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The vulnerable atherosclerotic plaque: evaluation of the lipid core in human coronary arteries using morphometry
Asteria Papavdi1, Georgia Kornaraki, Antonis Nikitakis
1Department of Forensic Sciences, Medical School, University of Crete, Greece. apapavdi7@gmail.com
Insights
Sudden coronary death in young adults is rising in Greece. Postmortem analysis of coronary arteries revealed significant plaque buildup and cholesterol accumulation, highlighting key factors in these tragic events.
Area of Science:
- Forensic pathology
- Cardiovascular pathology
- Public health
Background:
- Coronary artery disease (CAD) mortality has surged in Greece over 30 years, particularly in adults aged 30-40.
- Acute coronary events like myocardial infarction, thrombosis, and sudden death necessitate improved early diagnosis and treatment strategies.
Purpose of the Study:
- To investigate the characteristics of coronary arteries in individuals who experienced sudden coronary death.
- To evaluate the degree of lumen stenosis and cholesterol proportion in atherosclerotic plaques.
Main Methods:
- Postmortem examination of coronary arteries from 100 individuals undergoing routine autopsy.
- Quantitative analysis of lumen stenosis and cholesterol content in plaques using Image Pro Plus 4.5 software.
Main Results:
- Average lumen stenosis was 79.01% (range: 11%-99%).
- Average cholesterol proportion in plaques was 25.05% (range: 5.3%-66.3%), with 37.8% of specimens exceeding this average.
- Plaque vulnerability was not solely dependent on the degree of stenosis; cholesterol accumulation showed a linear pattern.
Conclusions:
- The degree of stenosis may not be the primary determinant of plaque vulnerability in sudden coronary death.
- Cholesterol accumulation is a significant factor, exhibiting a consistent pattern of increase.
- Findings underscore the need for further research into plaque composition and its role in sudden cardiac events.
Abstract:
In Greece, mortality due to coronary artery disease has alarmingly increased during the past 3 decades, especially among younger adults between 30 and 40 years old. Many studies have been conducted over the years in an effort to interpret the presence of acute coronary phenomena-myocardial infarction, thrombosis, and sudden death-in early diagnosis and treatment. The current study focuses on postmortem data from individuals who had sudden coronary death. The coronary arteries of 100 individuals who were routinely subjected to autopsy at the Department of Forensic Sciences of the University of Crete were removed and examined, aiming at the evaluation of the degree of stenosis of the lumen and measurement of proportion of cholesterol in the plaque using Image Pro Plus 4.5. The average degree of stenosis was 79.01%, ranging from 11% to 99%. The cholesterol proportion was measured in 66 specimens, and the average was 25.05%, ranging between 5.3% and 66.3%, whereas 25 of them (37.8% overall) were found to contain cholesterol above the average. It resulted that the degree of stenosis was not of major importance in vulnerable plaques and that the amount of cholesterol followed an almost linear pattern of accumulation.
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