Biomarkers of plaque instability

Area of Science:

• Cardiovascular Medicine
• Pathology
• Biomarker Discovery

Background:

• Atherosclerosis is the primary cause of arterial thrombosis and acute occlusive cardiovascular syndromes.
• Plaque rupture, often linked to inflammation and specific plaque features, leads to thrombosis.
• Vulnerable plaques share characteristics with ruptured plaques, indicating a risk for rupture.

Purpose of the Study:

• To explore the identification of vulnerable atherosclerotic plaques.
• To investigate the role of inflammation in plaque vulnerability and rupture.
• To assess the clinical predictive value of systemic inflammation markers for high-risk plaques and future athero-thrombotic events.

Main Methods:

• Review of pathological features associated with plaque rupture (inflammation, necrotic core, fibrous cap changes, neovascularity, microcalcification).
• Inference of vulnerable plaque characteristics based on features of ruptured plaques.
• Evaluation of systemic inflammation markers as potential biomarkers for plaque vulnerability.

Main Results:

• Plaque rupture is associated with inflammation, a large lipid-rich necrotic core, thin fibrous cap, outward remodeling, neovascularization, intraplaque hemorrhage, and microcalcification.
• Inflammation drives extracellular matrix dysregulation via metalloproteinases and smooth muscle cell death.
• Systemic inflammation markers have shown potential prognostic value, but their clinical predictive value is modest, especially for individuals.

Conclusions:

• Identifying vulnerable plaques could aid in predicting acute occlusive syndromes and guiding therapy.
• Inflammation plays a critical role in the development and rupture of atherosclerotic plaques.
• Further research is needed to develop reliable, cost-effective biomarkers with greater sensitivity and specificity for predicting high-risk plaques and cardiovascular events.