Time Dependent Changes in Atherosclerotic Plaque Composition in Patients Undergoing Carotid Surgery
Background—Time dependent trends in the incidence of cardiovascular disease have been reported in high-income countries. As 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, the Netherlands from 2002 to 2011. Histopathological features of plaques of 1583 patients were analysed 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 [0.650-0.789], 0.62 [0.569-0.679], 0.87 [0.800-0.940] and 0.75 (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 seems to go hand in hand with improvements in risk factor management.
- plaque haemorrhage
- secular trend
- vascular disease
- carotid artery
- Received November 18, 2013.
- Revision received March 4, 2014.
- Accepted March 10, 2014.