(Circulation. 2000;101:744.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Hyperfibrinogenemia Is Associated With Specific Histocytological Composition and Complications of Atherosclerotic Carotid Plaques in Patients Affected by Transient Ischemic Attacks
From the Cattedra Anatomia ed Istologia Patologica (A.M., G.P., L.G.S.) and Cattedra Chirurgia Vascolare (R.P., A.I.), Università di Roma Tor Vergata, Rome, Italy; the Department of Cardiovascular Pathology (R.V.), Armed Forces Institute of Pathology, Washington, DC; and the Division of Internal Medicine and Cardiovascular Diseases (G.S., D.R.H., R.S.S.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Correspondence to Prof Luigi Giusto Spagnoli, Cattedra di Anatomia ed Istologia Patologica, Dipartimento di Biopatologia e Diagnostica per Immagini, Università di Roma Tor Vergata, Via della Ricerca Scientifica, 00133 Rome, Italy. E-mail spagnoli{at}uniroma2.it
Background—Epidemiological studies have demonstrated that hyperfibrinogenemia is an independent risk factor for cerebrovascular atherosclerosis. However, the underlying mechanisms are poorly understood. We studied whether hyperfibrinogenemia could modify the histological composition of atherosclerotic plaque and precipitate carotid thrombosis resulting from rupture of the plaque.
Methods and Results—We studied the histological composition of 71 carotid atherosclerotic plaques from patients who had undergone surgical endarterectomy after a first episode of transient ischemic attack. Patients were divided into 3 groups corresponding to the tertiles of plasma fibrinogen values. Hypercholesterolemia, hypertriglyceridemia, hypertension, diabetes, and smoking habit were also assessed. At the histological analysis, plaques of patients in the highest tertile of fibrinogen (>407 mg/dL) were characterized by a high incidence of thrombosis (66.7% of cases) compared with plaques of subjects in the lower (21.7%) (P=0.002) and middle (29.2%) (P=0.009) tertiles. Plaque rupture was significantly associated with high fibrinogen levels (54.2%, P=0.003). Multivariate logistic regression indicated that hyperfibrinogenemia was an independent risk factor for a decrease in cap thickness (P=0.0005), macrophage foam cell infiltration of the cap (P=0.003), and thrombosis (P=0.003). When the presence of other risk factors was accounted for, hyperfibrinogenemia remained an independent predictor of carotid thrombosis with an odds ratio of 5.83, compared with other risk factors.
Conclusions—The results of the present study add to the evidence that hyperfibrinogenemia, independently of other risk factors, is associated with a specific histological composition of carotid atherosclerotic plaques that predisposes them to rupture and thrombosis.
Key Words: fibrinogen • atherosclerosis • carotid arteries • histology • thrombosis
This article has been cited by other articles:
 |
|
 |
|
  H. Yang, S. Lang, Z. Zhai, L. Li, W. H. A. Kahr, P. Chen, J. Brkic, C. M. Spring, M. J. Flick, J. L. Degen, et al. Fibrinogen is required for maintenance of platelet intracellular and cell-surface P-selectin expression Blood, July 9, 2009; 114(2): 425 - 436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Gao, Z.-q. Chen, Y.-h. Bao, L.-q. Jiao, and F. Ling Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms: Systematic Review of Observational Studies Stroke, August 1, 2007; 38(8): 2382 - 2390. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Sangiorgi, A. Mauriello, E. Bonanno, C. Oxvig, C. A. Conover, M. Christiansen, S. Trimarchi, V. Rampoldi, D. R. Holmes Jr, R. S. Schwartz, et al. Pregnancy-Associated Plasma Protein-A Is Markedly Expressed by Monocyte-Macrophage Cells in Vulnerable and Ruptured Carotid Atherosclerotic Plaques: A Link Between Inflammation and Cerebrovascular Events J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2201 - 2211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Iwaki, M. J. Sandoval-Cooper, M. Brechmann, V. A. Ploplis, and F. J. Castellino A fibrinogen deficiency accelerates the initiation of LDL cholesterol-driven atherosclerosis via thrombin generation and platelet activation in genetically predisposed mice Blood, May 15, 2006; 107(10): 3883 - 3891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Asakura, K. Kawaguchi, H. Sakaida, N. Toma, S. Matsushima, K. Kuraishi, H. Tanemura, Y. Miura, M. Maeda, and W. Taki Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 753 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nighoghossian, L. Derex, and P. Douek The Vulnerable Carotid Artery Plaque: Current Imaging Methods and New Perspectives Stroke, December 1, 2005; 36(12): 2764 - 2772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sabeti, M. Exner, W. Mlekusch, J. Amighi, P. Quehenberger, H. Rumpold, G. Maurer, E. Minar, O. Wagner, and M. Schillinger Prognostic Impact of Fibrinogen in Carotid Atherosclerosis: Nonspecific Indicator of Inflammation or Independent Predictor of Disease Progression? Stroke, July 1, 2005; 36(7): 1400 - 1404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Spagnoli, A. Mauriello, G. Sangiorgi, S. Fratoni, E. Bonanno, R. S. Schwartz, D. G. Piepgras, R. Pistolese, A. Ippoliti, and D. R. Holmes Jr Extracranial Thrombotically Active Carotid Plaque as a Risk Factor for Ischemic Stroke JAMA, October 20, 2004; 292(15): 1845 - 1852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H Reinhart Fibrinogen - marker or mediator of vascular disease? Vascular Medicine, August 1, 2003; 8(3): 211 - 216. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Federici, R. Menghini, A. Mauriello, M. L. Hribal, F. Ferrelli, D. Lauro, P. Sbraccia, L. G. Spagnoli, G. Sesti, and R. Lauro Insulin-Dependent Activation of Endothelial Nitric Oxide Synthase Is Impaired by O-Linked Glycosylation Modification of Signaling Proteins in Human Coronary Endothelial Cells Circulation, July 23, 2002; 106(4): 466 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Newman, B. L. Naydeck, J. Whittle, K. Sutton-Tyrrell, D. Edmundowicz, and L. H. Kuller Racial Differences in Coronary Artery Calcification in Older Adults Arterioscler Thromb Vasc Biol, March 1, 2002; 22(3): 424 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Palmieri, A. Celentano, M. J. Roman, G. de Simone, M. R. Lewis, L. Best, E. T. Lee, D. C. Robbins, B. V. Howard, and R. B. Devereux Fibrinogen and Preclinical Echocardiographic Target Organ Damage: The Strong Heart Study Hypertension, November 1, 2001; 38(5): 1068 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Rizos and D. P Mikhailidis Are high density lipoprotein (HDL) and triglyceride levels relevant in stroke prevention? Cardiovasc Res, November 1, 2001; 52(2): 199 - 207. [Abstract] [Full Text] [PDF]
|
|