Small entities with large impact: microcalcifications and atherosclerotic plaque vulnerability

Purpose of reviewAtherosclerotic plaque rupture and subsequent acute events, such as myocardial infarction and stroke, contribute to the majority of cardiovascular-related deaths. Calcification has emerged as a significant predictor of cardiovascular morbidity and mortality, challenging previously held notions that calcifications stabilize atherosclerotic plaques. In this review, we address this discrepancy through recent findings that not all calcifications are equivalent in determining plaque stability. Recent findingsThe risk associated with calcification is inversely associated with calcification density. As opposed to large calcifications that potentially stabilize the plaque, biomechanical modeling indicates that small microcalcifications within the plaque fibrous cap can lead to sufficient stress accumulation to cause plaque rupture. Microcalcifications appear to derive from matrix vesicles enriched in calcium-binding proteins that are released by cells within the plaque. Clinical detection of microcalcifications has been hampered by the lack of imaging resolution required for in-vivo visualization; however, recent studies have demonstrated promising new techniques to predict the presence of microcalcifications. SummaryMicrocalcifications play a major role in destabilizing atherosclerotic plaques. The identification of critical characteristics that lead to instability along with new imaging modalities to detect their presence in vivo may allow early identification and ...
Source: Current Opinion in Lipidology - Category: Lipidology Tags: ATHEROSCLEROSIS: CELL BIOLOGY AND LIPOPROTEINS: Edited by Andrew Newby and Yury Miller Source Type: research

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gro G Abstract Background: Combination of dual antiplatelet (DAPT) and oral anticoagulation therapy is required to decrease cardioembolic stroke and stent thrombosis risk in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS). We compared the safety and efficacy of dabigatran etexilate with vitamin K antagonist (VKA), in combination with DAPT (aspirin plus clopidogrel) treatment in AF patients who underwent percutaneous coronary intervention (PCI) with stenting for ACS. Methods: Consecutive nonvalvular AF patients who received twice-daily dabigatran 110 mg (n = 389) or VKA (n = 510) and D...
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Chronic inflammation and oxidative stress disrupt the function of smooth muscle cells in blood vessel walls. This is one of the contributing causes of vascular stiffness with age, alongside cross-links, calcification, and loss of elastin, all of which alter the structural properties of blood vessel tissue to produce a reduction in elasticity. There is the question of the relative importance of these contributions, a question that exists for most aspects of aging at the present time, lacking easy ways to remove only one contributing factor to assess the outcome. Nonetheless, the research results noted here suggest that smoo...
Source: Fight Aging! - Category: Research Authors: Tags: Daily News Source Type: blogs
Publication date: Available online 21 March 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Michael Stallard, Indran RajuAbstractCarotid endarterectomy (CEA) is a surgical procedure to prevent strokes in patients with atheromatous disease at the carotid bifurcation. The effectiveness of CEA has been established in large clinical trials. Patients should have surgery performed within 2 weeks from the onset of symptoms. This time frame presents challenges to the anaesthetist and surgeon in terms of risk stratification and optimization of patients. Optimization includes blood pressure control and use of antiplat...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Abstract Cardiovascular disease (CVD) represents the first cause of death globally. The nighttime is generally a period of relative protection from CVD events such as myocardial infarction, sudden cardiac death, and stroke, at least compared to the early morning period. The nighttime also generally entails lower values of arterial blood pressure (ABP) and heart rate (HR) and higher cardiac parasympathetic modulation. These day-night cardiovascular rhythms are ultimately driven by circadian molecular oscillators in the hypothalamic suprachiasmatic nucleus and in peripheral cells, including those in the heart, blood...
Source: Autonomic Neuroscience - Category: Neuroscience Authors: Tags: Auton Neurosci Source Type: research
Sickle cell disease (SCD) is one of the most common hereditary hemoglobinopathies worldwide, affecting almost 400,000 newborns globally each year. It is characterized by chronic hemolytic anemia and endothelial dysfunction, resulting in a constant state of disruption of the vascular system and leading to recurrent episodes of ischemia-reperfusion injury (I/RI) to multiple organ systems. I/RI is a fundamental vascular pathobiological paradigm and contributes to morbidity and mortality in a wide range of conditions, including myocardial infarction, stroke, acute kidney injury, and transplantation.
Source: American Journal of Pathology - Category: Pathology Authors: Tags: Review Source Type: research
Hypertension, raised blood pressure due to age-related dysfunction of blood vessels, is an important process in aging. It is one of the more important ways in which low-level biochemical damage and cellular malfunctioning is converted into high level structural damage to tissues. Pressure damage to the sensitive tissues of the brain, kidney, lungs, and more causes large degrees of functional loss when taking place over years. In the brain, rupture of capillaries leads to countless tiny, unnoticed strokes, each destroying a small volume of brain tissue. This slowly adds up to produce cognitive decline and dementia, one smal...
Source: Fight Aging! - Category: Research Authors: Tags: Daily News Source Type: blogs
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Source: Clinical Drug Investigation - Category: Drugs & Pharmacology Source Type: research
Zoltan Kiss, Gy örgy Rokszin, Zsolt Abonyi-Tóth, György Jermendy, Péter Kempler, István Wittmann
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
ConclusionIn patients suffering from severe CS due to AMI, the use of Impella is not associated with improved short-time survival but with higher complications rates compared to IABP and medical treatment. Better patient selection avoiding Impella implantation in futile situations or in possible lower risk CS might be necessary to elucidate possible advantages of Impella in future studies.
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Publication date: Available online 20 March 2019Source: Indian Heart JournalAuthor(s): Gaurang Nandkishor Vaidya, Abdur Khan, Shahab GhafghaziAbstractBackgroundMorphine is the recommended analgesic in acute myocardial infarction (AMI). This recommendation has come under scrutiny due to possible slow uptake of oral antiplatelet agents.ObjectiveWe performed a meta-analysis of all available studies in AMI patients treated with prasugrel or ticagrelor (P2Y12 inhibitors), that reported use of morphine prior to loading the antiplatelet agents to critically assess the safety of co-administration of morphine and the newer P2Y12 in...
Source: Indian Heart Journal - Category: Cardiology Source Type: research
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