Atherosclerosis

2015

DOI: 10.1016/j.atherosclerosis.2015.02.021

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Rosuvastatin may stabilize atherosclerotic aortic plaque: Transesophageal echocardiographic study in the EPISTEME trial

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Kazuo Yamashiro

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Yasutaka Tanaka

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et al.

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Aortic Arch Atheroma and Ascending Aortic Dissection1

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Cited by 23 publications

(16 citation statements)

References 44 publications

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“…The American and European guidelines both recommend intensive lipid lowering therapy using statins after TIA or ischemic stroke with atherosclerotic origin 31,32) . A previous study demonstrated that strict LDL-C control by rosuvastatin might stabilize atheromatous aortic plaques in acute ischemic stroke patients with large plaques ≥ 4 mm thick on TEE 33) . A recent trial, which evaluated the benefit of aggressive LDL-C control (LDL-C 70 mg/dL) via basal control with statins, reported a significant reduction of major cardiovascular events in patients with ischemic stroke and atherosclerotic disease including aortic arch plaques ≥ 4 mm in thickness 34) .…”

Section: Discussionmentioning

confidence: 97%

Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation

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et al. 2021

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Aortic arch atherosclerosis, particularly complex aortic arch plaques (CAPs), is an important source of cerebral emboli. CAPs and atrial fibrillation (AF) often co-exist; however, the prevalence and risk of CAPs in acute ischemic stroke patients with AF is unclear. Methods: In patients with acute ischemic stroke with non-valvular AF admitted to Jichi Medical University Hospital during April 2016 to September 2019, we retrospectively evaluated the presence of CAPs on transesophageal echocardiography (TEE). Results: CAPs were observed in 41 (38.7 %) of 106 patients with non-valvular AF. Older age, diabetes mellitus, chronic kidney disease, low high-density lipoprotein cholesterol (HDL-C) levels, higher levels of glycohemoglobin A1c (HbA1c), higher CHADS2 and CHA2DS2-VASc scores, and intracranial or carotid artery stenosis were more frequently observed in CAPs-positive than in CAPs-negative patients. In multivariable analyses, older age (odds ratio [OR]: 1.2 per year increase; 95% confidence interval [CI]: 1.07-1.24; P 0.0001), diabetes mellitus (OR: 4.7; 95%CI: 1.27-17.35; P 0.05), and low HDL-C (OR: 0.95 per 1 mg/dl increase; 95%CI: 0.92-0.99; P 0.01) were independent risk factors for CAPs. The prevalence of CAPs was age-dependent, and there was a significantly higher risk in patients aged either 75-84 years or 84 years than in those aged 65 (

“…The American and European guidelines both recommend intensive lipid lowering therapy using statins after TIA or ischemic stroke with atherosclerotic origin 31,32) . A previous study demonstrated that strict LDL-C control by rosuvastatin might stabilize atheromatous aortic plaques in acute ischemic stroke patients with large plaques ≥ 4 mm thick on TEE 33) . A recent trial, which evaluated the benefit of aggressive LDL-C control (LDL-C 70 mg/dL) via basal control with statins, reported a significant reduction of major cardiovascular events in patients with ischemic stroke and atherosclerotic disease including aortic arch plaques ≥ 4 mm in thickness 34) .…”

Section: Discussionmentioning

confidence: 97%

Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation

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,

²

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³

et al. 2021

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Aortic arch atherosclerosis, particularly complex aortic arch plaques (CAPs), is an important source of cerebral emboli. CAPs and atrial fibrillation (AF) often co-exist; however, the prevalence and risk of CAPs in acute ischemic stroke patients with AF is unclear. Methods: In patients with acute ischemic stroke with non-valvular AF admitted to Jichi Medical University Hospital during April 2016 to September 2019, we retrospectively evaluated the presence of CAPs on transesophageal echocardiography (TEE). Results: CAPs were observed in 41 (38.7 %) of 106 patients with non-valvular AF. Older age, diabetes mellitus, chronic kidney disease, low high-density lipoprotein cholesterol (HDL-C) levels, higher levels of glycohemoglobin A1c (HbA1c), higher CHADS2 and CHA2DS2-VASc scores, and intracranial or carotid artery stenosis were more frequently observed in CAPs-positive than in CAPs-negative patients. In multivariable analyses, older age (odds ratio [OR]: 1.2 per year increase; 95% confidence interval [CI]: 1.07-1.24; P 0.0001), diabetes mellitus (OR: 4.7; 95%CI: 1.27-17.35; P 0.05), and low HDL-C (OR: 0.95 per 1 mg/dl increase; 95%CI: 0.92-0.99; P 0.01) were independent risk factors for CAPs. The prevalence of CAPs was age-dependent, and there was a significantly higher risk in patients aged either 75-84 years or 84 years than in those aged 65 (

“…In this context, the risk factors for aortic atheroma are similar to those for coronary or cerebrovascular artery atherosclerotic disease, namely, older age and male gender, smoking, hypercholesterolemia, hypertension and diabetes 15 . Patients with aortic atherosclerotic disease also seem to benefit from statin use 16 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of patients with aortic atherosclerotic disease with paclitaxel-associated lipid nanoparticles

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et al. 2016

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OBJECTIVE:The toxicity of anti-cancer chemotherapeutic agents can be reduced by associating these compounds, such as the anti-proliferative agent paclitaxel, with a cholesterol-rich nanoemulsion (LDE) that mimics the lipid composition of low-density lipoprotein (LDL). When injected into circulation, the LDE concentrates the carried drugs in neoplastic tissues and atherosclerotic lesions. In rabbits, atherosclerotic lesion size was reduced by 65% following LDE-paclitaxel treatment. The current study aimed to test the effectiveness of LDE-paclitaxel on inpatients with aortic atherosclerosis.METHODS:This study tested a 175 mg/m2 body surface area dose of LDE-paclitaxel (intravenous administration, 3/3 weeks for 6 cycles) in patients with aortic atherosclerosis who were aged between 69 and 86 yrs. A control group of 9 untreated patients with aortic atherosclerosis (72-83 yrs) was also observed.RESULTS:The LDE-paclitaxel treatment elicited no important clinical or laboratory toxicities. Images were acquired via multiple detector computer tomography angiography (64-slice scanner) before treatment and at 1-2 months after treatment. The images showed that the mean plaque volume in the aortic artery wall was reduced in 4 of the 8 patients, while in 3 patients it remained unchanged and in one patient it increased. In the control group, images were acquired twice with an interval of 6-8 months. None of the patients in this group exhibited a reduction in plaque volume; in contrast, the plaque volume increased in three patients and remained stable in four patients. During the study period, one death unrelated to the treatment occurred in the LDE-paclitaxel group and one death occurred in the control group.CONCLUSION:Treatment with LDE-paclitaxel was tolerated by patients with cardiovascular disease and showed the potential to reduce atherosclerotic lesion size.

“…30 However, intensity of statin therapy was not determined, and no efficacy of statins for the prevention of recurrent vascular events was shown in the present study. Currently, ongoing clinical trials aim to compare the efficacy and safety of direct oral anticoagulant agents with aspirin.…”

Section: Strokementioning

confidence: 57%

Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source

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et al. 2016

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Background and Purpose-Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source. Methods-Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included. Recurrent vascular events, including ischemic stroke, cardiovascular and peripheral artery diseases, and vascular death, were retrospectively analyzed. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, embolic causes on transesophageal echocardiography, and the Calcification in the Aortic Arch, Age, Multiple Infarction score (CAM), based on the degree of aortic arch calcification on chest radiograph (0-3 points), age (≥70 years; 1 point), and multiple infarctions on magnetic resonance imaging (multiple infarcts in 1, 2, or ≥3 territories of large intracranial arteries, 1, 2, or 3 points) associated with recurrent vascular events. Results-A total of 177 patients (age, 64.1±14.2 years; 127 men) were enrolled. Thirty-one patients had recurrent vascular events (follow-up, 3.5±2.7 years; annualized rate, 5.0% per person-year). Among embolic causes on transesophageal echocardiography, incidence of recurrent vascular events was high in patients with large aortic arch plaques (7.5% per person-year). Diabetes mellitus (hazard ratio, 2.56; 95% confidence interval, 1.23-5.32; P=0.012) and CAM score grade (hazard ratio, 2.29; 95% confidence interval, 1.11-4.72; P=0.026) predicted recurrent vascular events. Conclusions-History of diabetes mellitus and the CAM score could be novel risk factors for recurrent vascular events in embolic stroke of undetermined source.

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