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Microplastics and Nanoplastics in Atheromas and CV Events
Quick Takes
- Those with evidence of microplastics and nanoplastics (MNPs) within the carotid plaque had a greater incidence of a composite of MI, stroke, or death from any cause than patients who did not have MNPs within the atheroma.
- Mechanistic data from preclinical models has proposed both direct translocation of MNPs into the circulation and indirect mechanisms as possible underpinnings of the CV toxic effects observed with MNPs.
- The association between the presence of MNPs within plaque and the incidence of a composite of CVD or death outcomes may also entail the risk from exposure to other residual, unmeasured confounding variables, such as unknown exposures during the life course of the patient.
Study Questions:
What is the association of microplastics and nanoplastics (MNPs) with cardiovascular disease (CVD) composite endpoint of myocardial infarction (MI), stroke, or death from any cause?
Methods:
The investigators conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis–gas chromatography–mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary endpoint was a composite of MI, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs. Cox regression analysis was used to examine the association between the presence of MNPs within plaque and the incidence of the composite primary endpoint.
Results:
A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7 ± 6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7 ± 24.5 μg/mg of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2 ± 2.4 μg/mg of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary endpoint event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00-10.27; p < 0.001).
Conclusions:
The authors report that patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of MI, stroke, or death from any cause at 34 months of follow-up.
Perspective:
This study reports that those with evidence of MNPs within the carotid plaque had a greater incidence of a composite of MI, stroke, or death from any cause than patients who did not have MNPs within the atheroma. Mechanistic data from preclinical models has proposed both direct translocation of MNPs into the circulation and indirect mechanisms as possible underpinnings of the CV toxic effects observed with MNPs. However, the association between the presence of MNPs within plaque and the incidence of a composite of CVD or death outcomes may also entail the risk from exposure to other residual, unmeasured confounding variables, such as unknown exposures during the life course of the patient or, more broadly, the health status and behaviors of the patients. Additional prospective studies are indicated.
Clinical Topics: Prevention
Keywords: Microplastics, Plaque, Atherosclerotic
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