Artery-related differences in atherosclerosis expression: implications for atherogenesis and dynamics in intima-media thickness.
OBJECTIVE
Information about the expression of atherosclerosis in different arteries is important. The impact of cardiovascular risk factors is artery-related, and the assessment of arterial structure and function in peripheral arteries are increasingly used as surrogate markers for coronary atherosclerosis and the risk of developing heart attack.


METHODS
In an autopsy study, we analyzed the coronary, carotid and superficial femoral arteries from 100 individuals (70 men; 20 to 82 years of age) of which 27 died from coronary atherosclerosis. Microscopic sections (n=4756) were analyzed blindly using a modification of the histological classification endorsed by the American Heart Association (AHA).


RESULTS
We found distinct artery-dependent patterns of atherosclerosis with a high prevalence of foam cell lesions and lipid core plaques in the carotid arteries. The femoral arteries were least affected by atherosclerosis, foam cell lesions were rare, and the development of advanced atherosclerosis was strongly age-dependent and dominated by fibrous plaques. Plaques were most common in the left anterior descending coronary artery and the carotid bifurcation. In coronary (versus noncoronary) death, lipid core plaques were more prevalent in all arteries.


CONCLUSIONS
The initiation, speed of development, and phenotypic expression of atherosclerotic plaques are artery-related. Foam cell lesions are frequent in the carotid arteries, probably explaining the dynamics in carotid intima-media thickness. Atherosclerosis develops slowly in femoral arteries, and severe atherosclerosis is dominated by fibrous plaques. The higher prevalence of lipid core plaques in all arteries in coronary death indicates a systemically more vulnerable expression of atherosclerosis in these individuals.
Dalager
Søren
S
Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Arhus C, Denmark. soren@dalager.eu
Paaske
William P
WP
Kristensen
Ingrid Bayer
IB
Laurberg
Jacob Marsvin
JM
Falk
Erling
E
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D050197:Atherosclerosis / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D005260:Female; D005263:Femoral Artery / Q000473:pathology; D005487:Foam Cells / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014481:United States / Q000453:epidemiology