Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: An autopsy study
Received 4 July 2007; accepted 21 October 2007.
Objectives
Risk factors for atherosclerosis have limited ability to identify persons at high risk of coronary heart disease. Assessment of subclinical atherosclerosis in peripheral arteries might improve this limitation. We studied the relationship between atherosclerotic plaques in peripheral arteries, coronary plaques, and coronary death.
Methods
Predefined segments from the left anterior descending coronary artery, the right coronary artery, bilateral carotid, and superficial femoral arteries (SFA) were obtained from 100 autopsies (20-82 years, 30 females, 27 coronary deaths). Based on microscopic examination of 4756 sections, the extension of atherosclerosis (plaque burden) and the largest plaque area in each segment were quantified.
Results
Plaque burden in all arteries increased with age and was larger in coronary death (P < .05). SFA plaques occurred later than coronary and carotid plaques. When SFA plaque had developed, coronary plaque was also present. SFA plaque (odds ratio, 95% confidence interval: 7.07 [2.40-20.81]), but not carotid plaque, was significantly associated with coronary death, also after age and gender adjustment (21.25 [5.02-89.97]). The area under the receiver operating characteristic curves for the identification of coronary death individuals was 0.72 (95% confidence interval: 0.62-0.83) for coronary plaque, and 0.80 (0.72-0.89) for SFA plaque (age and gender adjusted).
Conclusions
Atherosclerosis develops slower in SFA compared with coronary and carotid arteries. In persons with plaque in the SFA, plaque is always present in the coronary arteries. In younger persons, the presence of SFA plaque indicates a generalized susceptibility to atherosclerosis and vulnerability to coronary death.
aDepartment of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital, Skejby, Århus, Denmark
bDepartment of Cardiology B, Aarhus University Hospital, Skejby, Århus, Denmark
cInstitute of Forensic Medicine, University of Aarhus, Århus, Denmark.
Reprint requests: Søren Dalager, MD, PhD, Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Århus C, Denmark.
Competition of interest: Dr Falk is on the Scientific Advisory board of the High-Risk Plaque Initiative, BG Medicine, Waltham, Mass (>$10,000).
ABSTRACT