Recent Highlights of
            <i>ATVB</i>

Virmani, Renu; Joner, Michael; Sakakura, Kenichi

doi:10.1161/atvbaha.114.304000

Cited by 52 publications

(38 citation statements)

References 59 publications

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“…Echolucent or hypoechogenic plaques mainly comprise high lipid content, inflammatory cells, and neovessels, whereas echogenic plaques comprise calcific tissue (26,27). An accelerated arterial calcification has been described in diabetes wherein metabolic and inflammatory factors contribute to intimal and medial calcifications (28)(29)(30). Several large population studies have demonstrated that the identification of vulnerable carotid plaque characteristics is a significant predictor of cardiovascular events (4,14,31).…”

Section: Discussionmentioning

confidence: 99%

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

et al. 2015

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OBJECTIVEThe presence of carotid plaques is associated with future cardiovascular events, with local plaque composition being an independent outcome predictor. We examined the association between ultrasonographically determined carotid plaque calcification and incident major adverse cardiovascular events (MACE) and death in type 2 diabetes (T2D). RESEARCH DESIGN AND METHODSWe enrolled 581 patients with T2D who underwent routine carotid ultrasonography. Plaques were classified as echolucent (lipid rich), heterogenous, and echogenic (calcific). We collected demographic, anthropometric, and clinical data at baseline and followed the patients for up to 9 years. RESULTSPlaques were detected in 81.8% of the patients (echolucent in 16.4%, heterogenous in 43.2%, and echogenic in 22.2%). During follow-up (4.3 6 0.1 years), 58 deaths (27 cardiovascular) and 236 fatal and nonfatal MACE occurred. In univariate analyses, presence versus absence of any carotid plaque was associated with incident MACE, and the hazard ratio (95% CI) progressively increased from echolucent (1.97 [0.93-3.44]), to heterogeneous (3.10 [2.09-4.23]), to echogenic (3.71 [2.09-5.59]) plaques. Compared with echolucent plaques, echogenic plaques were associated with incident MACE independently from confounders. This association was attenuated after adjusting for the degree of stenosis, but in patients with stenosis £30%, echogenic plaque type still predicted total and atherosclerotic MACE, even after further adjusting for mean intima-media thickness. CONCLUSIONSIn T2D, carotid plaque calcification predicts MACE, especially in patients with a low degree of stenosis. The biology of atherosclerotic calcification in diabetes needs to be further elucidated to understand the basis of this association.Atherosclerosis is a common complication of diabetes, driving severe morbidity and mortality. Atherosclerotic plaques are complex structures with multiple tissues and cell types that differentially contribute to lesion vulnerability (1). In populationbased longitudinal studies, atherosclerotic plaque characteristics have been shown to predict atherosclerosis progression at a systemic level, being associated with incident cardio-and cerebrovascular events (2-7). Based on ultrasonographic plaque characterization, echolucent (lipid-rich) plaques seem to be a better predictor of stroke and cardiovascular events than echogenic or echorich plaques containing

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Section: Discussionmentioning

confidence: 99%

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

et al. 2015

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“…These lipid-laden cells promote inflammatory responses in the arterial wall, and lead to multiple fatal pathological consequences such as hemorrhage, rupture, and calcification. 1-3 Mechanisms of atherosclerosis relating to disruption of lipoprotein metabolism as well as inflammation have been the major focuses of atherosclerosis research. 4,5 Animal models are still the major tools to determine mechanisms and discover potential targets for therapeutic purpose.…”

Section: Introductionmentioning

confidence: 99%

Atherosclerosis

Lü

Daugherty

2015

ATVB

135

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Summary Mechanistic studies over the past decades using in vitro systems, animal models, and human tissues have highlighted the complexity of pathophysiological processes of atherosclerosis. Hypercholesterolemia, as one of the major risk factors for the development and progression of atherosclerosis, is still the focus of many mechanistic studies and the major therapeutic target of atherosclerosis. Although there is a dire need to validate many experimental findings in humans, there is a large number of approaches that have been showing promise for contributing to future therapeutic strategies.

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“…Unlike native disease, necrotic core formation in neoatherosclerosis is thought to occur from macrophage apoptosis in the absence of a lipid pool, as the necrotic core is typically found within clusters of macrophage foam cells in the peristrut regions or near the luminal surface, as more common for DES. 1,6 Focal calcification(s) also occurs at sites of macrophage apoptosis 10,22 in neoatherosclerosis similar to native disease ( Figure 3). The temporal onset of neoatherosclerosis is even further accelerated for DES where the earliest atherosclerotic change of foamy macrophage infiltration is recognized at 4 months after sirolimus-eluting stent (SES) implantation, whereas the same change in BMS is typically seen beyond 2 years and rarely occurs until 4 years.…”

Section: In-stent Neoatherosclerosismentioning

confidence: 99%

Neoatherosclerosis From a Pathologist’s Point of View

Romero

Yahagi

Kolodgie

et al. 2015

ATVB

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Figure 2. Progression of neoatherosclerosis occurring within drug-eluting stent (DES).A and B, Low-and high-power images of early atherosclerotic change characterized by luminal foam cells (arrows) with underlying fibrointimal thickening. C and D, Low-and high-power images of foamy macrophage clusters (arrows) in the peristrut region adjacent to luminal surface. E and F, Low-and high-power images of fibroatheroma with necrotic core (NC) within neointima. G and H, Low-and high-power images of thin cap fibroatheroma (arrows) with NC. I and J, Low-and high-power images of plaque rupture resulting in continuity between the overlying thrombus (Th) and the NC. * represents stent strut. Images E, F, and I are reprinted from Yahagi et al 1 with permission of the publisher.by guest on

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Recent Highlights of ATVB

Cited by 52 publications

References 59 publications

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

Carotid Plaque Calcification Predicts Future Cardiovascular Events in Type 2 Diabetes

Atherosclerosis

Neoatherosclerosis From a Pathologist’s Point of View

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