Matrix metalloproteinases and vulnerable atheromatous plaque

Area of Science:

• Cardiovascular Medicine
• Pathology
• Biomedical Engineering

Background:

• Atherosclerotic coronary artery disease (CAD) is the primary cause of death and disability in the USA and a growing concern in developing nations.
• Atherosclerosis is a progressive disease initiating early in life, often leading to plaque rupture and acute ischemic coronary syndromes.
• Plaque rupture involves endothelial surface disruption, exposing the prothrombotic vessel wall to platelets and coagulation factors.

Purpose of the Study:

• To identify the specific morphological and functional characteristics of high-risk atherosclerotic plaques.
• To provide a basis for distinguishing vulnerable plaques from stable ones.
• To aid in the early detection and management of patients at risk for acute coronary events.

Main Methods:

• Review of human histopathological studies.
• Analysis of in vivo imaging studies.
• Identification of key morphological markers associated with plaque instability.

Main Results:

• High-risk plaques are characterized by a large lipid core (≥40% plaque volume) with specific lipid compositions.
• Thin fibrous caps, depleted of smooth muscle cells and collagen, are indicative of vulnerable plaques.
• Other identified features include outward remodeling, inflammatory cell infiltration, and increased neovascularization.

Conclusions:

• Specific morphological features can identify high-risk atherosclerotic plaques.
• These features are associated with plaque vulnerability, regardless of current rupture status.
• Recognizing these characteristics is essential for predicting and potentially preventing acute ischemic events.