The atherosclerotic plaque: risk factors and cardiovascular outcome after carotid endarterectomy

Atherosclerosis causes major invalidating and fatal events, and is a major contributing factor to the burden of cardiovascular disease, which is the number one cause of death globally. The initiation of atherosclerosis already starts in utero, but generally becomes clinically apparent during adulthood. The reason for clinical events to occur is closely associated with the underlying plaque composition. Especially for the coronary arteries, postmortem studies have revealed that atherosclerotic plaque rupture is frequently found in coronary plaques from patients who died from myocardial infarction. Also for carotid arteries symptoms including stroke and transient ischemic attack have been associated with vulnerable underlying plaque characteristics. Due to the systemic nature of atherosclerosis, and pathophysiological involvement of inflammatory responses it has been suggested that some individuals have a systemic predisposition to irregularity and rupture of atherosclerotic plaques, independent of traditional vascular risk factors. This resulted in initiation of biobanking studies, linking local atherosclerotic plaque features to patient characteristics. The Athero-Express Biobank study started in 2002 with the atherosclerotic plaque harvested during carotid endarterectomy as a starting point, followed by a three year follow up and registration of cardiovascular morbidity and mortality. This unique design facilitated cross sectional but also prospective cohort research, and served as the foundation for this thesis. The findings of the studies included in this thesis, will be discussed in this thesis.