Aortic atheroma morphology and the risk of ischemic stroke in a multiethnic population

Background Protruding atheromas in the aortic arch are an independent risk factor for ischemic stroke in the elderly. However, the role of atheroma morphologic characteristics (ulceration and mobility) has been less well characterized. Moreover, data have been obtained in predominantly white populations, and little is known about the association between atheromas and stroke in minorities. Methods and Results We performed transesophageal echocardiography in 152 elderly patients with stroke (58 white; 45 black, 49 Hispanic) and in 152 age- and race/ethnicity-matched control patients. Atheromas were classified as small (<4-mm in thickness), large noncomplex (greater than or equal to 4 mm, no ulceration:or mobility), and complex (ulcerated or mobile). Logistic regression analysis was performed to assess the risk of stroke associated with different definitions of atheroma in the overall:group and in the race-ethnic strata after adjusting for the presence of other stroke risk factors. Complex atheromas were strongly associated with stroke in the overall group (22.4% in cases, 2.6% in control patients, adjusted odds ratio [OR] 17.1, 95% confidence intervals [CI] 5.1 to 57.3), whereas large noncomplex atheromas conferred a mildly increased stroke risk (22.4% vs 16.5%; adjusted OR 2.4, 95% CI 1.1 to 5.1). Complex atheromas also were strongly associated with stroke in whites (adjusted OR 24.3, 95% CI 3.9 to 150.6) and Hispanics: (adjusted OR 13.9, 95% CI 1.4 to 136). In blacks,complex atheromas were significantly more frequent in cases (15.6% vs 0%; P = .006), but their absence in control patients precluded the calculation of the OR. Complex atheromas were twice as frequent in white patients with stroke (32.3%) than in black or Hispanic patients (15.6% and 16.3%,respectively; P = .05). Conclusions Aortic atheroma complexity rather than size is strongly associated with ischemic stroke in the elderly. Complex atheromas are significantly associated with stroke in all 3 race-ethnic subgroups.