HHS / United States R01AG023629 / AG / NIA NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States U01HL130114 / HL / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201800001C / HL / NHLBI NIH HHS / United States 75N92021D00006 / HL / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States |
ePub date:
23/07