The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here:

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

ludc webb

Mihaela Nitulescu

Laboratory engineer

ludc webb

Plaque vulnerability index predicts cardiovascular events : A histological study of an endarterectomy cohort


  • Isabel Goncalves
  • Jiangming Sun
  • Christoffer Tengryd
  • Mihaela Nitulescu
  • Ana F. Persson
  • Jan Nilsson
  • Andreas Edsfeldt

Summary, in English

BACKGROUND: The balance between stabilizing and destabilizing atherosclerotic plaque components is used in experimental studies and in imaging studies to identify rupture prone plaques. However, we lack the evidence that this balance predicts future cardiovascular events. Here we explore whether a calculated histological ratio, referred to as vulnerability index (VI), can predict patients at higher risk to suffer from future cardiovascular events. METHODS AND RESULTS: Carotid plaques and clinical information from 194 patients were studied. Tissue sections were used for histological analysis to calculate the VI (CD68 [cluster of differentiation 68], alpha-actin, Oil red O, Movat pentachrome, and glycophorin A). Postoperative cardiovascular events were identified through the Swedish National Inpatient Health Register (2005-2013). During the follow-up (60 months) 45 postoperative cardiovascular events were registered. Patients with a plaque VI in the fourth quartile compared with the first to third quartiles had significantly higher risk to suffer from a future cardiovascular event (P=0.0002). The VI was an independent predictor and none of the 5 histological variables analyzed separately predicted events. In the 13 patients who underwent bilateral carotid endarterectomy, the VI of the right plaque correlated with the VI of the left plaque and vice versa (r=0.7, P=0.01). CONCLUSIONS: Our findings demonstrate that subjects with a high plaque VI have an increased risk of future cardiovascular events, independently of symptoms and other known cardiovascular risk factors. This strongly supports that techniques which image such plaques can facilitate risk stratification for subjects in need of more intense treatment.


  • Cardiovascular Research - Translational Studies
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health
  • Surgery (Lund)
  • Hepato-Pancreato-Biliary Surgery

Publishing year





Journal of the American Heart Association





Document type

Journal article




  • Cardiac and Cardiovascular Systems


  • Atherosclerosis
  • Histopathology
  • Plaque rupture
  • Vulnerable plaque



Research group

  • Cardiovascular Research - Translational Studies
  • Hepato-Pancreato-Biliary Surgery


  • ISSN: 2047-9980