Department of Neurology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany
Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany.
Eur Heart J Cardiovasc Imaging. 2015 Jun;16(6):684-90. doi: 10.1093/ehjci/jeu293. Epub 2014 Dec 30.
The aorta is a major source of cerebral thromboembolism, but its role in stroke pathogenesis is not well understood due to its poor accessibility for non-invasive imaging. We examined whether thoracic aortic calcification (TAC), a marker of aortic plaque load, is associated with stroke in addition to established risk factors.
A total of 3930 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.1% men) without previous stroke, coronary heart disease, or myocardial infarction were evaluated for incident stroke events over 109.0 ± 23.3 months. Cox proportional hazards regressions were used to examine associations with stroke of TAC in addition to established risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, and smoking) and coronary artery calcification (CAC). 101 incident strokes occurred during the follow-up period. Subjects suffering a stroke had significantly higher TAC values at baseline than the remaining subjects (median = 83.1 [Q1;Q3 = 4.7;472.9] vs. 15.7 [0.0;117.1]; P < 0.001). In a multivariable Cox proportional hazards regression, log(TAC + 1) (hazards ratio [HR] = 1.09 [95% confidence interval = 1.00-1.19]; P = 0.044) was associated with stroke in addition to established risk factors. Further analyses revealed that log(DTAC + 1), i.e. calcification of the descending aorta (1.11 [1.02-1.20]; P = 0.016), but not log(ATAC + 1), i.e. calcification of the ascending aorta (1.02 [0.93-1.11]; P = 0.713), was associated with stroke. The HR for log(TAC + 1) decreased to 1.06 (0.97-1.16; P = 0.202), when log(CAC + 1) was also inserted into multivariable analyses.
Calcification of the thoracic aorta, more specifically its descending segment, is associated with incident stroke in addition to established risk factors. CAC outperforms aortic calcification as a stroke predictor.
主动脉是脑栓子的主要来源，但由于其难以进行非侵入性成像，其在中风发病机制中的作用仍不清楚。我们研究了除了已确立的危险因素之外，胸主动脉钙化（TAC），即主动脉斑块负荷的标志物，是否与中风有关。
在这项基于人群的 Heinz Nixdorf 召回研究（45-75 岁；47.1%为男性）中，共有 3930 名无先前中风、冠心病或心肌梗死的受试者，评估了 109.0±23.3 个月内的中风事件发生率。使用 Cox 比例风险回归来检查 TAC 与已确立的危险因素（年龄、性别、收缩压、LDL、HDL、糖尿病和吸烟）以及冠状动脉钙化（CAC）之间与中风的关联。在随访期间发生了 101 例中风事件。与其余受试者相比，患有中风的受试者在基线时的 TAC 值明显更高（中位数=83.1[Q1；Q3=4.7；472.9]vs.15.7[0.0；117.1]；P<0.001）。在多变量 Cox 比例风险回归中，log（TAC+1）（风险比[HR]=1.09[95%置信区间=1.00-1.19]；P=0.044）与除已确立的危险因素外，还与中风有关。进一步的分析表明，log（DTAC+1），即降主动脉的钙化（1.11[1.02-1.20]；P=0.016），而不是 log（ATAC+1），即升主动脉的钙化（1.02[0.93-1.11]；P=0.713）与中风有关。当将 log（CAC+1）也插入多变量分析时，log（TAC+1）的 HR 降至 1.06（0.97-1.16；P=0.202）。
除了已确立的危险因素外，胸主动脉的钙化，特别是其降段，与中风事件的发生有关。CAC 作为中风预测因子优于主动脉钙化。
