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Pathological features of coronary atherosclerotic plaques in nonagenarians
Insights
Atherosclerotic plaques in nonagenarians show more fibrous, resting lesions and fewer active ones compared to younger adults. This may explain similar coronary heart disease rates but lower acute myocardial infarction risk in the oldest group.
Area of Science:
- Cardiovascular Pathology
- Geriatric Medicine
- Atherosclerosis Research
Background:
- Coronary heart disease (CHD) risk increases with age.
- Atherosclerosis, the buildup of plaques in arteries, is a primary driver of CHD.
- Understanding age-related changes in atherosclerotic plaque morphology is crucial for assessing cardiovascular risk.
Purpose of the Study:
- To compare the morphological characteristics of atherosclerotic plaques in the major epicardial coronary arteries of nonagenarians (90-99 years) versus younger adults (60-69 years).
- To investigate potential correlations between plaque morphology and clinical outcomes like CHD incidence and acute myocardial infarction (AMI) risk.
Main Methods:
- Comparative analysis of atherosclerotic lesions from 4 major coronary arteries (left main, LAD, LCx, RCA).
- Tissue samples from 23 nonagenarians and 23 individuals aged 60-69 were sectioned and microscopically examined.
- Computerized morphometric analysis was used to measure lumen circumference and plaque characteristics.
Main Results:
- No significant differences were found in the number of plaques, lumen narrowing percentage, or lumen circumference between the two age groups.
- Nonagenarians exhibited a higher proportion of fibrous and resting (silent) or regressive plaques.
- Conversely, the younger group showed a greater prevalence of lipid-rich and active or progressive plaques.
Conclusions:
- Despite similar overall plaque burden, atherosclerotic plaque composition differs significantly with extreme aging.
- The shift towards more stable, fibrous plaques in nonagenarians may contribute to a similar incidence of coronary heart disease but a reduced risk of acute myocardial infarction compared to younger individuals.
Abstract:
The atherosclerotic lesions from 4 major epicardial coronary arteries (left main, left anterior descending, left circumflex and right coronary arteries) of 23 nonagenarians patients were compared with that from 23 patients aged 60-69. The arteries were cut into transversely 5 mm long segments and were examined by microscope. The inside circumferences of the lumen were measured by computerized morphometric analysis. The results showed that the numbers of atherosclerotic plaques, percentages of narrowing of the coronary arterial lumen and circumferences of the arterial lumen in both groups were similar. But there were much more fibrous and resting (silent) or regressive plaques in the group aged 90-99 years as well as less lipid and active or progressive plaques than those in the group of 60-69 years. The above morphological findings may be correlated with the fact that there was a similar incidence of coronary heart disease but a less risk of acute myocardial infarction in patients aged 90-99 years than those aged 60-69 years.