Abstract
AbstractObjectiveThis study aimed to compare the plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), hemopexin (Hpx), and interleukin-4 (IL-4) in patients with carotid artery atherosclerosis based on neurological symptoms and plaque histopathology and to find association between plaque stability and neurological symptoms. This single-center study included patients treated surgically for significant stenosis of the internal carotid artery. Serum levels of biomarkers were determined, and a histopathological analysis of the carotid plaques was performed. Within 70 patients, 40 asymptomatic and 30 symptomatic; 38 patients (54.3%) were diagnosed with unstable carotid plaque and 32 patients (45.7%) had a stable carotid plaque. Significantly higher incidence of unstable carotid plaque was detected in symptomatic patients (p <0.001). Compared to asymptomatic patients, higher expression of Lp-PLA2 (285.30 ± 2.05 μg/l), Hpx (0.38 ± 0.01 ng/l), and IL-4 (65.77 ± 3.78 ng/l) in plasma were detected in symptomatic patients. Subsequently, higher expression of Lp-PLA2 (297.34 ± 2.3 μg/l), Hpx (0.41 ± 0.02 ng/l), and IL-4 (64.74 ± 4.47 ng/l) in plasma was observed in patients with unstable plaques (n=38). Statistically significant (p <0.001) differences in expression of Lp-PLA2, Hpx, and IL-4 between patients with unstable and stable plaques were detected. Moreover, only the differences between symptomatic and asymptomatic patients in the expression of Lp-PLA2 and IL-4 in plasma were statistically significant (p <0.001). This study showed that Lp-PLA2, IL-4, and Hpx levels are significantly increased in patients with an unstable carotid plaque.
Highlights
Stroke is considered the primary cause of acquired disability in the elderly population and the second most common cause of mortality in developed countries
No significant differences were noted in the plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) between men and women within the two groups
Our research showed that patients with symptomatic stenosis of the internal carotid artery had significantly higher plasma levels of Lp-PLA2 and IL-4 compared to patients with asymptomatic stenosis
Summary
Stroke is considered the primary cause of acquired disability in the elderly population and the second most common cause of mortality in developed countries. Recent studies have suggested that not merely the degree of carotid artery stenosis and plaque features could contribute to brain ischemia [3]. The detection of a vulnerable carotid plaque can help in identifying patients who are at a high risk for stroke, but they are not candidates for surgery according to the current guidelines. Such patients might be candidates for surgery or stenting even if they have a lesser degree of carotid artery stenosis, that is, below 70% in asymptomatic and below 50% in symptomatic patients. Evidence suggests that an unstable carotid plaque might be a predictor of the presence and severity of coronary artery disease and other forms of systemic atherosclerosis [10]
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