Heijl Caroline, Kahn Fredrik, Edsfeldt Andreas, Tengryd Christoffer, Nilsson Jan, Goncalves Isabel
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Department of Infection Medicine, Clinical Sciences, Lund University, Lund, Sweden.
Clin Med Insights Cardiol. 2020 Aug 25;14:1179546820951793. doi: 10.1177/1179546820951793. eCollection 2020.
Chronic Kidney Disease (CKD) is associated with an increased risk for cardiovascular events such as stroke. However, it is still unclear if decreased kidney function is associated with a vulnerable atherosclerotic plaque phenotype. To explore if renal function was associated with carotid plaque vulnerability we analyzed carotid plaques obtained at surgery from the Carotid Plaque Imaging Project (CPIP).
Patients were enrolled through the CPIP cohort. The indication for surgery was plaques with stenosis >70%, associated with ipsilateral symptoms or plaques with stenosis >80% not associated with symptoms. Transversal sections from the most stenotic plaque region were analyzed for connective tissue, calcium, lipids, macrophages, intraplaque hemorrhage, and smooth muscle cells. Homogenates were analyzed for collagen and elastin.
Carotid endarterectomy specimens from 379 patients were obtained. The median GFR was 73 ml/min/1.73 m. Plaque characteristics showed no significant association with eGFR, neither when eGFR was divided in CKD groups nor when eGFR was handled as a continuous variable and adjusting for other known risk factors (ie, age, diabetes, hypertension, and smoking).
The higher risk of cardiovascular disease such as stroke in CKD is not associated with increased plaque vulnerability and other factors have to be sought.
慢性肾脏病（CKD）与中风等心血管事件风险增加相关。然而，肾功能下降是否与易损性动脉粥样硬化斑块表型相关仍不清楚。为了探究肾功能是否与颈动脉斑块易损性相关，我们分析了从颈动脉斑块成像项目（CPIP）手术中获取的颈动脉斑块。
通过CPIP队列招募患者。手术指征为狭窄>70%且伴有同侧症状的斑块或狭窄>80%且无症状的斑块。对最狭窄斑块区域的横断面进行结缔组织、钙、脂质、巨噬细胞、斑块内出血和平滑肌细胞分析。对匀浆进行胶原蛋白和弹性蛋白分析。
获取了379例患者的颈动脉内膜切除术标本。估算肾小球滤过率（eGFR）中位数为73 ml/min/1.73m²。斑块特征与eGFR无显著相关性，无论是将eGFR分为CKD组时，还是将eGFR作为连续变量并对其他已知危险因素（即年龄、糖尿病、高血压和吸烟）进行校正时。
CKD患者中风等心血管疾病风险较高与斑块易损性增加无关，必须寻找其他因素。
