Morphologic findings of coronary atherosclerotic plaques in diabetics: a postmortem study.
OBJECTIVE
Coronary atherosclerotic plaque composition of diabetic subjects and localization of receptor for advanced glycation end products (RAGE) and its ligands have not been extensively studied.


RESULTS
Hearts from diabetic subjects and age, race, and sex-matched nondiabetic subjects dying suddenly were examined. Coronary arteries were dissected and lesions were evaluated for plaque burden, necrotic core size, and inflammatory infiltrate. The expression of RAGE, the RAGE-binding protein (S100-A12, EN-RAGE), and cell death (apoptosis) were also determined. Lesions from type II diabetic subjects had larger mean necrotic cores (P=0.01) and greater total and distal plaque load (P<0.001) than nondiabetic subjects. Necrotic core size correlated positively with diabetic status, independent of other risk factors. Intimal staining for macrophages, T-cells, and HLA-DR was also significantly greater in diabetic subjects (P=0.03, P=0.003, and P<0.0001), respectively. The association of increased macrophage infiltrate was independent of cholesterol levels and patient age. Expression of RAGE and EN-RAGE was significantly greater in diabetic subjects (P=0.004) and was associated with apoptotic smooth muscle cells and macrophages.


CONCLUSIONS
In sudden coronary death, inflammation and necrotic core size play a greater role in the progression of atherosclerosis in diabetic subjects. The expression of RAGE and EN-RAGE may further compromise cell survival and promote plaque destabilization.
Burke
Allen P
AP
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Kolodgie
Frank D
FD
Zieske
Arthur
A
Fowler
David R
DR
Weber
Deena K
DK
Varghese
P Jacob
PJ
Farb
Andrew
A
Virmani
Renu
R
D000328:Adult; D017209:Apoptosis; D002114:Calcinosis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D003328:Coronary Thrombosis / Q000209:etiology / Q000473:pathology; D003920:Diabetes Mellitus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000473:pathology; D006973:Hypertension / Q000150:complications / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic / Q000032:analysis*; D012307:Risk Factors; D009418:S100 Proteins / Q000032:analysis; D000067616:S100A12 Protein; D012907:Smoking; D013601:T-Lymphocytes / Q000473:pathology; D014657:Vasculitis / Q000150:complications / Q000378:metabolism / Q000473:pathology
D017127:Glycation End Products, Advanced; D006684:HLA-DR Antigens; D000067759:Receptor for Advanced Glycation End Products; D011971:Receptors, Immunologic; D009418:S100 Proteins; D000067616:S100A12 Protein; C090441:S100A12 protein, human