From the Guidelines
Aortic atherosclerosis is indeed strongly linked to coronary artery disease (CAD), as evidenced by the association found in the SPARC study, where aortic atherosclerosis was associated with CAD (OR, 2.99; 95% CI, 1.47–6.10; P=0.003) 1. This link is not surprising, given that both conditions share the same underlying pathological process of atherosclerosis, which involves the buildup of plaque in the arterial walls.
- Key factors contributing to this association include:
- Shared risk factors such as hypertension, dyslipidemia, diabetes, smoking, and age, which affect the entire arterial system
- Systemic nature of atherosclerosis, suggesting that its presence in one part of the body, like the aorta, may indicate its presence in other parts, such as the coronary arteries
- The severity of aortic plaque correlating with the extent of coronary disease, as observed in clinical studies 1 When aortic atherosclerosis is detected, it is reasonable to consider it a marker for possible coronary disease, prompting further cardiac evaluation, especially in patients with cardiovascular risk factors or symptoms suggestive of CAD.
- The presence of aortic atherosclerosis should prompt clinicians to:
- Assess the patient's overall cardiovascular risk
- Consider the use of preventive measures such as aspirin, as recommended for patients with coronary artery disease to reduce the risk of cardiovascular events, including stroke, death caused by coronary artery disease, and myocardial infarction 1
- Evaluate the need for further diagnostic testing to assess for CAD, given the strong association between the two conditions.
From the Research
Aorta Atherosclerosis and CAD
- Aorta atherosclerosis is linked to coronary artery disease (CAD) as evidenced by studies that show a significant relationship between the two conditions 2, 3, 4.
- The presence and severity of aortic atherosclerosis are independently related to significant CAD, suggesting that aortic atherosclerosis may be a marker for CAD 2, 3.
- Studies have used various methods to detect aortic atherosclerosis, including transesophageal echocardiography (TEE) and computed tomography coronary angiography (CTA), and have found significant correlations between aortic atherosclerosis and CAD 2, 3.
Mechanisms and Risk Factors
- Atherosclerosis is a generalized process that may involve the entire vasculature, including the coronary arteries, and is associated with an increased risk for recurrent ischemic stroke and cardiovascular death 2.
- The risk factors for aortic atherosclerosis and CAD are similar, including age, systolic blood pressure, and hyperlipidemia 4.
- Statins have been shown to reduce the progression of atherosclerosis in patients with normal or average lipid levels, suggesting that they may be beneficial in preventing the progression of aortic atherosclerosis and CAD 5.
Diagnosis and Detection
- TEE and CTA are useful tools for detecting aortic atherosclerosis and assessing its relationship to CAD 2, 3.
- The grading system used to detect aortic atherosclerosis by TEE includes grades I-V, with grades III-V considered as aortic atherosclerosis 2.
- The presence and severity of aortic atherosclerosis can be assessed using various parameters, including maximal wall thickness and percentage of affected segments 3.