Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China; Taizhou People's Hospital, Taizhou, Jiangsu, China.
Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou, China.
World Neurosurg. 2022 Feb;158:e778-e787. doi: 10.1016/j.wneu.2021.11.064. Epub 2021 Nov 25.
The association between high-risk cardiovascular factors and atherosclerotic is well established. However, whether plaque vulnerability is related to specific cardiovascular risk factors remains unknown. The association between plaque vulnerability and cardiovascular risk factors was evaluated in plaques removed in a carotid endarterectomy.
Consecutive subjects scheduled for a carotid endarterectomy were recruited. All patients' baseline characteristics, risk factors, laboratory results, cardiovascular disease history, and medication use history were collected preoperatively. Histopathologic features within the vulnerable plaques were analyzed postoperatively. Risk factors for plaque vulnerability were assessed by univariate and multivariate analyses with adjustment for potential confounders.
A total of 128 carotid plaques were removed during the carotid endarterectomy. On multivariate analysis, hypertension (odds ratio [OR] 5.971, 95% confidence interval [CI] 1.959-18.203, P = 0.002) and dyslipidemia (OR 3.822, 95% CI 1.317-11.089, P = 0.014) were independently associated with plaque vulnerability. Hypertension was independently associated with the presence of a ruptured fibrous cap (OR 6.122, 95% CI 2.318-16.166, P < 0.001), intraplaque hemorrhage (OR 3.535, 95% CI 1.551-8.055, P = 0.003), and a large lipid core (OR 2.335, 95% CI 1.053-5.180, P = 0.037). The incidence of having a large lipid core was increased by 3.216-fold in patients with dyslipidemia (95% CI 1.409-7.340, P = 0.006). When the multivariate analysis was restricted to symptomatic patients, hypertension (OR 5.005, 95% CI 1.294-19.350, P = 0.020) was the most significant risk factor associated with vulnerable plaque.
The composition heterogeneity in the atherosclerotic plaque was significantly correlated to specific cardiovascular risk factors.
高危心血管因素与动脉粥样硬化之间的关联已得到充分证实。然而，斑块的脆弱性是否与特定的心血管危险因素有关仍不清楚。本研究评估了颈动脉内膜切除术切除的斑块中的斑块脆弱性与心血管危险因素之间的关系。
连续入选拟行颈动脉内膜切除术的患者。所有患者术前均采集基线特征、危险因素、实验室结果、心血管疾病史和用药史。术后分析易损斑块的组织病理学特征。采用单因素和多因素分析评估斑块易损性的危险因素，并对潜在混杂因素进行调整。
在 128 例颈动脉内膜切除术中共切除 128 个颈动脉斑块。多因素分析显示，高血压（比值比 [OR] 5.971，95%置信区间 [CI] 1.959-18.203，P=0.002）和血脂异常（OR 3.822，95%CI 1.317-11.089，P=0.014）与斑块易损性独立相关。高血压与纤维帽破裂（OR 6.122，95%CI 2.318-16.166，P<0.001）、斑块内出血（OR 3.535，95%CI 1.551-8.055，P=0.003）和大脂质核（OR 2.335，95%CI 1.053-5.180，P=0.037）的发生独立相关。血脂异常患者发生大脂质核的风险增加 3.216 倍（95%CI 1.409-7.340，P=0.006）。当多因素分析仅限于有症状的患者时，高血压（OR 5.005，95%CI 1.294-19.350，P=0.020）是与易损斑块最显著的相关危险因素。
动脉粥样硬化斑块的组成异质性与特定的心血管危险因素显著相关。
