Stabilization of symptomatic carotid atherosclerotic plaques by statins: a clinico-pathological analysis

Abstract

Human and animal studies have revealed a stabilization of atherosclerotic plaques by statins. However, the stabilization of human carotid plaques has not been thoroughly described pathologically. This analysis explored the relationship between statin therapy and plaque stability in carotid endarterectomy (CEA) specimens. We analyzed specimens harvested between May 2015 and February 2017, from 79 consecutive patients presenting with > 70% carotid artery stenoses, of whom 66 were untreated (group 1) and 13 treated (group 2) with a statin. Immunohistochemistry was performed, using an endothelial specific antibody to CD31, CD34 and platelet derived growth factor receptor-β. The prevalence of plaque ruptures (P = 0.009), lumen thrombi (P = 0.009), inflammatory cells (P = 0.008), intraplaque hemorrhages (P = 0.030) and intraplaque microvessels (P < 0.001) was significantly lower in group 2 than in group 1. Among 66 patients presenting with strokes and infarct sizes > 1.0 cm3 on magnetic resonance imaging, the mean infarct volume was significantly smaller (P = 0.031) in group 2 (4.2 ± 2.5 cm3) than in group 1 (8.2 ± 7.1 cm3). The difference in mean concentration of low-density lipoprotein cholesterol between group 1 (121 ± 32 mg/dl) and group 2 (105 ± 37 mg/dl) was non-significant (P = 0.118). This analysis of plaques harvested from patients undergoing CEA suggests that statin therapy mitigates the plaque instability, which, in patients presenting with strokes, might decrease infarct volume.Electronic supplementary materialThe online version of this article (10.1007/s00380-018-1193-6) contains supplementary material, which is available to authorized users.

Effect of Statins on Platelet Activation and Function: From Molecular Pathways to Clinical Effects

“…In a study by Konishi et al on patients with carotid atherosclerosis, treatment with statins resulted in reduced thrombotic complications such as plaque rupture and embolic/thrombotic events, intraplaque hemorrhage, or aneurysmal degeneration. They also performed a histological analysis of vessel samples from patients treated with statins and found a decreased activation and migration of inflammatory cells and platelets, as well as a reduction of intraplaque angiogenetic phenomena [ 54 ].…”

Statin/ezetimibe combination therapy vs statin monotherapy for carotid atherosclerotic plaque inflammation

“…[ 8 , 9 ] Inflammation is the key reaction leading to plaque instability, and statins are believed to induce plaque stabilization by exerting anti-inflammatory effects. [ 10 – 12 ] The beneficial effects of LDL-C lowering therapy might not depend on the methods by which LDL-C is reduced. [ 13 ] Therefore, to minimize side effects, combination therapy with low-intensity statins and ezetimibe is often used as an alternative to moderate- or high-intensity statins.…”

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

“…Bioinformatic analysis suggested that only ABCA1 has a preventive role in carotid plaque rupture and atherosclerosis progression during the inflammatory reaction [49]. There are many IHC markers (CD3, CD68, CD31, CD34, MMP9) expression in special localization in the plaque, which were suspected to be useful to identify the high-risk plaques [50][51][52]. (In Fig.…”