Published Online
on August 30, 2007

A more recent version of this article appeared on October 1, 2007

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Submitted on March 8, 2007
Revised on April 9, 2007
Accepted on April 20, 2007

Artery-Related Differences in Atherosclerosis Expression. Implications for Atherogenesis and Dynamics in Intima-Media Thickness

Søren Dalager MD, PhD^*; William P. Paaske MD, DrMedSci; Ingrid Bayer Kristensen MD; Jacob Marsvin Laurberg MD, PhD; and Erling Falk MD, DrMedSci

From the Departments of Cardiothoracic and Vascular Surgery T (S.D., W.P.P.), and Cardiology B (S.D., J.M.L., E.F.), Aarhus University Hospital, Skejby, Denmark; and the Institute of Forensic Medicine, University of Aarhus (I.B.K., S.D.), Århus, Denmark.

^* To whom correspondence should be addressed. E-mail: soren{at}dalager.eu.

Background and Purpose—Information about the expression of atherosclerosis in different arteries is important. The impact of cardiovascular risk factors is artery-related, and the assessment of arterial structure and function in peripheral arteries are increasingly used as surrogate markers for coronary atherosclerosis and the risk of developing heart attack.

Methods—In an autopsy study, we analyzed the coronary, carotid and superficial femoral arteries from 100 individuals (70 men; 20 to 82 years of age) of which 27 died from coronary atherosclerosis. Microscopic sections (n=4756) were analyzed blindly using a modification of the histological classification endorsed by the American Heart Association (AHA).

Results—We found distinct artery-dependent patterns of atherosclerosis with a high prevalence of foam cell lesions and lipid core plaques in the carotid arteries. The femoral arteries were least affected by atherosclerosis, foam cell lesions were rare, and the development of advanced atherosclerosis was strongly age-dependent and dominated by fibrous plaques. Plaques were most common in the left anterior descending coronary artery and the carotid bifurcation. In coronary (versus noncoronary) death, lipid core plaques were more prevalent in all arteries.

Conclusions—The initiation, speed of development, and phenotypic expression of atherosclerotic plaques are artery-related. Foam cell lesions are frequent in the carotid arteries, probably explaining the dynamics in carotid intima-media thickness. Atherosclerosis develops slowly in femoral arteries, and severe atherosclerosis is dominated by fibrous plaques. The higher prevalence of lipid core plaques in all arteries in coronary death indicates a systemically more vulnerable expression of atherosclerosis in these individuals.

Key words: atherosclerosis • carotid atherosclerosis • coronary atherosclerosis • pathology • peripheral vascular disease

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