Predictors of increased risk of carotid plaque rupture and thrombosis

To determine the correlation between major cardiovascular risk factors and carotid plaque morphology, the incidence of thrombotic, vulnerable and stable plaques along with the degree of plaque inflammatory infiltration was evaluated in 457 carotid atherosclerotic lesions removed during carotid endarterectomy, from symptomatic and asymptomatic patients. Out of 457 carotid plaques, histopathology analysis showed that 181 (40%) were thrombotic plaques, 72 (16%) vulnerable plaques, and 204 (45%) stable plaques. Multivariate analysis revealed that hypertension, low HDL cholesterol (HDL-C), and a ratio of total to HDL-C >5.0 were strongly associated with vulnerable and thrombotic carotid plaques. Furthermore, hypertension, hypercholesterolaemia, and low HDL-C also significantly correlated with the presence of high inflammatory plaque infiltration. After restricting multivariate analysis to asymptomatic patients, hypertension, low HDL-C, and a ratio of total to HDL-C >5.0 were the risk factors that were most significantly associated with unstable plaques. For asymptomatic patients with a high Framingham cardiovascular risk score compared to those with a low risk score, the relative risk to carry an unstable plaque was 2.06. According to these results, asymptomatic patients with a high risk factor profile may constitute a specific target to benefit from interventions to reduce the likelihood of cerebrovascular events.

Abstract

Keywords:
Atherosclerosis – Cardiovascular risk – Dyslipidaemia – HDL cholesterol – Hypertension – Inflammation – Stroke – Thrombosis