Plaque, Atherosclerosis

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Editorial

From Atheroma to Atherogenic Index, Secular Evidence

Dalton Bertolim Precoma et al. Guilherme Luiz da Rocha

The discovery of atherosclerosis was first described by the Austrian paleontologist Johan N. Nepomuk Czemark when he observed great calcified plaques in the ascending thoracic artery in mummies. Other fellow researchers had similar findings, but one particular case gained attention. Murphy et al., in 2003, using computer tomography, revealed in a 5300-year-old mummy atherosclerotic plaques in the aorta, coronaries, carotids, and iliac arteries.

In early 1900, a significant number of studies about atherosclerosis were published. Highlight for Alexander I. Ignatowski, who published in 1908 a pioneer study associating high total cholesterol (TC) foods with enhanced atherosclerosis in an animal model. In 1910, Adolf Windaus, who would win a Nobel prize in chemistry in 1928, demonstrated that the atherosclerotic plaques had 25 times more cholesterol than a normal artery wall.

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Editorial

Carotid Artery Atherosclerotic Profile as a Progression Marker for Cardiovascular Disease

Guilherme Brasileiro de Aguiar et al. José Guilherme Mendes Pereira Caldas

Conditions directly linked to atherosclerosis are among the main causes of mortality worldwide, notably ischemic stroke and coronary artery disease (CAD). Diagnosing cardiovascular disease or its progression in the early stages, aiming to apply measures that can prevent or delay its progression and subsequent complications is currently a major challenge. The identification and characterization of atherosclerotic plaques allows the identification of a significant number of patients with low or intermediate risk scores. Many of these patients would not be identified by the available algorithms for cardiovascular diseases, which could result in the lack of correct management.

The quantification of the carotid artery plaque may be a measure of atherosclerosis, which should be associated with future risk of atherosclerotic cardiovascular disease, encompassing coronary, cerebrovascular, and peripheral arterial diseases. It is already known that impaired endothelial function and increased carotid intima-media thickness are substantial events in the atherosclerotic process,^, with imaging of carotid features being used to predict the risk of cardiovascular events.

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Editorial

High Residual Platelet Activity in Response to Acetylsalicylic Acid in Acute Coronary Syndrome: A New Challenge for Antiplatelet Treatment?

Dário C. Sobral Filho et al. José Gildo de Moura Monteiro Júnior

Cardiovascular diseases (CVD) are the leading cause of death in the world, with coronary heart disease being the main etiology, accounting in 2016 for 31% of global deaths. Myocardial infarction (MI) is usually due to changes in the arterial wall or thrombotic occlusion of a coronary vessel caused by the rupture of a vulnerable plaque.^, Instability in the atherosclerotic plaque is the result of local and systemic oxidative stress, thus leading to platelet activation and formation of aggregates in the circulation. The major function of platelets is as part of the homeostatic mechanism, halting blood loss after tissue trauma, but in oxidative conditions, they are associated with various CVD such as hypertension, heart failure, stroke, diabetes and atherosclerosis.

Previous studies have shown the importance of aspirin in reducing cardiovascular events in patients with coronary artery disease, hence the importance of anti-platelet aggregation in acute and chronic coronary syndromes.^– However, in this issue of the Arquivos Brasileiros de Cardiologia, Dracoulakis et al. demonstrate the high residual variability in response to aspirin in patients with non-ST-elevation acute coronary syndrome, comparing acute and late phases, correlating with laboratory evaluation tests of platelet aggregation and the variation of inflammatory markers (C-reactive protein and interleukin-6). In this study, the authors demonstrate statistically significant differences in response to aspirin during the acute and late phases of acute coronary disease.

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Artigo Original

Correlation between plaque composition as assessed by virtual histology and C-reactive protein

Dimytri Alexandre de Alvim Siqueira et al. Amanda Guerra Moraes R. Sousa José de Ribamar Costa Junior Ricardo Alves da Costa … Rodolfo Staico Luis Fernando Leite Tanajura Marinella Patrizia Centemero Fausto Feres Alexandre Antonio Cunha Abizaid J. Eduardo Moraes R. Sousa

BACKGROUND: Previous studies have shown that coronary plaque composition plays a pivotal role in plaque instability, and imaging modalities and serum biomarkers have been investigated to identify vulnerable plaque. Virtual histology IVUS (VH-IVUS) characterizes plaque components as calcified, fibrotic, fibrofatty, or necrotic core. C-reactive protein (hsCRP) is an independent risk factor and a powerful predictor of future coronary events. However, a relationship between inflammatory response indicated by CRP and plaque characteristics in ACS patients remains not well established. OBJECTIVE: To determine, by using VH-IVUS, the relation between coronary plaque components and plasma high-sensitivity CRP levels in patients with acute coronary syndromes (ACS). METHODS: 52 patients with ACS were enrolled in this prospective study. Electrocardiographically-gated VH-IVUS were performed in the culprit lesion before PCI. Blood sample was drawn from all patients before the procedure and after 24 hours, and hs-CRP levels were determined. RESULTS: Mean age was 55.3±4.9 years, 76.9% were men and 30.9% had diabetes. Mean MLA was 3.9±1.3 mm², and plaque burden was 69±11.3%, as assessed by IVUS. VH-IVUS analysis at the minimum luminal site identified plaque components: fibrotic (59.6±15.8%), fibrofatty (7.6±8.2%), dense calcium (12.1±9.2%) and necrotic core (20.7±12.7%). Plasma hs-CRP (mean 16.02±18.07 mg/L) did not correlate with necrotic core (r=-0.089, p = 0.53) and other plaque components. CONCLUSIONS: In this prospective study with patients with ACS, the predominant components of the culprit plaque were fibrotic and necrotic core. Serum hs C-reactive protein levels did not correlate with plaque composition.

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From Atheroma to Atherogenic Index, Secular Evidence

Carotid Artery Atherosclerotic Profile as a Progression Marker for Cardiovascular Disease

High Residual Platelet Activity in Response to Acetylsalicylic Acid in Acute Coronary Syndrome: A New Challenge for Antiplatelet Treatment?

Correlation between plaque composition as assessed by virtual histology and C-reactive protein

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