title: Time-dependent changes in atherosclerotic plaque composition in patients undergoing carotid surgery.
abstract: 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.
  
  
  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.
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Guus W
authors.initials: GW
authors.lastname: van Lammeren
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Joyce E P
authors.initials: JE
authors.lastname: Vrijenhoek
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Sander W
authors.initials: SW
authors.lastname: van der Laan
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Evelyn
authors.initials: E
authors.lastname: Velema
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Dominique P V
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Aryan
authors.initials: A
authors.lastname: Vink
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.).
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: From the Experimental Cardiology Laboratory (G.W.v.L., H.M.d.R., J.E.P.V., S.W.v.d.L., E.V., D.P.V.d.K., G.P.), Departments of Vascular Surgery (G.W.v.L., J.E.P.V., G.J.d.B., F.L.M.) and Pathology (A.V.), and Julius Center for Health Sciences and Primary Care (H.M.d.R., M.L.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands (J.E.P.V., J.-P.P.M.d.V.); Surgery NUS and Cardiovascular Research Institute National University Heart Centre, Singapore (D.P.V.d.K.); and the Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (J.-P.P.M.d.V.). G.Pasterkamp@umcutrecht.nl.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
mesh_terms: D000368:Aged; D018070:Biological Specimen Banks; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D058226:Plaque, Atherosclerotic / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors
keywords: endarterectomy, carotid; histology; plaque, atherosclerotic; primary prevention