Strokes and myocardial infarctions (MIs) are the leading causes of death and long-term disability world-wide. Every 7 minutes, one Canadian dies from a heart attack or stroke, resulting in close to 100,000 deaths each year. Survivors remain at a high annual risk of recurrent ischemic events and mortality. An estimated 1.6 million Canadians have heart disease or are living with the effects of a stroke, according to the Public Health Agency of Canada. This causes a deep burden on the health care system, costing the Canadian economy more than $21 billion in direct and indirect costs each year. With numbers like these, there is a serious need to help patients living with this disease.
What is atherosclerosis?
Atherosclerosis is the buildup of fatty deposits in the arteries that provide blood to the heart and brain. The rupture of unstable atherosclerotic plaques (also known as high-risk or vulnerable plaques) in the internal carotid artery (artery of the neck that feeds blood to the brain) is one of the main etiological factors that causes severe and potentially life-threatening cerebrovascular events. Similarly, the most common cause of a MI is the rupture of an unstable atherosclerotic plaque that forms in the coronary arteries, which supply blood to the heart. Current guidelines recommend the surgical intervention of plaques (removal or stenting) based solely on the degree of artery stenosis (>i.e., ≥50%) caused by the plaque. However, it is increasingly recognized that stenosis alone is an incomplete determinant of heart attack or stroke risk, as it does not entirely reflect a plaque’s true instability and likelihood to rupture, leading to suboptimal medical decisions and inappropriate treatment allocation. Many plaques causing high-grade stenoses remain stable and asymptomatic (~40%), while unstable and potentially dangerous plaques often cause or even low-grade stenoses.
Many patients with stable plaques are being recommended unnecessary surgeries that impose unjustified risk, while others have unstable plaques that are ready to rupture and not recieving the treatment they need
help us change the status quo
Zheng H, Gasbarrino K, Veinot JP, Lai C, Daskalopoulou SS. New Quantitative Digital Image Analysis Method of Histological Features of Carotid Atherosclerotic Plaques. Eur J Vasc Endovasc Surg. 2019 Nov;58(5):654-663.
Hafiane A, Daskalopoulou SS. Extracellular vesicles characteristics and emerging roles in atherosclerotic cardiovascular disease. Metabolism. 2018 Aug;85:213-222
Gasbarrino K, Zheng H, Hafiane A, Veinot JP, Lai C, Daskalopoulou SS. Decreased Adiponectin-Mediated Signaling Through the AdipoR2 Pathway Is Associated With Carotid Plaque Instability. Stroke. 2017 Apr;48(4):915-924. doi: 10.1161/STROKEAHA.116.015145. Epub 2017 Mar 3.
Gasbarrino K, Mantzoros C, Gorgui J, Veinot JP, Lai C, Daskalopoulou SS. Circulating Chemerin Is Associated With Carotid Plaque Instability, Whereas Resistin Is Related to Cerebrovascular Symptomatology. Arterioscler Thromb Vasc Biol. 2016 Aug;36(8):1670-8.
Tat J, Psaromiligkos IN, Daskalopoulou SS. Carotid Atherosclerotic Plaque Alters the Direction of Longitudinal Motion in the Artery Wall. Ultrasound Med Biol. 2016 Sep;42(9):2114-22
Doonan RJ, Gorgui J, Veinot JP, Lai C, Kyriacou E, Corriveau MM, Steinmetz OK, Daskalopoulou SS. Plaque echodensity and textural features are associated with histologic carotid plaque instability. J Vasc Surg. 2016 Sep;64(3):671-677.e8.
Patterson NH, Doonan RJ, Daskalopoulou SS, Dufresne M, Lenglet S, Montecucco F, Thomas A, Chaurand P. Three-dimensional imaging MS of lipids in atherosclerotic plaques: Open-source methods for reconstruction and analysis. Proteomics. 2016 Jun;16(11-12):1642-51.
Doonan RJ, Hafiane A, Lai C, Veinot JP, Genest J, Daskalopoulou SS. Cholesterol efflux capacity, carotid atherosclerosis, and cerebrovascular symptomatology. Arterioscler Thromb Vasc Biol. 2014 Apr;34(4):921-6.
Doonan RJ, Dawson AJ, Kyriacou E, Nicolaides AN, Corriveau MM, Steinmetz OK, Mackenzie KS, Obrand DI, Daskalopoulos ME, Daskalopoulou SS. Association of ultrasonic texture and echodensity features between sides in patients with bilateral carotid atherosclerosis. Eur J Vasc Endovasc Surg. 2013 Sep;46(3):299-305
Gorgui J, Doonan RJ, Gomez YH, Kwong C, Daskalopoulou SS. Carotid endarterectomy improves peripheral but not central arterial stiffness. Eur J Vasc Endovasc Surg. 2013 Jun;45(6):548-53.
Daskalopoulou SS, Daskalopoulos ME, Perrea D, Nicolaides AN, Liapis CD. Carotid artery atherosclerosis: what is the evidence for drug action? Curr Pharm Des. 2007;13(11):1141-59
Daskalopoulou SS, Daskalopoulos ME, Theocharis S, Kavantzas N, Perrea D, Karandrea D, Constantinides AG, Mikhailidis DP, Nicolaides AN, Liapis CD. Metallothionein expression in the high-risk carotid atherosclerotic plaque. Curr Med Res Opin. 2007 Mar;23(3):659-70.