Guus W van Lammeren1, Hester M den Ruijter1, Joyce E P Vrijenhoek1, Sander W van der Laan1, Evelyn Velema1, Jean-Paul P M de Vries1, Dominique P V de Kleijn1, Aryan Vink1, Gert Jan de Borst1, Frans L Moll1, Michiel L Bots1, Gerard Pasterkamp2. 1. From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.). 2. From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.). G.Pasterkamp@umcutrecht.nl.
Abstract
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.
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.
Authors: Albeir Y Mousa; Ali F AbuRahma; Joseph Bozzay; Mike Broce; Maher Kali; Michael Yacoub; Patrick Stone; Mark C Bates Journal: J Endovasc Ther Date: 2015-04-15 Impact factor: 3.487
Authors: Grégory Franck; Thomas Mawson; Grasiele Sausen; Manuel Salinas; Gustavo Santos Masson; Andrew Cole; Marina Beltrami-Moreira; Yiannis Chatzizisis; Thibault Quillard; Yevgenia Tesmenitsky; Eugenia Shvartz; Galina K Sukhova; Filip K Swirski; Matthias Nahrendorf; Elena Aikawa; Kevin J Croce; Peter Libby Journal: Circ Res Date: 2017-04-20 Impact factor: 17.367
Authors: G Bergström; G Berglund; A Blomberg; J Brandberg; G Engström; J Engvall; M Eriksson; U de Faire; A Flinck; M G Hansson; B Hedblad; O Hjelmgren; C Janson; T Jernberg; Å Johnsson; L Johansson; L Lind; C-G Löfdahl; O Melander; C J Östgren; A Persson; M Persson; A Sandström; C Schmidt; S Söderberg; J Sundström; K Toren; A Waldenström; H Wedel; J Vikgren; B Fagerberg; A Rosengren Journal: J Intern Med Date: 2015-06-19 Impact factor: 8.989