Determinants of plaque instability in atherosclerotic vascular disease.
BACKGROUND
Despite numerous advances in the understanding of the pathogenesis of atherosclerosis, the factors that determine atheromatous plaque instability remain unclear. The prediction of the vulnerability of a plaque to rupture and subsequent thrombosis would be useful in guiding development of diagnostic and therapeutic approaches.


METHODS
Aortas with areas of gross atherosclerosis were obtained from seven autopsy cases. These were then serially sectioned at 3-mm intervals, analyzed histologically, and scored as to plaque size, calcification, lipid content, intraplaque hemorrhage, inflammation, plaque disruption, and plaque thrombosis. Bivariate correlations and binary multivariate regression analyses were performed using SPSS software.


RESULTS
Plaque instability was highly correlated with intraplaque hemorrhage, lipid content, and plaque size. Weaker but statistically significant correlations were found with inflammation and calcification. However, in multivariate regression analyses, only plaque size, intraplaque hemorrhage, and lipid content, independent predictors of plaque instability, were significant.


CONCLUSIONS
Atheromatous plaques may be rendered unstable by increases in size, increased intra- and extracellular lipid accumulation, and intraplaque hemorrhage. Based on these results, diagnostic modalities that detect plaque size, plaque hemorrhage, and/or lipid content are most likely to be useful in predicting unstable plaques.
Rao
Dinesh S
DS
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Goldin
Jonathan G
JG
Fishbein
Michael C
MC
D001011:Aorta / Q000473:pathology*; D050197:Atherosclerosis / Q000150:complications / Q000473:pathology*; D002114:Calcinosis; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008055:Lipids / Q000032:analysis; D013927:Thrombosis / Q000209:etiology
D008055:Lipids