Open AccessAtheromatous plaque reflects serum total cholesterol levels: A comparative morphologic study of endarterectomy coronary atherosclerotic plaques removed from patients from the southern part of India and caucasians from Ottawa, Canada
Author(s) -
Varghese P. Jacob,
Walley Virginia,
Arumugam Sarasa Bharati,
Cherian K. M.,
Farb Andrew,
Virmani Renu
Publication year - 1998
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960210507
Subject(s) - medicine , stenosis , cholesterol , population , coronary artery disease , cardiology , artery , endarterectomy , incidence (geometry) , surgery , physics , environmental health , optics
Background : Natives of South India have a very high incidence of coronary artery disease, despite low calorie and fat intake. Hypothesis : This study was undertaken to determine whether morphologic features of atheromatous plaque reflect the serum total cholesterol. Methods : Fifty‐three endarterectomy specimens from patients (mean age 47 ± 9 years, mean cholesterol 203 ± 47 mg/dl) obtained from one cardiac surgeon working in a single institution in South India were evaluated. Morphologic findings were compared with 40 endoarterectomy specimens obtained from age‐matched Caucasians from Ottawa, Canada, with a reported mean cholesterol of 262 ± 47 mg/dl. Morphometric measurements of the vessel size, percent stenosis, and the various components of the atherosclerotic plaque were determined by computerized planimetry. Results : The vessel size was smaller in the Indian than in the Canadian population (4.6 ± 2.9 vs. 5.6 ± 3.0 mm 2 , p = 0.07), the plaque area was less (4.3 ± 2.3 vs. 5.3 ± 2.8 mm 2 , p = 0.055) and the calculated percent stenosis was significantly less (93 vs. 96%, p = 0.028). Of all the parameters evaluated, only necrotic core in the Indian population (7.1 ± 10.9% vs. Canadian 16.7 ± 19.7%, p <0.001) and proteoglycan deposition (7.9 ± 11.2% vs. Canadian 3.7 ± 5.3%, p<0.023) were significantly different. Despite the Indians having low total cholesterol, there was greater diffuse double and triple‐vessel disease and at a younger age than in the Caucasians. Conculsions : From our data, it appears that the mechanism of development of atherosclerotic disease in the Indians may be different because they have smaller vessels, smaller necrotic core, and greater proteoglycan deposition. Other etiologies, especially those related to a high carbohydrate diet (which is typical for South Indians), should be considered.