Carotid Plaque Morphology is Similar in Patients with Reduced and Normal Renal Function
Caroline Heijl1, Fredrik Kahn2, Andreas Edsfeldt1,3
1Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Insights
Chronic Kidney Disease (CKD) increases stroke risk, but this study found no link between reduced kidney function and vulnerable carotid plaques. Other factors likely explain the heightened cardiovascular risk in CKD patients.
Area of Science:
- Cardiovascular Science
- Nephrology
- Atherosclerosis Research
Background:
- Chronic Kidney Disease (CKD) significantly elevates cardiovascular event risk, including stroke.
- The relationship between diminished kidney function and atherosclerotic plaque vulnerability remains unclear.
- Investigating renal function's impact on carotid plaque phenotype is crucial for understanding CKD-related cardiovascular risks.
Purpose of the Study:
- To determine if decreased kidney function, indicated by estimated glomerular filtration rate (eGFR), is associated with carotid plaque vulnerability.
- To analyze specific plaque characteristics in relation to renal function in patients undergoing carotid endarterectomy.
Main Methods:
- Analysis of carotid endarterectomy specimens from 379 patients within the Carotid Plaque Imaging Project (CPIP) cohort.
- Assessment of plaque composition, including connective tissue, calcium, lipids, macrophages, hemorrhage, smooth muscle cells, collagen, and elastin.
- Statistical analysis correlating eGFR with plaque characteristics, adjusting for cardiovascular risk factors.
Main Results:
- No significant association was found between eGFR and carotid plaque characteristics.
- This lack of association persisted whether eGFR was categorized into CKD groups or treated as a continuous variable.
- Adjusting for age, diabetes, hypertension, and smoking did not reveal any link between renal function and plaque vulnerability.
Conclusions:
- The increased risk of stroke and cardiovascular disease in CKD patients is not attributable to increased atherosclerotic plaque vulnerability.
- Further research is needed to identify the specific mechanisms driving the heightened cardiovascular risk in individuals with CKD.
- These findings suggest that other pathophysiological pathways, beyond plaque instability, contribute to cardiovascular complications in CKD.
Background:
Chronic Kidney Disease (CKD) is associated with an increased risk for cardiovascular events such as stroke. However, it is still unclear if decreased kidney function is associated with a vulnerable atherosclerotic plaque phenotype. To explore if renal function was associated with carotid plaque vulnerability we analyzed carotid plaques obtained at surgery from the Carotid Plaque Imaging Project (CPIP).
Methods:
Patients were enrolled through the CPIP cohort. The indication for surgery was plaques with stenosis >70%, associated with ipsilateral symptoms or plaques with stenosis >80% not associated with symptoms. Transversal sections from the most stenotic plaque region were analyzed for connective tissue, calcium, lipids, macrophages, intraplaque hemorrhage, and smooth muscle cells. Homogenates were analyzed for collagen and elastin.
Results:
Carotid endarterectomy specimens from 379 patients were obtained. The median GFR was 73 ml/min/1.73 m2. Plaque characteristics showed no significant association with eGFR, neither when eGFR was divided in CKD groups nor when eGFR was handled as a continuous variable and adjusting for other known risk factors (ie, age, diabetes, hypertension, and smoking).
Conclusions:
The higher risk of cardiovascular disease such as stroke in CKD is not associated with increased plaque vulnerability and other factors have to be sought.
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