Abstract
To investigate the effect of dietary factors such as calorie intake and dietary fats on the progression of aortic arch atheroma (AA). In stroke/TIA patients, progression of AA is associated with recurrent vascular events. Consecutive patients with measurable (>1 mm) AA atheroma on baseline transesophageal echocardiogram (TEE) evaluation consented to a protocol mandated follow-up TEE at 12 months. Patients that had adequate paired AA images were assessed for progression, defined as Δ ≥ 1 grade worsening (based on plaque thickness over 12 months). Stroke risk factors and fasting lipid profile were assessed at baseline. The patient's nutritional intake was measured at baseline using the Gladys Block Food Frequency Questionnaire. One-hundred-nine patients (70 strokes, 33 TIAs) had sequential TEEs, of whom 27% (N=30) progressed and 73% (N=79) did not. Patients with progression had higher daily calorie (1778 ± 623 vs. 1378 ± 406 Calories, p=0.008), fat (76 ± 33 vs. 52 ± 23 grams, p=0.0002), carbohydrate (208 ± 78 vs. 169 ± 57 grams, p=0.01) and protein (73 ± 26 vs. 57 ± 21 grams, p=0.005) intake. On Further analysis among different fats showed a higher consumption of saturated fats (25 ± 12 vs. 17 ±8 grams, p=0.00051) as well as unsaturated fats (44 ± 20 vs. 30 ± 13 grams, p=0.002). These differences remained significant after we adjusted for the medication use. However the significance of these differences was attenuated after adjusting for the calorie intake. Cholesterol consumption did not differ between the progression and no-progression group (262 ± 125 vs. 213 ± 149 mg, p=0.2). Calorie intake plays a significant role in the progression of AA. Further studies are needed to confirm these findings and determine the specific dietary modifications that may prevent AA progression and associated recurrent vascular events.
Highlights
Aortic arch atheroma (AA) has been known for its association with stroke [1,2,3,4] and is believed to be the potential source of embolic phenomenon leading to subsequent strokes [5,6,7,8,9]
On further analysis among fats, we found an average consumption of oleic acid at 23 ± 12 grams/day and linolenic acid at 12 ± 6 grams/day. (Tables 1A and 1B) depicts the baseline risk factors and dietary characteristics among the stroke and transient ischemic attack (TIA) patients
Our results suggest that increased calorie intake is significantly associated with the progression of AA in stroke and TIA patients
Summary
Aortic arch atheroma (AA) has been known for its association with stroke [1,2,3,4] and is believed to be the potential source of embolic phenomenon leading to subsequent strokes [5,6,7,8,9]. It is reported that the progression of AA is associated with recurrent vascular events [10]. Progression of AA, may predict recurrent vascular events in stroke/TIA patients [13]. Prevention of atheroma progression may be important in the prevention of recurrent vascular event in the stroke/TIA population. In stroke/TIA patients, progression of AA is associated with recurrent vascular events
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