Asymptomatic Plaques of Lower Peripheral Arteries and Their Association with Cardiovascular Disease: An Autopsy Study.
Asymptomatic Plaques of Lower Peripheral Arteries and Their Association with Cardiovascular Disease: An Autopsy Study.
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DOI：
10.5551/jat.39669
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发表时间：
2017-09-01
影响因子：
4.4
通讯作者：
Asada Y
中科院分区：
文献类型：
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作者：
Nakamura E;Sato Y;Iwakiri T;Yamashita A;Moriguchi-Goto S;Maekawa K;Gi T;Asada Y
目的：外周动脉疾病（PAD）患者的心血管发病率和死亡率较高;然而，大多数PAD患者无症状。本研究旨在通过尸检病例，从组织学上评估无症状下肢动脉斑块是否与系统性动脉粥样硬化和心血管疾病（CVD）事件的发生相关。研究方法：我们对121例无PAD症状的尸检病例（平均年龄：67.6岁; 63%男性; 83%非CVD死亡）的髂总动脉、颈总动脉、冠状动脉和肾动脉粥样硬化斑块进行了组织学研究。我们评估了髂动脉粥样硬化程度与其他动脉粥样硬化程度之间的关系，以及任何CVD、心肌梗死、中风和肾衰竭的存在。结果：86支（72%）髂总动脉存在美国心脏协会分级≥ 4级的动脉粥样硬化斑块。这些动脉还显示出高频率的钙化（66%）、斑块内出血（42%）和斑块破裂（24%）。年龄（≥ 60岁）、性别（男性）、高血压、糖尿病、吸烟与晚期病变的发生有关（P均< 0.05）。此外，它与CVD（比值比，95%置信区间; 6.2，2.2-22）、心肌梗死（6.4，1.2- 19）、卒中（8.7，1.7 - 16）和肾衰竭/血液透析（5.8，1.1 - 11）显著相关。晚期髂动脉粥样硬化斑块的病例有晚期冠状动脉和颈动脉粥样硬化。结论：这些结果表明，在髂总动脉中经常观察到无症状的晚期斑块，并且与全身性动脉粥样硬化和CVD事件相关。
Aims: Patients with peripheral artery disease (PAD) have a high prevalence of cardiovascular morbidity and mortality; however, majority of patients with PAD are asymptomatic. This study aimed to histologically evaluate whether asymptomatic, lower extremity artery plaques are associated with systemic atherosclerosis and the onset of cardiovascular disease (CVD) events using autopsy cases. Methods: We histologically investigated the atherosclerotic plaques of the common iliac, common carotid, coronary, and renal arteries from 121 autopsy cases without symptoms of PAD (mean age: 67.6 years; 63% men; 83% non-CVD death). We evaluated the relationship between the degree of iliac artery atherosclerosis and that of other arteries, and also the presence of any CVD, myocardial infarction, stroke, and renal failure. Results: Advanced atherosclerotic plaques (American Heart Association ≥ 4) were present in 86 (72%) common iliac arteries in these cases. These arteries also showed high frequencies of calcification (66%), intraplaque hemorrhage (42%), and plaque disruption (24%). These advanced lesions were associated with age (≥ 60 years), sex (male), hypertension, diabetes, and smoking habit (all P < 0.05). Additionally, it was significantly associated with CVD (odds ratio, 95% confidence interval; 6.2, 2.2–22), myocardial infarction (6.4, 1.2– 19), stroke (8.7, 1.7 –16), and renal failure/hemodialysis (5.8, 1.1 – 11). Cases with advanced iliac artery plaques had advanced coronary and carotid atherosclerosis. Conclusion: These results indicate that asymptomatic advanced plaques are frequently observed in common iliac arteries, and are associated with generalized atherosclerosis and CVD events.