The risk of carotid plaque instability in patients with metabolic syndrome is higher in women with hypertriglyceridemia

Francesca Servadei,Francesca Di Daniele,Arnaldo Ippoliti,Lucia Anemona,Manuela Montanaro,Massimo Federici,Annalisa Noce,Nicola Di Daniele,Manuel Scimeca,Rita Bonfiglio,Erica Giacobbi,Iacopo Maria Legramante,Marina Cardellini,Valentina Rovella,Patrizia Borboni,Alessandro Mauriello

doi:10.1186/s12933-021-01277-8

Abstract

BackgroundMetabolic syndrome certainly favors growth of carotid plaque; however, it is uncertain if it determines plaque destabilization. Furthermore, it is likely that only some components of metabolic syndrome are associated with increased risk of plaque destabilization. Therefore, we evaluated the effect of different elements of metabolic syndrome, individually and in association, on carotid plaques destabilization.MethodsA total of 186 carotid endarterectomies from symptomatic and asymptomatic patients were histologically analysed and correlated with major cardiovascular risk factors.ResultsMetabolic syndrome, regardless of the cluster of its components, is not associated with a significant increase in risk of plaque destabilization, rather with the presence of stable plaques. The incidence of unstable plaques in patients with metabolic syndrome is quite low (43.9 %), when compared with that seen in the presence of some risk factors, but significantly increases in the subgroup of female patients with hypertriglyceridemia, showing an odds ratio of 3.01 (95% CI, 0.25–36.30).ConclusionsOur data may help to identify patients with real increased risk of acute cerebrovascular diseases thus supporting the hypothesis that the control of hypertriglyceridemia should be a key point on prevention of carotid atherosclerotic plaque destabilization, especially in post-menopausal female patients.

Highlights

Metabolic syndrome certainly favors growth of carotid plaque; it is uncertain if it determines plaque destabilization
The hypertension was the most frequently observed when it was evaluated according to both the ACC/American Heart Association (AHA) (162 patients, 87.1 %) and to the European Society of Cardiology (ESC)/ European Society of Hypertension (ESH) criteria (112 patients, 60.2 %)
The results obtained in our study show that Metabolic syndrome (MetS) is not associated with a significant increase in the risk of carotid plaque destabilization, regardless of the analyzed risk factors

Summary

Introduction

Metabolic syndrome certainly favors growth of carotid plaque; it is uncertain if it determines plaque destabilization. Despite it is known that the cardiovascular risk factors certainly facilitate the development and growth of atherosclerotic plaque, it is not yet fully understood exactly which in particular favor its destabilization by accelerating plaque growth with consequent rupture and thrombosis [16,17,18]. The identification of specific risk factors associated with plaque destabilization is important in the prevention and treatment of cerebrovascular syndromes. It is clear that the degree of stenosis alone is not sufficient to accurately identify patients at high risk of developing an acute cerebrovascular event. In this scenario, the identification of risk factors correlated with plaque destabilization becomes necessary to calculate the most real probability of ischemic cerebrovascular complications, stratifying patients with carotid atherosclerosis

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Results

Discussion

Conclusion