Temporal trends from 2002 to 2011 showed significant decreases in large atheroma (OR 0.72; 95% CI 0.650-0.789 per 2-year increase) and plaque thrombosis in carotid endarterectomy plaques.
Cohort (n=1,583)
Does the composition of atherosclerotic plaques change over time in patients undergoing carotid endarterectomy?
Over a decade, atherosclerotic plaques from carotid endarterectomy showed a decrease in features associated with plaque instability, coinciding with improved risk factor management.
Effect estimate: OR 0.72 (95% CI 0.650-0.789)
BACKGROUND: Time-dependent trends in the incidence of cardiovascular disease have been reported in high-income countries. Because atherosclerosis underlies the majority of cardiovascular diseases, we investigated temporal changes in the composition of atherosclerotic plaques removed from patients undergoing carotid endarterectomy. METHODS AND RESULTS: The Athero-Express study is an ongoing, longitudinal, vascular biobank study that includes the collection of atherosclerotic plaques of patients undergoing primary carotid endarterectomy in the province of Utrecht from 2002 to 2011. Histopathologic features of plaques of 1583 patients were analyzed in intervals of 2 years. The analysis included quantification of collagen, calcifications, lipid cores, plaque thrombosis, macrophages, smooth muscle cells, and microvessels. Large atheroma, plaque thrombosis, macrophages, and calcifications were less frequently observed over time, with adjusted odds ratios of 0.72 (95% confidence interval, 0.650-0.789), 0.62 (95% confidence interval, 0.569-0.679), 0.87 (95% confidence interval, 0.800-0.940), and 0.75 (95% confidence interval, 0.692-0.816) per 2-year increase in time, respectively. These changes in plaque characteristics were consistently observed in patient subgroups presenting with stroke, transient ischemic attack, ocular symptoms, and asymptomatic patients. Concomitantly, risk factor management and secondary prevention strategies among vascular patients scheduled for carotid endarterectomy significantly improved over the past decade. CONCLUSIONS: In conclusion, over the past decade, atherosclerotic plaques harvested during carotid endarterectomy show a time-dependent change in plaque composition characterized by a decrease in features currently believed to be causal for plaque instability. This appears to go hand in hand with improvements in risk factor management.
Lammeren et al. (Tue,) conducted a cohort in Atherosclerotic plaques in patients undergoing carotid endarterectomy (n=1,583). Temporal trends (per 2-year increase) was evaluated on Large atheroma (OR 0.72, 95% CI 0.650-0.789). Temporal trends from 2002 to 2011 showed significant decreases in large atheroma (OR 0.72; 95% CI 0.650-0.789 per 2-year increase) and plaque thrombosis in carotid endarterectomy plaques.
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