Moving Vessel Wall Research Beyond the Plaque

Abstract

The overlap between atherosclerotic disease of the cerebrovascular, cardiovascular, and peripheral vasculature has long been recognized. Carotid atherosclerosis increases the odds of coronary events1 and of finding atherosclerotic changes in coronary, cerebral, aortic, and iliac arteries.2 Similarly, peripheral vascular disease is a risk factor for both stroke and myocardial infarction and is associated with extracranial carotid and intracranial atherosclerosis.3,4 Data from the Reduction of Atherothrombosis for Continued Health (REACH) registry show that atherosclerosis in 1 vascular bed increases the risk of adverse outcomes in each of the other locations, and that multiple disease locations at baseline increase the risk of subsequent cardiovascular and cerebrovascular events.5 Given shared underlying risk factors and pathophysiology, it is not surprising that those who present with atherosclerotic disease in 1 vascular bed are at increased risk for disease in others.6 See accompanying article on page 2240 It is fair to say that although considerable attention has been given to atherosclerotic disease affecting peripheral, cardiac, and carotid arteries, important gaps remain in our knowledge. For example, the intracranial circulation has received comparatively …