Closed relation between carotid and ascending aortic atherosclerosis in cardiac patients

Background-Carotid atherosclerosis and aortic atherosclerosis are both asso ciated with coronary artery disease and cerebral thromboembolism. However, the relationship between asymptomatic carotid and aortic atherosclerosis is not well known. Methods and Results-Sixty-two consecutive cardiac patients (mean age 57 yea rs) without a history of atherosclerotic cardiovascular disease who were re ferred for transesophageal echocardiography were included. By means of a hi gh-resolution ultrasound technique, normal carotid arteries were found in 1 2 patients (19.4%), whereas 15 patients (24.2%) had increased intima-media thickness, and the remaining 35 patients (56.5%) had atherosclerotic plaque s (intima-media thickness greater than or equal to1.3 mm). Transesophageal echocardiography characterized ascending aortic intimal morphology as norma l in 1 patient (1.6%), as thickening in 22 patients (35.5%), and as atheros clerotic plaques in 39 patients (62.9%). Patients with both carotid and aor tic plaques were older compared with patients without plaques; also, a high er percentage of patients with carotid and aortic plaques suffered from hyp ertension and diabetes mellitus compared with patients without plaques (P<0 .001). The incidence of carotid plaques was 74.3% (29 of 39 patients) in th e subgroup with aortic plaques; there was a stepwise increase in the percen tage of patients with carotid plaques among the patients with increasing gr ades of aortic atherosclerosis. Furthermore, the incidence of ascending aor tic plaques was 82.8% (29 of 35 patients) in the subgroup with carotid plaq ues. Regression analysis revealed that age and carotid plaques were indepen dently related to the presence of aortic plaques. In the entire study popul ation, the presence of carotid plaques had a high positive predictive value (83%), an acceptable sensitivity (75%) and specificity (74%), and a relati vely low negative predictive value (63%) for the presence of aortic plaques . Conclusions-In cardiac patients without clinical evidence of atheroscleroti c cardiovascular disease, a high prevalence of combined aortic and carotid plaques were detected. The presence of carotid plaque reflects the presence of aortic plaque, whereas the absence of carotid plaque may not reflect th e absence of aortic plaque.