![]() ![]() Here we show results from a clinicopathological evaluation of the role of obesity in the destabilization of carotid plaques and development of cerebrovascular events.Ī total of 390 carotid specimens from the Interinstitutional Carotid Tissue Bank (ICTB) were studied carotid samples were collected from 265 symptomatic patients (major stroke or transient ischemic attack 67.9%) and 125 asymptomatic patients (32.1%) underwent to surgical carotid endarterectomy (CEA) at the University of Rome Tor Vergata (Italy).Īmong symptomatic patients, only those diagnosed with thrombo-embolism due to carotid atherosclerosis were included, whereas patients referred to any other cause of thrombo-embolism assessed by clinical examination and imaging were excluded. Thus, the evaluation of any correlation between obesity and plaque histologic features may be of significant clinical relevance. The main target for preventing ischemic cerebrovascular events is the identification of vulnerable plaques, prior to the onset of acute clinical symptoms. Furthermore, it remains still unknown whether the pro- or anti-atherosclerotic effect of obesity may be affected by age, gender and other major cerebrovascular risk factors. Nevertheless, histology is regarded as the gold standard for assessing the degree of atherosclerotic plaque vulnerability as well as the presence of cap rupture and acute luminal thrombosis, which is the major source of emboli in the cerebral circulation. Such conflicting evidence may be due to the fact that, in the carotid district, the atherosclerotic disease has been mainly investigated through imaging methods, instead of histologic evaluation. While obesity is regarded as a well-established risk factor for stroke, some studies reported significantly lower mortality rates in stroke patients with higher body mass index (BMI) values. The influence of obesity on atherosclerotic disease in the carotid district is still unclear. An analogous paradoxical influence of obesity was also demonstrated in an autopsy study on the aortic district. More recently, several studies underlined the so-called “obesity survival paradox” in patients suffering from acute myocardial infarction. Despite this mechanistic evidence, the role of obesity as a significant risk factor for development of clinically manifest cardiovascular disease is still controversial with both positive and neutral studies. Obesity is often accompanied by other comorbidities increasing the risk of atherosclerosis, particularly hypertension, dyslipidemia, and type 2 diabetes mellitus, the combination of which is observed in the metabolic syndrome. Conversely, obesity is confirmed to be an independent risk factor for carotid plaque destabilization, particularly in males aged < 70 years, significantly increasing such risk among patients with metabolic syndrome. Results from our study appear to do not confirm any paradoxical effect of obesity on the carotid artery district. Similar results were obtained when assessing the occurrence of acute cerebrovascular symptoms. When obesity featured among metabolic syndrome risk factors, the OR for plaque destabilization was 3.97 (95% CI 1.81–6.22), a significantly higher value compared to OR in non-obese individuals with metabolic syndrome (OR = 1.48 95% CI 0.86–2.31). Unstable carotid plaque OR for obese patients with age < 70 years was 5.91 (95% CI 1.17–29.80), thus being the highest OR compared to that of other risk factors. Data were analyzed by multivariate logistic regression and for each variable in the equation the estimated odds ratio (OR) was calculated. Patients with a BMI ≥ 30.0 kg/m 2 were considered as obese. ![]() MethodsĪ total of 390 carotid plaques from symptomatic and asymptomatic patients submitted to endarterectomy, for whom complete clinical and laboratory assessment of major cardiovascular risk factors was available, were studied by histology. Therefore, the purpose of our study was to evaluate by histology the role of obesity in destabilization of carotid plaques and the interaction with age, gender and other major cerebrovascular risk factors. This so called “obesity paradox effect” has been mainly investigated through imaging methods instead of histologic evaluation, which is still the best method to study the instability of carotid plaque. In the last decade, several studies have reported an unexpected and seemingly paradoxical inverse correlation between BMI and incidence of cardiovascular diseases.
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