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Microplastics and Nanoplastics in Atheromas and Cardiovascular Events
Raffaele Marfella1, Francesco Prattichizzo1, Celestino Sardu1
1From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.).
Background:
Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking.
Methods:
We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary end point was a composite of myocardial infarction, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs.
Results:
A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7±6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7±24.5 μg per milligram of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2±2.4 μg per milligram of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001).
Conclusions:
In this study, patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom MNPs were not detected. (Funded by Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale and others; ClinicalTrials.gov number, NCT05900947.).
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