power point presentation of Clinical evaluation of strabismus
Plaque rupture definition
1. Plaque Rupture: Definition
Structural failure of the fibrocellular cap11
that
separates an atheromatous core22
from the lumen
of an atherosclerotic artery (ie, lumen ↔ core).
11
cap defect/gapcap defect/gap rupture, fissure, break, tear
not just missing endotheliumnot just missing endothelium
22
lipid-richlipid-rich Greek athere, gruel (soft)
Propensity to rupture
lipid-rich corelipid-rich core + → +++
no coreno core →→ no capno cap -
12. Plaque Rupture → Fatal Thrombosis
sexsex && ageage
Sex Age, y n Rupture Study
Male >41, all 37 86% Falk-
1983
<50 7 86%
-------------
+12 Females 50-70 22 82%
-------------
>70 20 80%
-------------
Male ~47 59 69%
Burke-1997
unrelated to age
13. Plaque Rupture → Fatal Thrombosis
sexsex && ageage
Sex Age, y n Rupture Study
Male >41, all 37 86% Falk-
1983
<50 7 86%
-------------
+12 Females 50-70 22 82%
-------------
>70 20 80%
-------------
Male ~47 59 69%
Burke-1997
unrelated to age
14. Plaque Rupture → Coronary Thrombosis
burden of CHDburden of CHD
*MI + fatal CHD. AHA 2002 Heart and Stroke Statistical Update.
Annual heart attacks in the US: 1,107,000*
• Men 668,000
Women,
• ≥45 y
430,000
• <45 y 9,000
39%
<1%
60%
15. Plaque Rupture → Coronary Thrombosis
burden of CHDburden of CHD
Annual heart attacks in the US: 1,107,000
Plaque erosionPlaque erosion
is the major substrate
for thrombosis in
premenopausal women.
Burke et al. Am Heart J 2001
39%
60%
~1%
16. Plaque Rupture → Coronary Thrombosis
burden of CHDburden of CHD
Annual heart attacks in the US: 1,107,000
Plaque erosionPlaque erosion
is the major substrate
for thrombosis in
premenopausal women.
Burke et al. Am Heart J 2001
Plaque rupturePlaque rupture
is the major substrate
in postmenopausal
women and men
~1%
17. Fatal Thrombosis: Rupture vs Non-rupture
ageage && sexsex
Rupture
+ - Study
p
Age, mean
53 y 44 y Farb-1996
<.02
68 y 70 y Arbustini-
1999 NS
69 y 71 y Kojima-2000
NS
Male 48 y 45 y Burke-1997
NS
18. Fatal Thrombosis: Rupture vs Non-rupture
ageage && sexsex
Rupture
+ - Study
p
Age, mean
53 y 44 y Farb-1996
<.02
68 y 70 y Arbustini-
1999 NS
69 y 71 y Kojima-2000
NS
Male 48 y 45 y Burke-1997
NS
19. Fatal Thrombosis: Rupture vs Non-rupture
whites vs blackswhites vs blacks
Rupture
+ - Study
p
Race
Race was not significantly (p>0.4)
associated with plaque rupture in men*
*Burke AP et al. N Engl J Med 1997;336:1276-82
20. Fatal Thrombosis: Rupture vs Non-rupture
hypercholesterolemiahypercholesterolemia
Rupture
+ - Study
p
Cholesterol
Male
mg/dlmg/dl 262 220 Burke-1997
.003
totaltotal::HDLHDL 8.5 5.0 Burke-1997
.003
Female
mg/dlmg/dl 270 188 Burke-1998
.007
totaltotal::HDLHDL 6.2 6.0 Burke-1998
NS
21. Fatal Thrombosis: Rupture vs Non-rupture
hypertensionhypertension
Rupture
+ - Study
p
Hypertension
22% 11% Burke-1997
NS
38% 22% Burke-1998
NS
56% 58% Kojima-2000
NS
22. Fatal Thrombosis: Rupture vs Non-rupture
diabetes mellitus ~ type 2diabetes mellitus ~ type 2
Rupture
n + - Study
p
Diabetes
8 13% 33% Falk-1983
41 11% 64% Davies-1996,
Circ
57 61% 42% Kojima-2000
NS
GlycoHgb
59 7.9% 6.9% Burke-1997
NS
23. Fatal Thrombosis: Rupture vs Non-rupture
diabetes mellitus ~ type 2diabetes mellitus ~ type 2
Rupture
n + - Study
p
Diabetes
8 13% 33% Falk-1983
41 11% 64% Davies-1996,
Circ
5757 61%61% 42%42% Kojima-2000Kojima-2000
NSNS
GlycoHgb
5959 7.9%7.9% 6.9%6.9% Burke-1997Burke-1997
NSNS
24. Fatal Thrombosis: Rupture vs Non-rupture
cigarette smokingcigarette smoking
Rupture
+ - Study
p
Smokers
71% 83% Burke-1997
NS
50% 78% Burke-1998
NS
62% 26% Kojima-2000
.04
25. Fatal Thrombosis: Rupture vs Non-rupture
local flow and shearlocal flow and shear
Rupture
+ - Study
p
Stenosis, mean
area, %area, % 91 93 Falk-1983
NS
78 70 Farb-1996
<.03
77 70 Burke-1998
NS
76 70 Kojima-
2000 NS
diameter, %diameter, % 39 64 Davies-
26. Fatal Thrombosis: Rupture vs Non-rupture
plaque calcificationplaque calcification
Rupture
+ - Study
p
Calcification
69% 23% Farb-1996
.002
27. Plaque Rupture → Fatal Thrombosis
exertion and sudden deathexertion and sudden death
Coronary thrombosis in men
n Rupture
Study
Acute exertion
+ 19 89%
Burke*
- 51 53%
--------
*Burke et al. JAMA 1999;281:921-26