Published online before print June 7, 2004, doi: 10.1161/01.CIR.0000130786.28008.56
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;109:3158-3163.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability
From the Cardiology Institute, Catholic University, Rome (A.L., L.M.B., G.A.L., S.C., P.S., G.L., F.B., F.C.), and Department of Cardiothoracic and Vascular Diseases, University Vita-Salute, San Raffaele Scientific Institute, Milan (D.C., A.M.), Italy.
Correspondence to Antonella Lombardo, MD, Cardiology Institute, Catholic University, L. go A. Gemelli, 8-00168 Rome, Italy. E-mail a.lombardo{at}rm.unicatt.it
Received September 12, 2003; de novo received January 13, 2004; revision received March 4, 2004; accepted March 27, 2004.
Background— Multiple complex stenoses, plaque fissures, and widespread coronary inflammation are common in acute coronary syndromes. A systemic cause of atherosclerotic plaque instability is also suggested by studies of ischemic cerebrovascular disease. We investigated the association between coronary and carotid plaque instability and the potential common causal role of inflammation.
Methods and Results— The ultrasound characteristics of carotid plaques were evaluated retrospectively in patients scheduled for coronary bypass surgery, 181 with unstable and 92 with stable angina, and prospectively in a similar group of patients, 67 with unstable and 25 with stable angina, in whom serum C-reactive protein levels were also measured. The prevalence of carotid plaques was similar in the retrospective and prospective studies and >64% in both unstable and stable coronary patients. The prevalence of complex, presumably unstable carotid plaques was 23.2% in unstable versus 3.2% in stable patients (P<0.001) in the retrospective study and 41.8% versus 8.0% (P=0.002) in the prospective study. C-reactive protein levels were higher in patients with complex (7.55 mg/L) than in those with simple (3.94 mg/L; P<0.05) plaques or without plaques (2.45 mg/L; P<0.05). On multivariate analysis, unstable angina and C-reactive protein levels >3 mg/L were independently associated with complex carotid plaques (OR, 6.09; 95% CI, 1.01 to 33.72; P=0.039, and OR, 5.80; 95% CI, 1.55 to 21.69; P=0.009, respectively).
Conclusions— In unstable angina, plaque instability may not be confined to coronary arteries, and inflammation may be the common link with carotid plaque instability. These observations may have relevant implications for understanding the mechanisms of acute widespread atherothrombotic plaque inflammation.
Key Words: angina • carotid arteries • inflammation • plaque
This article has been cited by other articles:
 |
|
 |
|
  J. Herrmann, D. Mannheim, C. Wohlert, D. Versari, F. B. Meyer, J. P. McConnell, M. Gossl, L. O. Lerman, and A. Lerman Expression of lipoprotein-associated phospholipase A2 in carotid artery plaques predicts long-term cardiac outcome Eur. Heart J., December 1, 2009; 30(23): 2930 - 2938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Montalescot, H. Drexler, R. Gallo, T. Pearson, M. Thoenes, and D. L. Bhatt Effect of irbesartan and enalapril in non-ST elevation acute coronary syndrome: results of the randomized, double-blind ARCHIPELAGO study Eur. Heart J., November 2, 2009; 30(22): 2733 - 2741. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V P van Halm, M J L Peters, A E Voskuyl, M Boers, W F Lems, M Visser, C D A Stehouwer, A M W Spijkerman, J M Dekker, G Nijpels, et al. Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation Ann Rheum Dis, September 1, 2009; 68(9): 1395 - 1400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Burioni, F. Canducci, D. Saita, M. Perotti, N. Mancini, D. De Marco, N. Clementi, A. Chieffo, M. Denaro, D. Cianflone, et al. Antigen-Driven Evolution of B Lymphocytes in Coronary Atherosclerotic Plaques J. Immunol., August 15, 2009; 183(4): 2537 - 2544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Lund Haheim, P. Nafstad, I. Olsen, P. Schwarze, and K. S. Ronningen C-reactive protein variations for different chronic somatic disorders Scand J Public Health, August 1, 2009; 37(6): 640 - 646. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Brevetti, G. Sirico, G. Giugliano, S. Lanero, J. I. De Maio, R. Luciano, E. Laurenzano, and M. Chiariello Prevalence of hypoechoic carotid plaques in coronary artery disease: relationship with coexistent peripheral arterial disease and leukocyte number Vascular Medicine, February 1, 2009; 14(1): 13 - 19. [Abstract] [PDF]
|
|
|
|
 |
|
 A Abbate, R Bussani, G Liuzzo, G G L Biondi-Zoccai, E Barresi, P Mellone, G Sinagra, A Dobrina, F De Giorgio, R Sharma, et al. Sudden coronary death, fatal acute myocardial infarction and widespread coronary and myocardial inflammation Heart, June 1, 2008; 94(6): 737 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Foglieni, F. Maisano, L. Dreas, A. Giazzon, G. Ruotolo, E. Ferrero, L. Li Volsi, S. Coli, G. Sinagra, B. Zingone, et al. Mild inflammatory activation of mammary arteries in patients with acute coronary syndromes Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2831 - H2837. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kinlay, G. G. Schwartz, A. G. Olsson, N. Rifai, M. Szarek, D. D. Waters, P. Libby, P. Ganz, and for the Myocardial Ischemia Reduction with Aggress Inflammation, Statin Therapy, and Risk of Stroke After an Acute Coronary Syndrome in the MIRACL Study Arterioscler Thromb Vasc Biol, January 1, 2008; 28(1): 142 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sabeti, O. Schlager, M. Exner, W. Mlekusch, J. Amighi, P. Dick, G. Maurer, K. Huber, R. Koppensteiner, O. Wagner, et al. Progression of Carotid Stenosis Detected by Duplex Ultrasonography Predicts Adverse Outcomes in Cardiovascular High-Risk Patients Stroke, November 1, 2007; 38(11): 2887 - 2894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Johnsen, E. B. Mathiesen, O. Joakimsen, E. Stensland, T. Wilsgaard, M.-L. Lochen, I. Njolstad, and E. Arnesen Carotid Atherosclerosis Is a Stronger Predictor of Myocardial Infarction in Women Than in Men: A 6-Year Follow-Up Study of 6226 Persons: The Tromso Study Stroke, November 1, 2007; 38(11): 2873 - 2880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Mahmud, J. J. Cavendish, and A. Salami Current Treatment of Peripheral Arterial Disease: Role of Percutaneous Interventional Therapies J. Am. Coll. Cardiol., August 7, 2007; 50(6): 473 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Cao, A. M. Arnold, T. A. Manolio, J. F. Polak, B. M. Psaty, C. H. Hirsch, L. H. Kuller, and M. Cushman Association of Carotid Artery Intima-Media Thickness, Plaques, and C-Reactive Protein With Future Cardiovascular Disease and All-Cause Mortality: The Cardiovascular Health Study Circulation, July 3, 2007; 116(1): 32 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Prabhakaran, T. Rundek, R. Ramas, M. S.V. Elkind, M. C. Paik, B. Boden-Albala, and R. L. Sacco Carotid Plaque Surface Irregularity Predicts Ischemic Stroke: The Northern Manhattan Study Stroke, November 1, 2006; 37(11): 2696 - 2701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Van De Graaff, M. Dutta, P. Das, E. A. Shry, P. D. Frederick, M. Blaney, D. J. Pasta, and S. R. Steinhubl Early Coronary Revascularization Diminishes the Risk of Ischemic Stroke With Acute Myocardial Infarction Stroke, October 1, 2006; 37(10): 2546 - 2551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. I. Suarez Acute Myocardial Infarction, Ischemic Stroke, Sympathetic Stress, and Inflammation: Birds of a Feather Stroke, October 1, 2006; 37(10): 2449 - 2450. [Full Text] [PDF]
|
|
|
|
|
|
G. Stoll and M. Bendszus Inflammation and Atherosclerosis: Novel Insights Into Plaque Formation and Destabilization Stroke, July 1, 2006; 37(7): 1923 - 1932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Paffen and M. P.M. deMaat C-reactive protein in atherosclerosis: A causal factor? Cardiovasc Res, July 1, 2006; 71(1): 30 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Momiyama, R. Kato, Z. A. Fayad, N. Tanaka, H. Taniguchi, R. Ohmori, T. Kihara, A. Kameyama, K. Miyazaki, K. Kimura, et al. A Possible Association Between Coronary Plaque Instability and Complex Plaques in Abdominal Aorta Arterioscler Thromb Vasc Biol, April 1, 2006; 26(4): 903 - 909. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Toutouzas, M. Drakopoulou, J. Mitropoulos, E. Tsiamis, S. Vaina, M. Vavuranakis, V. Markou, E. Bosinakou, and C. Stefanadis Elevated Plaque Temperature in Non-Culprit De Novo Atheromatous Lesions of Patients With Acute Coronary Syndromes J. Am. Coll. Cardiol., January 17, 2006; 47(2): 301 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Watanabe, S. Sugiyama, K. Kugiyama, O. Honda, H. Fukushima, H. Koga, Y. Horibata, T. Hirai, T. Sakamoto, M. Yoshimura, et al. Stabilization of Carotid Atheroma Assessed by Quantitative Ultrasound Analysis in Nonhypercholesterolemic Patients With Coronary Artery Disease J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2022 - 2030. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Witt, R. D. Brown Jr., S. J. Jacobsen, S. A. Weston, B. P. Yawn, and V. L. Roger A Community-Based Study of Stroke Incidence after Myocardial Infarction Ann Intern Med, December 6, 2005; 143(11): 785 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Crea and F. Andreotti Pregnancy associated plasma protein-A and coronary atherosclerosis: marker, friend, or foe? Eur. Heart J., October 2, 2005; 26(20): 2075 - 2076. [Full Text] [PDF]
|
|
|
|
 |
|
 G Liuzzo, G Giubilato, and M Pinnelli T cells and cytokines in atherogenesis Lupus, September 1, 2005; 14(9): 732 - 735. [Abstract] [PDF]
|
|
|
|
 |
|
 A. R. Chade, A. Lerman, and L. O. Lerman Kidney in Early Atherosclerosis Hypertension, June 1, 2005; 45(6): 1042 - 1049. [Abstract] [Full Text] [PDF]
|
|