Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Lombardo, Antonella; Biasucci, Luigi M.; Lanza, Gaetano Antonio; Coli, Stefano; Silvestri, Pasquale; Cianflone, Domenico; Liuzzo, Giovanna; Burzotta, Francesco; Crea, Filippo; Maseri, Attilio

doi:10.1161/01.cir.0000130786.28008.56

Cited by 188 publications

(65 citation statements)

References 41 publications

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“…CRP level has also been shown to reflect the intensity of occult plaque inflammation [19]. In patients scheduled for coronary bypass surgery, CRP level is closely linked to the stability of carotid plaque lesion in that those with complex carotid plaques are independently associated with higher CRP [22]. Putting together our findings, this suggests an elevated CRP may more accurately reflect plaque inflammation rather than thickening of intima-media layer.…”

Section: Discussionsupporting

confidence: 56%

“…Of importance is the novel synergistic effect between CRP and serum calcium in relation to carotid plaque. Plaque formation represents a more advanced and established atherosclerotic lesion and involves a systemic inflammatory process regulated by T cell and macrophage activation [22]. However, the role of hypercalcemia in carotid plaque formation has so far not been studied in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

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Differential Associations of Traditional and Non-Traditional Risk Factors with Carotid Intima-Media Thickening and Plaque in Peritoneal Dialysis Patients

Wang

Liu

et al. 2007

Am J Nephrol

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Background: This study sought to examine the associations of traditional and non-traditional cardiovascular risk factors with carotid intima-media thickening and plaque in peritoneal dialysis (PD) patients. Methods: A cross-sectional study was performed in 147 PD patients with carotid intima-media thickness (IMT) and plaque assessed by B-mode ultrasonography and fasting blood collected for biochemical measurements. Results: On univariate analysis, age, smoking history, fibrinogen, C-reactive protein (CRP), adiponectin, fetuin-A, lipoprotein(a) and diastolic blood pressure were associated with carotid IMT while age, smoking history, diabetes, CRP and diastolic blood pressure were associated with carotid plaque. Using multivariate analysis, elevated CRP (p = 0.015) and serum calcium (p = 0.022) were associated with carotid plaque but not with IMT. CRP and serum calcium were synergistically associated with carotid plaque in that those with CRP > median and serum calcium > median showed the highest prevalence of carotid plaque than either factor alone (p = 0.003). Conclusions: An elevated CRP appeared to be a better biomarker of presence of carotid plaque than intima-media thickening. Furthermore, CRP and serum calcium showed synergistic association with presence of carotid plaque. However, our study was limited by the cross-sectional design and baseline laboratory abnormalities were inevitably confounded by the treatment already given, resulting in difficulty to distinguish cause and effect relationship. Nevertheless, these observations warrant further investigation as it may potentially have important implications on differentiating therapeutic strategies for reducing carotid IMT and plaque progression in PD patients.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Differential Associations of Traditional and Non-Traditional Risk Factors with Carotid Intima-Media Thickening and Plaque in Peritoneal Dialysis Patients

Wang

Liu

et al. 2007

Am J Nephrol

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“…The circulatory inflammatory cytokines [23] may incite a cascade of events in the cerebral circulation. As evidence of this, complex and presumably unstable carotid plaques are found to be common in patients with ACS (42% with unstable angina versus 8% with stable angina, p = 0.002) [24]. This may contribute to plaque rupture and subsequent thrombus formation in the cerebral circulation.…”

Section: Pathogenesis Of Stroke After An MImentioning

confidence: 99%

Incidence and Prevention of Ischemic Stroke following Myocardial Infarction: Review of Current Literature

Dutta¹,

Hanna²,

Das

et al. 2006

Cerebrovasc Dis

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Myocardial infarction is the leading cause of death today. With the fast progress in pharmacotherapy and revascularization technology, outcomes following a myocardial infarction have become very favorable. While most of the complications from a myocardial infarction can be adequately managed, thus leading to reduced mortality, stroke following a myocardial infarction remains a challenge even today, and can lead to potentially devastating complications. We discuss the incidence, pathophysiology, and management options of non-hemorrhagic stroke following a myocardial infarction.

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“…Patients triaged to CABG had higher rates of atrial fibrillation compared with those triaged to primary PCI or medical management (35.9% versus 6.3% versus 4.2%, respectively; P<0.0001). The index hospitalization was significantly prolonged in patients with a cerebrovascular event (6 [4-11] versus 5 [3][4][5][6][7] days; P=0.005).…”

Section: What the Study Addsmentioning

confidence: 99%

Cerebrovascular Events After a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment– Elevation Myocardial Infarction

Nikolsky

Mehran

Dangas

et al. 2015

Circ: Cardiovascular Interventions

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Stroke is among the leading causes of mortality and disability worldwide.1 Patients with ST-segment-elevation myocardial infarction (STEMI) are at increased risk of cerebrovascular events compared with the general population. 2 Common mechanisms of cerebrovascular events in patients with STEMI include cerebral embolism, plaque rupture with thrombosis in situ, and intracranial hemorrhage. Emboli of cardiac origin because of rhythm disturbances (mostly atrial fibrillation), mural thrombus, and severely impaired left ventricular ejection fraction (LVEF) are well-recognized sources of ischemic stroke. [3][4][5][6] Acute cerebrovascular and coronary thrombosis may coexist because of a systemic prothrombotic and inflammatory state accompanying plaque rupture. Finally, potent fibrinolytic, antithrombotic, and antiplatelet agents and their combination used for the treatment of STEMI raise the risk of hemorrhagic stroke.Before the reperfusion era, the risk of early (in-hospital or 30-day) cerebrovascular events in patients with STEMI ranged from 1.7% to 4.7%, depending on the population studied.2,8 Fibrinolysis improved survival and resulted in anBackground-Patients with ST-segment-elevation myocardial infarction are at increased risk of cerebrovascular events.We assessed the incidence, predictors, and implications of cerebrovascular events in patients with ST-segment-elevation myocardial infarction managed with a primary percutaneous coronary intervention strategy. Methods and Results-In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction(HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at least 1 cerebrovascular event (stroke: 63 patients; transient ischemic attack: 12 patients) during the 3-year follow-up (40.3% within 30 days, 20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients. More than half of all strokes (52.3%) were disabling. By principal management strategy, cerebrovascular events developed in 2.0%, 14.9%, and 1.9% of patients triaged to primary percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy, respectively (P<0.0001). Cerebrovascular events were independently predicted by older age, creatinine clearance <60 mL/min, treatment with coronary artery bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events were associated with significantly increased rates of 3-year mortality (20.5% versus 6.5%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001). Conclusions-In HORIZONS-AMI, cerebrovascular events within 3 years after ST-segment-elevation myocardial infarction in patients undergoing a primary percutaneous coronary intervention management strategy occurred in 2.0% of patients and were most frequent after coronary artery bypass grafting. Cerebrovascular events were often disabling...

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Inflammation as a Possible Link Between Coronary and Carotid Plaque Instability

Cited by 188 publications

References 41 publications

Differential Associations of Traditional and Non-Traditional Risk Factors with Carotid Intima-Media Thickening and Plaque in Peritoneal Dialysis Patients

Differential Associations of Traditional and Non-Traditional Risk Factors with Carotid Intima-Media Thickening and Plaque in Peritoneal Dialysis Patients

Incidence and Prevention of Ischemic Stroke following Myocardial Infarction: Review of Current Literature

Cerebrovascular Events After a Primary Percutaneous Coronary Intervention Strategy for Acute ST-Segment– Elevation Myocardial Infarction

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