Calcium in atherosclerosis

Why it is sometimes good and sometimes bad

The Calcium and VP paradox

• Ca burden is significant predictor of future cardiovascular events

• Ca rupture papers often do not refer to calcification

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1: Detrano RC, Doherty TM, Davies MJ, Stary HC.Related Articles, Links – Predicting coronary events with coronary calcium: pathophysiologic and

clinical problems.Curr Probl Cardiol. 2000 Jun;25(6):374-402. Review. No abstract available.PMID: 10849509 [PubMed - indexed for MEDLINE]

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Although not previously emphasized in the literature, several of the concepts described in this paper have been previously shown.

• Cheng 8462145 in their figure 2 show a section with plaque rupture significant calcification in close contact with the lipid core, very deep in the plaque and close to the lumen. A stable plaque (their Fig 3) shows a densely calcified plaque with no lipid core.

• Virmani 8273736 showed in figures 1,2,8, and 11 deep calcification. In fig 12 deep when is mild and diffuse when is extensive

• Burke 11804983 calcification deep and far from the lumen in a case of rupture. Plaque hemorrhage possibly due to angiogenesis?

• Huang 11222465 2 foci: a more superficial is lipid core with deep small calcification; the second is deeper than the first and complete calcification

• Scott 11078233 calcification from lumen to media without calcification• Kolodgie 11021830 Perfect diagram, with cholesterol clefts and deep

calcification

• Virmani 10807742. Fig. 3 – Right side. Fibrous cap atheroma. In the diagram there is a large necrotic core with cholesterol clefts. The core is underlined by a focus of calification that adjacent to the media.

• Fig. 4 – Far left. With rupture. Calcification focus deep into the core.• 3rd from left. Case of erosion. Almost same as previous.• Far roght is the calcified nodule where there is still great co-localization between the necrotic core

and the Ca, that reaches the lumen. As opposed to what we saw, there is still lipid core in the diagram. What we saw was disappearance of core at this stage.

• Fig 5. – Left. Fibrous cap atheroma. Calcification is in the deep portion and to the far right of the core. There is hemorrhage in the core, that also goes well with our co-localization study of angiogenesis and calcium.

• Center. Necrotic core with calcification deep in the plaque.• Right. Fibrocalcification. Reaches lumen, but again, it shows some lipid core. The text mentions

that fiibrocalcific plaques “when present, the necrotic core is small”.• Fig. 7 – Healed erosion.• Healed rupture. SMC. Calcification deep and at edge of necrotic core.• Total occlusion. Calcification occupying half of the deep necrotic core.• Fig. 8 – No diagram, but the Ca is obvious, co-localized with the necrotic core.• Stary Fig. 38 – “Calcification and fibrosis at the base of a lipid core of a lesion in the distal

abdominal aorta. Irregular masses of mineral at such location suggest that deep parts of the core were calcified.”

• Gronholdt 11802145 Macrophages are associated with lipid-rich carotid artery plaques, echolucency on B-mode imaging, and elevated plasma lipid levels.

• “Macrophages were particularly common in plaques with a high content of lipid and hemorrhage and, conversely, rare in plaques dominated by calcification and fibrous tissue.”

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Rabbit calcification

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