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Goncalves I, Sun J, Tengryd C, Nitulescu M, Persson AF, Nilsson J, Edsfeldt A. Plaque Vulnerability Index Predicts Cardiovascular Events: A Histological Study of an Endarterectomy Cohort. J Am Heart Assoc 2021; 10:e021038. [PMID: 34325529 PMCID: PMC8475655 DOI: 10.1161/jaha.120.021038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The balance between stabilizing and destabilizing atherosclerotic plaque components is used in experimental studies and in imaging studies to identify rupture prone plaques. However, we lack the evidence that this balance predicts future cardiovascular events. Here we explore whether a calculated histological ratio, referred to as vulnerability index (VI), can predict patients at higher risk to suffer from future cardiovascular events. Methods and Results Carotid plaques and clinical information from 194 patients were studied. Tissue sections were used for histological analysis to calculate the VI (CD68 [cluster of differentiation 68], alpha‐actin, Oil red O, Movat pentachrome, and glycophorin A). Postoperative cardiovascular events were identified through the Swedish National Inpatient Health Register (2005–2013). During the follow‐up (60 months) 45 postoperative cardiovascular events were registered. Patients with a plaque VI in the fourth quartile compared with the first to third quartiles had significantly higher risk to suffer from a future cardiovascular event (P=0.0002). The VI was an independent predictor and none of the 5 histological variables analyzed separately predicted events. In the 13 patients who underwent bilateral carotid endarterectomy, the VI of the right plaque correlated with the VI of the left plaque and vice versa (r=0.7, P=0.01). Conclusions Our findings demonstrate that subjects with a high plaque VI have an increased risk of future cardiovascular events, independently of symptoms and other known cardiovascular risk factors . This strongly supports that techniques which image such plaques can facilitate risk stratification for subjects in need of more intense treatment.
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Affiliation(s)
- Isabel Goncalves
- Clinical Sciences Malmö Lund University Malmo Sweden.,Department of Cardiology Skåne University Hospital Lund/Malmö Sweden
| | - Jiangming Sun
- Clinical Sciences Malmö Lund University Malmo Sweden
| | | | | | - Ana F Persson
- Clinical Sciences Malmö Lund University Malmo Sweden
| | - Jan Nilsson
- Clinical Sciences Malmö Lund University Malmo Sweden
| | - Andreas Edsfeldt
- Clinical Sciences Malmö Lund University Malmo Sweden.,Department of Cardiology Skåne University Hospital Lund/Malmö Sweden.,Wallenberg Center for Molecular Medicine Lund University Lund Sweden
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Singh P, Goncalves I, Tengryd C, Nitulescu M, Persson AF, To F, Bengtsson E, Volkov P, Orho-Melander M, Nilsson J, Edsfeldt A. Correction to: Reduced oxidized LDL in T2D plaques is associated with a greater statin usage but not with future cardiovascular events. Cardiovasc Diabetol 2021; 20:61. [PMID: 33711997 PMCID: PMC7955620 DOI: 10.1186/s12933-021-01227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 12/31/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Pratibha Singh
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Isabel Goncalves
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.,Dept. of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Christofer Tengryd
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Mihaela Nitulescu
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Ana F Persson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Fong To
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Eva Bengtsson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Petr Volkov
- Diabetes Center Bioinformatics Unit, Lund University, Malmö, Sweden
| | - Marju Orho-Melander
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Jan Nilsson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Andreas Edsfeldt
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden. .,Dept. of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden. .,Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden.
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Singh P, Goncalves I, Tengryd C, Nitulescu M, Persson AF, To F, Bengtsson E, Volkov P, Orho-Melander M, Nilsson J, Edsfeldt A. Reduced oxidized LDL in T2D plaques is associated with a greater statin usage but not with future cardiovascular events. Cardiovasc Diabetol 2020; 19:214. [PMID: 33317535 PMCID: PMC7737372 DOI: 10.1186/s12933-020-01189-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Type 2 diabetes (T2D) patients are at a greater risk of cardiovascular events due to aggravated atherosclerosis. Oxidized LDL (oxLDL) has been shown to be increased in T2D plaques and suggested to contribute to plaque ruptures. Despite intensified statin treatment during the last decade the higher risk for events remains. Here, we explored if intensified statin treatment was associated with reduced oxLDL in T2D plaques and if oxLDL predicts cardiovascular events, to elucidate whether further plaque oxLDL reduction would be a promising therapeutic target. Methods Carotid plaque OxLDL levels and plasma lipoproteins were assessed in 200 patients. Plaque oxLDL was located by immunohistochemistry. Plaque cytokines, cells and scavenger receptor gene expression were quantified by Luminex, immunohistochemistry and RNA sequencing, respectively. Clinical information and events during follow-up were obtained from national registers. Results Plaque oxLDL levels correlated with markers of inflammatory activity, endothelial activation and plasma LDL cholesterol (r = 0.22-0.32 and p ≤ 0.01 for all). T2D individuals exhibited lower plaque levels of oxLDL, sLOX-1(a marker of endothelial activation) and plasma LDL cholesterol (p = 0.001, p = 0.006 and p = 0.009). No increased gene expression of scavenger receptors was identified in T2D plaques. The lower oxLDL content in T2D plaques was associated with a greater statin usage (p = 0.026). Supporting this, a linear regression model showed that statin treatment was the factor with the strongest association to plaque oxLDL and plasma LDL cholesterol (p < 0.001 for both). However, patients with T2D more frequently suffered from symptoms and yet plaque levels of oxLDL did not predict cardiovascular events in T2D (findings are summarized in Fig. 1a). Conclusions This study points out the importance of statin treatment in affecting plaque biology in T2D. It also implies that other biological components, beyond oxLDL, need to be identified and targeted to further reduce the risk of events among T2D patients receiving statin treatment.
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Affiliation(s)
- Pratibha Singh
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Isabel Goncalves
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.,Dept. of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Christoffer Tengryd
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Mihaela Nitulescu
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Ana F Persson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Fong To
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Eva Bengtsson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Petr Volkov
- Diabetes Center Bioinformatics Unit, Lund University, Malmö, Sweden
| | - Marju Orho-Melander
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Jan Nilsson
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
| | - Andreas Edsfeldt
- Dept. of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden. .,Dept. of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden. .,Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden.
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