Analysis Of Clinical Factors Related To Pathological Composition And Vulnerability Of Carotid Atherosclerotic Plaque

Background:Cardiovascular diseases(CVD)are the leading cause of disability and death worldwide,and atherosclerosis(AS)is the main pathological change of cardiovascular diseases.Plaque composition and vulnerability are important factors affecting cardiovascular events caused by AS.In recent years,the incidence of obesity,diabetes and hypertension is on the rise,population aging is developing,and the number of smokers is increasing.These common risk factors may accelerate the early formation of AS,but the relationship between them and the composition and vulnerability of AS plaques is not completely clear.Carotid endarterectomy(CEA)is an important method for the treatment of carotid artery AS stenosis,and the plaque featured by the surgery provides more opportunities for the pathological study of human AS plaque.Objective:1.To analyze the correlation between carotid plaque composition and common cardiovascular risk factors.2.To explore the relationship between common cardiovascular risk factors on the overall vulnerability of carotid plaque.Methods:A total of 91 patients with CEA due to moderate and severe carotid artery stenosis in neurosurgery department of our hospital from August 2020 to December 2021 were selected,and 76 patients meeting the study criteria were finally included.The clinical data and laboratory data of the above patients were collected.The plaques obtained during the operation were stained by histopathological sections and various methods:macrophages,smooth muscle cells(SMCs),collagen fibers and calcification in the plaques were divided into no/minor staining group and moderate/heavy staining group according to the staining results.Intraplaque hemorrhage(IPH)was divided into groups with and without hemorrhage.Lipid core size was the percentage of lipid core area in total plaque area,which was divided into>10%group and≤10%group.At the same time,the number of new blood vessels in the plaque was measured,and the vulnerability index of 0～5 was used to evaluate the overall vulnerability of the plaque.The differences in clinical data of each group were analyzed by comparison between groups,and the influencing factors of plaque composition and vulnerability index were discussed by univariate and multivariate regression analysis.Results:1.Comparison between groups:The proportion of alcohol drinking history in plaque macrophage moderate/heavy staining group was higher than that in plaque macrophage no/minor staining group(P<0.05);The proportion of diabetes in plaque SMCs moderate/heavy staining group was higher than that in plaque SMCs no/minor staining group and the levels of body mass index(BMI),triglyceride(TG)and uric acid(UA)in plaque SMCs were lower than those in no/minor staining group(P<0.05).The levels of BMI and glomerular filtration rate(eGFR)in moderate/heavy plaque calcium group were lower than those in no/minor plaque calcium group(P<0.05).The proportion of smoking history in IPH group was higher than that in without IPH group(P<0.05).The BMI level of plaque lipid core>10%group was higher than that of plaque lipid core ≤10%group(P<0.05),and more patients in plaque lipid core>10%group were treated with statins and antiplatelet drugs(P<0.05).BMI was weakly to moderately correlated with plaque neovascularization density(r=0.283,P<0.05).2.Univariate logistic regression analysis showed that alcohol consumption history could be a factor affecting the content of plaque macrophages(OR=2.696,P=0.038).BMI,diabetes history and UA may be the factors influencing the content of plaque SMCs(OR=0.806,P=0.012;OR=4.714,P=0.026;OR=0.992,P=0.019);BMI and eGFR may be the factors influencing the degree of plaque calcification(OR=0.823,P=0.022;OR=0.940,P=0.003);Smoking history and homocysteine(Hcy)may be the influencing factors of SMCs(OR=3.855,P=0.014;OR=1.078,P=0.039);BMI may be the influence factor of plaque lipid core size(OR=1.195,P=0.039).BMI and drinking history could be the influencing factors of plaque vulnerability index(OR=1.196,P=0.014;OR=2.342,P=0.041).3.Multivariate logistic regression analysis showed that increased BMI was an independent factor for the decrease of plaque SMCs(OR=0.820,P=0.045),and diabetes history was an independent factor for the increase of plaque SMCs(OR=4.785,P=0.037).Increased BMI was an independent factor for decreased plaque calcification(OR=0.813,P=0.025),and decreased eGFR was an independent factor for increased plaque calcification(OR=0.929,P=0.007).Smoking history was an independent factor for IPH(OR=4.327,P=0.030).Increased BMI and alcohol consumption history were independent influencing factors for increased plaque vulnerability index(OR=1.188,P=0.016;OR=2.420,P=0.036).Conclusion:1.In patients with moderate and severe lumen stenosis caused by carotid artery AS plaque,the pathological changes of plaque were complex,and most plaques had the characteristics of vulnerability.Common cardiovascular risk factors were associated with AS plaque composition and vulnerability.2.With the increase of BMI,the content of SMCs in plaque decreased and the degree of calcification decreased,and BMI was positively correlated with the density of new blood vessels in plaque.Diabetic patients had more SMCs in their plaques.The macrophages in plaque increased in patients with alcohol consumption.The proportion of IPH in smoking patients increased obviously.As eGFR decrease,plaque calcification increased.3.In this study,increased BMI and alcohol consumption were independent predictors of increased plaque vulnerability index.