Atherosclerotic aorta
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Atherosclerotic Aorta: Insights and Implications
Atherosclerosis of the Ascending Aorta: Predictors of Neurologic Events and Mortality
Atherosclerosis of the ascending aorta has been identified as a significant predictor of long-term neurologic events and mortality. A study involving 1,957 patients undergoing cardiac surgery found that the severity of atherosclerosis in the ascending aorta, assessed via epiaortic ultrasound, was independently associated with increased risks of neurologic events and mortality. Specifically, hypertension, diabetes mellitus, and advanced age were also significant predictors. The study highlighted a more than threefold increase in the incidence of these adverse outcomes as the severity of atherosclerosis progressed from mild to severe .
Metabolic Profiling of Atherosclerotic Plaques
Metabolic alterations in atherosclerotic plaques provide insights into the disease mechanisms. Research using liquid chromatography/mass spectrometry on aortic tissues revealed significant differences in metabolic patterns between plaque-containing and plaque-free aortas. Dysregulation in oxidative stress pathways and inflammation-related metabolites, such as glucosylceramide and tryptophan, were noted. Additionally, quinic acid levels were elevated in plaques, suggesting its potential role in modulating inflammatory responses and oxidative stress .
Murine Models and Atherosclerosis Correlation
Murine models, particularly LDL receptor-deficient and apolipoprotein E-deficient mice, have been instrumental in studying atherosclerosis. These models exhibit extensive lesion formation throughout the aorta, correlating with the severity of hypercholesterolemia. The extent of atherosclerosis in the aortic origin was found to be indicative of the overall aortic lesion burden. Notably, male mice showed a higher prevalence of lesions compared to females, underscoring the influence of gender on atherosclerosis development .
Early Life Atherosclerosis: The Bogalusa Heart Study
The Bogalusa Heart Study examined atherosclerotic lesions in young individuals aged 6 to 30 years. The study found that aortic fatty streaks were more extensive in black individuals compared to whites, and coronary artery fatty streaks were more prevalent in males. These early lesions were strongly associated with traditional cardiovascular risk factors such as cholesterol levels and blood pressure, emphasizing the importance of early preventive measures .
Frequency and Location of Atherosclerotic Plaques
A study of 97 specimens from adults with coronary disease revealed that 38% had atherosclerotic plaques larger than 8 mm in the ascending aorta. The right side of the ascending aorta was more commonly affected, particularly near the orifice of the innominate and left subclavian arteries. This distribution pattern highlights specific areas of the aorta that are more susceptible to plaque formation .
Transcriptional Landscape of Aortic Macrophages
Single-cell RNA sequencing has uncovered the heterogeneity of aortic macrophages in atherosclerosis. Inflammatory macrophages and TREM2hi macrophages, which are involved in lipid metabolism and lesion calcification, were predominantly found in atherosclerotic aortas. These findings suggest specialized functions for different macrophage subsets in the progression of atherosclerosis .
Aortic Plaques as Markers for Coronary Artery Disease
Transesophageal echocardiography (TEE) has proven effective in detecting atherosclerotic plaques in the thoracic aorta, which are strong markers for coronary artery disease. Studies have shown that the presence of aortic plaques correlates with significant coronary artery obstruction, with high sensitivity and specificity. This diagnostic tool can thus aid in identifying patients at risk for coronary artery disease Parthenakis1996Agmon2003.
Aortic Dilatation and Atherosclerosis
The relationship between aortic dilatation and atherosclerosis is complex. While age, gender, and body surface area are major determinants of thoracic aortic dimensions, atherosclerosis risk factors and plaques have a minor association with distal aortic dilatation. This suggests that atherosclerosis plays a limited role in aortic dilatation compared to other factors .
Ulcerated Atherosclerotic Plaques and Stroke
Ulcerated plaques in the thoracic aorta, identified via TEE, are associated with cryptogenic ischemic strokes. These plaques, characterized by significant depth and width, are more prevalent in patients with unexplained strokes compared to those with known causes or no stroke history. This association underscores the potential of ulcerated plaques as sources of cerebral emboli .
Conclusion
Atherosclerosis of the aorta, particularly the ascending aorta, is a critical predictor of neurologic events and mortality. Metabolic profiling and murine models provide valuable insights into the disease mechanisms and progression. Early detection and preventive measures are essential, given the association of aortic plaques with coronary artery disease and stroke. Understanding the heterogeneity of aortic macrophages and the limited role of atherosclerosis in aortic dilatation further enriches our knowledge of this complex condition.
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