Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease

Background

The coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis ≥50% in the carotid or vertebrobasilar territories (Group_athero) and a control group (Group_control).

Methods

In this cross-sectional study, Group_athero included two subgroups: Group_ExtraorIntra, with stenoses in either cervical or intracranial arteries, and Group_Extra&Intra, with stenoses in at least one cervical and one intracranial artery. Group_control had no history of prior stroke/transient ischemic attacks and no stenoses ≥50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC ≥100 and CAC > 0 were compared between Group_athero and Group_control, as well as between Group_ExtraorIntr, Group_Extra&Intra, and Group_control, with bivariate logistic regressions. Multivariate analyses were also performed.

Results

A total of 120 patients were included: 80 in Group_athero and 40 in Group_control. CAC >0 was significantly more frequent in Group_athero (85%) than Group_control (OR, 4.19; 1.74-10.07; p = 0.001). Rates of CAC ≥100 were not significantly different between Group_athero and Group_control but were significantly greater in Group_Extra&Intra (n = 13) when compared to Group_control (OR 4.67; 1.21-18.04; p = 0.025). In multivariate-adjusted analyses, "Group_athero" and "Group_Extra&Intra" were significantly associated with CAC.

Conclusion

The frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.

Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study

BACKGROUND

COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19.

METHODS

Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity.

RESULTS

Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers (P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis (P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant.

CONCLUSIONS

Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.