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Cited by 1,127Atherosclerosis and Cardiovascular DiseasesAortic Thrombus and EmbolismCerebrovascular and Carotid Artery Diseases

Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content.

Open access
Davies, M J, Richardson, P D, Woolf, N, Katz, D R, Mann, J·1993·Heart
DOI 10.1136/hrt.69.5.377PMC PMC1025095
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Abstract

OBJECTIVE: To assess the size of the lipid pool and the number of smooth muscle cells and monocyte/macrophages in human aortic plaques that were intact and to compare the results with those in aortic plaques undergoing ulceration and thrombosis. DESIGN: The lipid pool was measured as a percentage of the total cross sectional area of the plaque. Immunohistochemistry was used to identify cell types (monocytes/macrophages (M phi) by EBM11 and HAM56, smooth muscle cells by alpha actin). The area of the tissue occupied by each cell type was measured by quantitative microscopy in the peripheral (shoulder) area of the plaque and the plaque cap. Absolute counts of each cell type were expressed as the ratio of SMC:M phi. MATERIAL: Aortas were obtained at necropsy from men aged less than 69 years who died suddenly (within 6 hours of the onset of symptoms) of ischaemic heart disease. 155 plaques from 13 aortas were studied. Four aortas showed intact plaques only (group A, n = 31). Nine aortas showed both intact plaques (group B, n = 79) and plaques that were undergoing thrombosis (group C, n = 45). RESULTS: In 41 (91.1%) of the 45 plaques undergoing thrombosis (group C) lipid pools occupied more than 40% of the cross sectional area of the plaque. Only 12 (10.9%) of the 110 intact plaques (groups A + B) had lipid pools of this size. The mean size of the lipid pool in plaques of groups A, B, and C was 12.7%, 27.3% and 56.7% respectively. Compared with intact plaques those undergoing thrombosis contained a smaller volume of smooth muscle cells (2.8% v 11.8%) and a larger volume of monocyte/macrophages (13.7% v 2.9%) in the plaque cap. The ratio of the number of smooth muscle cells to monocytes/macrophages was 7.8 in group A plaques, 4.1 in group B plaques, and 1.0 in group C plaques. This gradient was the result of an absolute increase in monocyte/macrophages and an absolute decrease in smooth muscle cells. CONCLUSIONS: In the aorta ulceration and thrombosis were characteristic of plaques with a high proportion of their volume occupied by extracellular lipid, and in which there was a shift toward a preponderance of monocyte/macrophages compared with smooth muscle cells in the cap.

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  • The integrity of the fibrous cap, comprising mostly αSMA-positive cells and associated ECM, is critical to stabilise and protect plaques from rupture.

    “detailed post-mortem analyses of culprit plaques in sudden cardiac death established that the integrity of the fibrous cap, comprising mostly α SMA-positive cells and associated extracellular matrix (ECM), is critical to stabilise and protect plaques from rupture, a major cause of the clinical sequalae of atherosclerosis 142,163,168 .”

    From Vascular smooth muscle cells in atherosclerosis (2019) · cites this paper as [142]

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Research works printed but not linked: 5

  1. Fuster V, Badimon L, Badimon J, Chesebro J. The patho- genesis of coronary artery disease and the acute coro- nary syndrome II. N Engl Jf Med 1992;326:310-8.
  2. Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation 1985;71:699-708.
  3. Nissen S, Gurley J, Booth D, et al. Differences in ultravas- cular plaque morphology in stable and unstable patients [abstr]. Circulation 1991;84:436.
  4. Faggiotto A, Ross R. Studies of hypercholesterolaemia in non-human primates. II Fatty streak conversion to fibrous plaque. Arteriosclerosis 1984;4:341-56.
  5. Stary H. Progression and regression of experimental atherosclerosis in rhesus monkeys. In: Goldsmith E, Morr-Hankowsky J, ed. Medical primatology. Basel: S Karger, 1972:356-7.

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Authors
Davies, M. J., Richardson, P. D., Woolf, N., Katz, D. R., & Mann, J.
Affiliations
St George's, University of London (GB)
ORCID
Venue
Heart
Publisher
BMJ
Published
1993-05-01
Volume
69
Issue
5
Pages
377-381
ISSN
1355-6037 (ISSN-L)
DOI
10.1136/hrt.69.5.377
PMC
PMC1025095
OpenAlex
W2026856116
Cited by
1,127
References
29
Citations by year
2026: 2 · 2025: 9 · 2024: 12 · 2023: 14 · 2022: 12 · 2021: 18 · 2020: 25 · 2019: 14 · 2018: 23 · 2017: 20 · 2016: 27 · 2015: 37 · 2014: 45 · 2013: 36 · 2012: 37
FWCI
10.14
Type
journal article
Language
en
Open access
Locations
  • Heart (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords
atherosclerosis, aortic plaque, thrombosis, plaque ulceration, lipid pool, extracellular lipids, macrophages, smooth muscle cells, plaque vulnerability, sudden cardiac death, ischemic heart disease, plaque composition, plaque rupture risk, plaque regression
MeSH terms
Aged, Aorta, Arteriosclerosis, Cell Count, Humans, Immunohistochemistry, Lipids, Macrophages, Male, Muscle, Smooth, Vascular, Risk Factors, Thrombosis

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