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

Abstract

92 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 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 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.