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Hyperhomocysteinemia is a Risk Factor for Progression of Aortic Atheroma in Stroke/TIA Patients


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 Background
 and
 Purpose
 Aortic atheroma, an independent risk factor for stroke, is known to undergo temporal progression. The clinical correlates of such progression are not known. The objective of this study was to identify if the stroke risk factors and/or stroke sub-types correlated with progression of aortic atheroma in stroke/TIA patients.
 Methods
 We prospectively investigated 78 patients (38 Males, 58 Blacks, 12 Whites)with recent (≤7 days) stroke/TIA (57 stroke and 21 TIA patients). Sequential multiplanar transesophageal echocardiograms(TEEs) were performed ≤7 days and 9 months from the stroke/TIA. Aortic atheroma was graded according to the maximal thickness as <1 mm, 1–3.9 mm and ≥4 mm at each time point by cardiologists blinded to the patient information. The stroke risk factors, usage of anticoagulant/antiplatelet drugs and hypolipidemic drugs, clinical (OCSP), neuroradiological (large vs small vessel distribution stroke), and etiological (TOAST) subtypes of stroke were recorded and compared in patients with and without progression of aortic atheroma. Fisher’s exact test was used to compare categorical data and t-test was used to compare continuous data.
 Results
 Of the 78 patients investigated 29 (37%) progressed and 49 (63%, 32 unchanged + 17 regressed) did not. Most patients progressed at the aortic arch. Regression occurred mostly at the descending aorta. Most patients without aortic atheroma remained unchanged on the sequential TEE. Hyperhomocysteinemia (>14.0 mcm/l), TACI and large artery atherosclerosis significantly (p<0.05) correlated with progression of aortic atheroma. The stroke risk factors and medications did not appear to influence the progression of aortic atheroma in stroke TIA patients.
 Conclusions
 Patients with TACI and large artery atherosclerosis as presumed cause of stroke are at higher risk of progression of aortic atheroma. Patients with aortic atheroma need to be assessed for homocysteine levels to assess the risk of progression. Further studies need to be conducted to investigate if the vitamin therapy used to treat hyperhomocysteinemia may also prevent progression of aortic atheroma in stroke/TIA patients.
