Document Detail

Histological features of symptomatic carotid plaques in relation to age and smoking: the oxford plaque study.
MedLine Citation:
PMID:  20814007     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Rates of incident and recurrent cardiovascular events rise steadily with age, due partly to more extensive atherosclerotic burden. However, in patients with similarly severe symptomatic carotid stenosis, increasing age is associated with a greater risk of ipsilateral ischemic stroke. This effect may be due to age-related differences in the pathology of symptomatic carotid plaques. However, previous studies of plaque pathology in relation to age have not accounted for potential confounders, particularly smoking, which is often less prevalent in the elderly population undergoing endarterectomy. Method-We related patient age (<55, 55 to 64, 65 to 74, 75+ years) and smoking habit (never, exsmoker, recent smoker, and current smoker; and number of cigarettes smoked per day) to detailed histological assessments of 526 carotid plaques from consecutive patients undergoing carotid endarterectomy for symptomatic carotid stenosis. RESULTS: Three hundred seventy-nine (72.1%) patients were male (mean/SD age 66.6/8.7). Current/recent smokers were on average 7 years younger at carotid endarterectomy than ex-/never smokers (P<0.001), and age at carotid endarterectomy decreased with increasing number of cigarettes smoked per day (P trend=0.005). Plaques from current/recent smokers had a lower prevalence of intraplaque hemorrhage (P -trend=0.01), but histology was otherwise similar to that in ex-/never smokers, and both groups showed similar changes with age. With increasing age, plaque calcification and large lipid core increased (P<0.001 and P=0.01, respectively) and fibrous tissue (P=0.01) decreased, but lymphocyte infiltration of the plaque (P=0.03) and cap (P=0.002) and overall plaque inflammation (P=0.03) also decreased such that overall plaque instability was unrelated to age. CONCLUSIONS: Smoking is associated with a lower age at carotid endarterectomy suggesting that it may accelerate the development and/or progression of atherosclerosis. However, the mechanisms of plaque instability seem largely unrelated to smoking. Plaques from younger patients had greater inflammatory cell infiltration, whereas those from older patients had a larger lipid core, but there were no age trends in overall plaque instability suggesting the increased risk of stroke in the elderly with symptomatic carotid stenosis is due to other factors.
Jessica N E Redgrave; Joanne K Lovett; Peter M Rothwell
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-02
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2010-10-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2288-94     Citation Subset:  IM    
Stroke Prevention Research Unit, University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK.
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MeSH Terms
Age Factors
Aged, 80 and over
Atherosclerosis / pathology*,  surgery
Carotid Stenosis / pathology*,  surgery*
Chi-Square Distribution
Endarterectomy, Carotid
Middle Aged

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