title: Low elastin content of carotid plaques is associated with increased risk of ipsilateral stroke.
abstract: OBJECTIVE
  Atherosclerotic plaques with a low content of connective tissue proteins are believed to have an increased risk of rupture and to give rise to clinical events. The aim of the present study was to investigate if the content of elastin, collagen and of the matrix metalloproteinase (MMP) -1, -3, -9 and -12 in plaques removed at surgery can be associated with the occurrence of ipsilateral symptoms.
  
  
  METHODS
  The atherosclerotic plaques of 221 patients undergoing carotid endarterectomy were analyzed and their composition was related to the incidence of preoperative, intraoperative and postoperative neurological events.
  
  
  RESULTS
  Elastin, collagen and MMP-12 contents were lower in males and diabetic patients. Elastin (P .010), MMP-3 (P .008) and MMP-9 (P < .0001) were lower, while MMP-1 (P .004) and MMP-9 (P .002) were higher in plaques of patients with preoperative symptoms, even after correction for the time between the occurrence of symptoms and surgery. Elastin and MMP-12 decreased (r = -0.17, P .009 and r = -.288, P <.0001 respectively) while MMP-1 (r = 0.17, P .012) and MMP-9 (r = .21 P <.0001) increased with age. After a mean follow-up time of 39.6 ± 16.6 months, 7.7% of patients had suffered one or multiple ipsilateral neurological events. Patients with plaque elastin levels lower than the median (52 mg/g) had increased post-operative incidence of ipsilateral stroke (P for trend 0.009 using Log Rank Chi-square test). This finding was confirmed when controlling for age, gender, hypertension, diabetes, smoking, pre-operative symptoms and statin usage in a Cox Proportional Hazard model (hazard ratio 7.38, 95% C.I. 1.50-36.31).
  
  
  CONCLUSIONS
  These observations support the concept that elastin may be important for plaque stability, and suggest that a low plaque content of elastin is associated with a higher risk for ipsilateral stroke.
authors: Vascular Centre Malmö-Lund, Skåne University Hospital, Malmö, Sweden.
authors: Giuseppe
authors: G
authors: Asciutto
authors: Vascular Centre Malmö-Lund, Skåne University Hospital, Malmö, Sweden.
authors: Nuno V
authors: NV
authors: Dias
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Andreas
authors: A
authors: Edsfeldt
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Mihaela
authors: M
authors: Nitulescu
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Ana
authors: A
authors: Persson
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Marie
authors: M
authors: Nilsson
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Pontus
authors: P
authors: Dunér
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors: Jan
authors: J
authors: Nilsson
authors: Experimental Cardiovascular Research Unit, Clinical Research Centre, Dept. of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors: Isabel
authors: I
authors: Gonçalves
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism* / Q000601:surgery; D003094:Collagen / Q000378:metabolism; D015897:Comorbidity; D004549:Elastin / Q000378:metabolism*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D020782:Matrix Metalloproteinases / Q000378:metabolism; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism* / Q000601:surgery; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology
chemical_list: D003094:Collagen; D004549:Elastin; D020782:Matrix Metalloproteinases