Atherosclerotic disease of the aorta
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Atherosclerotic Disease of the Aorta: Insights and Implications
Introduction to Atherosclerotic Disease of the Aorta
Atherosclerosis is a chronic inflammatory condition characterized by the thickening of the arterial wall due to plaque buildup. This disease can affect various parts of the aorta, including the ascending aorta, aortic arch, and abdominal aorta, leading to significant health risks such as neurologic events, ischemic stroke, and coronary artery disease.
Ascending Aorta Atherosclerosis: Predictors and Outcomes
Long-term Neurologic Events and Mortality
Atherosclerosis of the ascending aorta is a significant predictor of long-term neurologic events and mortality. A study involving 1,957 patients undergoing cardiac surgery found that the severity of atherosclerosis in the ascending aorta was independently associated with an increased risk of neurologic events and all-cause mortality. The risk increased more than threefold as the severity of atherosclerosis progressed from mild to severe.
Coronary Artery Disease Marker
Transesophageal echocardiography has shown that the presence of atherosclerotic plaques in the thoracic aorta is a strong marker for obstructive coronary artery disease. In a study of 61 patients, the presence of aortic plaque had a sensitivity and specificity of 90% for detecting obstructive coronary artery disease, making it a reliable indicator for further cardiovascular assessment .
Aortic Arch Atherosclerosis: Stroke Risk
Ischemic Stroke Association
Atherosclerotic disease of the aortic arch is strongly associated with an increased risk of ischemic stroke. Research involving 250 stroke patients and 250 controls revealed that plaques ≥4 mm in thickness were significantly more common in stroke patients. The odds ratio for ischemic stroke in patients with such plaques was 9.1, indicating a strong independent association.
Abdominal Aorta Atherosclerosis: Heart Failure Implications
Prognostic Implications in Heart Failure
Atherosclerosis of the abdominal aorta and its branches is prevalent in patients with heart failure and is associated with increased morbidity. A study of 355 heart failure patients found that those with significant aortic atherosclerosis had longer hospital stays, more frequent admissions, and worse overall prognosis. However, the disease was not independently related to outcomes when other factors were considered.
Metabolic and Epigenetic Insights
Metabolic Alterations in Atherosclerotic Plaques
Metabolic profiling of atherosclerotic plaques in the aorta has revealed significant alterations in oxidative stress and inflammation pathways. Dysregulation in purine and glutathione pathways, along with increased levels of inflammatory markers like glucosylceramide and tryptophan, were observed in plaque-containing aortic tissues. These findings provide insights into the metabolic underpinnings of atherosclerosis and potential therapeutic targets.
DNA Methylation Changes
Atherosclerosis is also associated with significant changes in DNA methylation, particularly in vascular smooth muscle cells. Disease-linked hypermethylated regions often overlap with aorta-associated enhancer chromatin, affecting genes related to smooth muscle function and contributing to the phenotypic changes seen in atherosclerosis. This epigenetic modulation plays a crucial role in the progression of the disease.
Conclusion
Atherosclerotic disease of the aorta is a multifaceted condition with significant implications for neurologic events, coronary artery disease, ischemic stroke, and heart failure. Understanding the predictors, metabolic alterations, and epigenetic changes associated with aortic atherosclerosis can aid in the development of targeted therapies and improve patient outcomes. Further research is essential to explore these mechanisms and their clinical applications.
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