Age-associated changes in human carotid atherosclerotic plaques

Abstract

Little is known about changes in carotid plaque morphology during aging and the possible impact on cardiovascular events. Only few studies addressed so far age-related modifications within atherosclerotic lesions. Therefore, in this work we endeavored to summarize the current knowledge about changing of plaque composition in elderly. The data from hitherto existing studies confirm that atherosclerotic plaques undergo distinct alternations with advanced age. However, the results are often ambiguous and the changes do not seem to be as disastrous as expected. Interestingly, none of the studies could definitely evidence increased plaque vulnerability with advanced age. Nevertheless, based on the previous work showing decrease in elastin fibers, fibroatheroma, SMCs, overall cellularity and increase in the area of lipid core, hemorrhage, and calcification, the plaque morphology appears to transform toward unstable plaques. Otherwise, even if inflammatory cells often accumulate in plaques of younger patients, their amount is reduced in the older age and so far no clear association has been observed between thin fibrous cap and aging. Thus, the accurate contribution of age-related changes in plaque morphology to cardiovascular events has yet to be elucidated. KEY MESSAGES Composition of carotid atherosclerotic lesions changes during aging. These alternations are however, just moderate and depend upon additional variables, such as life style, accompanying disease, genetics, and other factors that have yet to be determined. Based on the current data, the age-associated plaque morphology seems to transform toward vulnerable plaques. However, the changes do not seem to be as disastrous as expected.

Carotid Disease and Ageing: A Literature Review on the Pathogenesis of Vascular Senescence in Older Subjects

“…Consistently, carotid intima-media thickness (cIMT), a common measure of atherosclerosis and useful tool for the prediction of cardiovascular and cerebrovascular events, displays a linear increase along with age irrespectively of other factors [23,24]. Furthermore, complicated carotid atheromas with intraplaque hemorrhage are related with older age as confirmed in multiple studies with use of ultrasound, magnetic resonance, and histological assessment of carotid plaques [25,26].…”

“…Carotid atheromatous disease and stenosis is a major factor of mortality among the elderly [3,20,138]. Advancing age is linearly associated with arterial stiffness and strongly associated with thickening of the vascular wall as assessed with cIMT and pulse wave velocity [21][22][23][24][25]. Alterations involving CA diameter and tortuosity increase along with age, while histological findings reveal consistent structural deformation [21-26, 139, 140].Moreover, atheromatous plaques develop with their score increasing along age [25].…”

“…Stable plaques that are at a solid state have a thick fibrous cap, while vulnerable or unstable ones are at a rather liquid state having a large lipid core and a thin fibrous cap related with inflammatory infiltrates [25][26][27].…”

“…e concurrent reduction of endothelial shear stress and increase of arterial stiffness and wall tension promote atherosclerosis. Consequently, the age-associated plaque morphology seems to change towards more vulnerable plaques, [25,28] the rupture of which leads to acute cerebrovascular and cardiovascular events, which increase in incidence with age.…”

Ultrasonic assessment of liver stiffness and carotid artery elasticity in patients with chronic viral hepatitis

“…Age is also a critical factor affecting the potential for development of arteriosclerosis [ 14 , 15 ]. In this study, participants were divided into two groups according to their age, with those aged 50 or above in one group and those aged under 50 in the other.…”