TY - JOUR
T1 - Time-Dependent Changes in Atherosclerotic Plaque Composition in Patients Undergoing Carotid Surgery
AU - van Lammeren, G.W.
AU - den Ruijter, H.M.
AU - Vrijenhoek, J.E.P.
AU - Laan, W.
AU - Velema, E.
AU - de Vries, J.P.
AU - de Kleijn, D.P.V.
AU - Vink, A.
AU - de Borst, G.J.
AU - Moll, F.L.
AU - Bots, M.L.
AU - Pasterkamp, G.
PY - 2014/6/3
Y1 - 2014/6/3
N2 - Background-Time-dependent trends in the incidence of cardiovascular disease have been reported in high-income countries. Because atherosclerosis underlies the majority of cardiovascular diseases, we investigated temporal changes in the composition of atherosclerotic plaques removed from patients undergoing carotid endarterectomy.Methods and Results-The Athero-Express study is an ongoing, longitudinal, vascular biobank study that includes the collection of atherosclerotic plaques of patients undergoing primary carotid endarterectomy in the province of Utrecht from 2002 to 2011. Histopathologic features of plaques of 1583 patients were analyzed in intervals of 2 years. The analysis included quantification of collagen, calcifications, lipid cores, plaque thrombosis, macrophages, smooth muscle cells, and microvessels. Large atheroma, plaque thrombosis, macrophages, and calcifications were less frequently observed over time, with adjusted odds ratios of 0.72 (95% confidence interval, 0.650-0.789), 0.62 (95% confidence interval, 0.569-0.679), 0.87 (95% confidence interval, 0.800-0.940), and 0.75 (95% confidence interval, 0.692-0.816) per 2-year increase in time, respectively. These changes in plaque characteristics were consistently observed in patient subgroups presenting with stroke, transient ischemic attack, ocular symptoms, and asymptomatic patients. Concomitantly, risk factor management and secondary prevention strategies among vascular patients scheduled for carotid endarterectomy significantly improved over the past decade.Conclusions-In conclusion, over the past decade, atherosclerotic plaques harvested during carotid endarterectomy show a time-dependent change in plaque composition characterized by a decrease in features currently believed to be causal for plaque instability. This appears to go hand in hand with improvements in risk factor management.
AB - Background-Time-dependent trends in the incidence of cardiovascular disease have been reported in high-income countries. Because atherosclerosis underlies the majority of cardiovascular diseases, we investigated temporal changes in the composition of atherosclerotic plaques removed from patients undergoing carotid endarterectomy.Methods and Results-The Athero-Express study is an ongoing, longitudinal, vascular biobank study that includes the collection of atherosclerotic plaques of patients undergoing primary carotid endarterectomy in the province of Utrecht from 2002 to 2011. Histopathologic features of plaques of 1583 patients were analyzed in intervals of 2 years. The analysis included quantification of collagen, calcifications, lipid cores, plaque thrombosis, macrophages, smooth muscle cells, and microvessels. Large atheroma, plaque thrombosis, macrophages, and calcifications were less frequently observed over time, with adjusted odds ratios of 0.72 (95% confidence interval, 0.650-0.789), 0.62 (95% confidence interval, 0.569-0.679), 0.87 (95% confidence interval, 0.800-0.940), and 0.75 (95% confidence interval, 0.692-0.816) per 2-year increase in time, respectively. These changes in plaque characteristics were consistently observed in patient subgroups presenting with stroke, transient ischemic attack, ocular symptoms, and asymptomatic patients. Concomitantly, risk factor management and secondary prevention strategies among vascular patients scheduled for carotid endarterectomy significantly improved over the past decade.Conclusions-In conclusion, over the past decade, atherosclerotic plaques harvested during carotid endarterectomy show a time-dependent change in plaque composition characterized by a decrease in features currently believed to be causal for plaque instability. This appears to go hand in hand with improvements in risk factor management.
KW - endarterectomy, carotid
KW - histology
KW - plaque, atherosclerotic
KW - primary prevention
KW - RISK-FACTORS
KW - CARDIOVASCULAR-DISEASE
KW - RANDOMIZED-TRIAL
KW - STROKE INCIDENCE
KW - OXFORD PLAQUE
KW - CASE-FATALITY
KW - ENDARTERECTOMY
KW - MORTALITY
KW - TRENDS
KW - STENOSIS
U2 - 10.1161/CIRCULATIONAHA.113.007603
DO - 10.1161/CIRCULATIONAHA.113.007603
M3 - Article
C2 - 24637558
SN - 0009-7322
VL - 129
SP - 2269-+
JO - Circulation
JF - Circulation
IS - 22
ER -