Elemental Composition Of Surgically Removed Carotid Plaques

INTRODUCTION: Epidemiological studies indicate that metal exposure through diet, environment and smoking is associated with increased risk of cardiovascular disease. There are few data on the elemental composition of atherosclerotic carotid plaques.
METHODS: We examined clinical characteristics and elemental composition of surgical carotid endarterectomy plaques. Carotid endarterectomy plaques from 19 patients were collected and elemental compositions were determined by inductively coupled plasma optical emission spectrometry (ICP-OES) method.
RESULTS: Two of the 19 patients were female. Average age of the patients was 71.9±7.2 years. 47.4% of the patients were diabetic and 52.6% were hypertensive. Only one of the patients never smoked. Sodium (Na), magnesium (Mg), potassium (K), calcium (Ca), phosphorus (P), iron (Fe), copper (Cu), boron (B), manganese (Mn), zinc (Zn), aluminum (Al), sulphur (S), chromium (Cr), nickel (Ni), platinum (Pt), antimony (Sb), selenium (Se) were found in different concentrations but concentrations of arsenic (As), bismuth (Bi), cadmium (Cd), cobalt (Co), molybdenum (Mo), lead (Pb) in the carotid endarterectomy samples were below the detection limit of ICP-OES. Despite of fluctuations of metal concentrations among the patients, concentrations of Ca and P were significantly high with averages of 68613 ppm and 36669 ppm respectively.
DISCUSSION AND CONCLUSION: Results of those element levels should be carefully evaluated for their role in proatherogenic role. Common salts of Ca and P such as Ca(NO3)2, CaCl2, Na2HPO4, (NH4)2HPO4 are highly soluble in water and in blood but complexes of Ca with P such as Ca10(PO4)6(OH)2 (hydroxyapatite in bones) has very low solubility. Since there is a cell layer between the atherosclerotic plaques and the blood flow, probably soluble salts of Ca and P ions come to the accumulation site separately and they form insoluble complexes, which cannot pass the cell layer and accumulate. Also, reasons of the elemental accumulation and sources of the elements from bones, diet or other sources should be investigated in detail because they lead to development of new preventive and treatment approaches for carotid atherosclerotic plaques.

Cerrahi Endarterektomi Plaklarýnýn Elemental Yapýsý

GÝRÝÞ ve AMAÇ: Epidemiyolojik çalýþmalar diyet, sigara ve çevresel faktörler ile alýnan metallerin artmýþ kardiyovasküler risk oluþturduðunu göstermektedir. Aterosklerotik karotis plaklarýnýn element yapýsý ile ilgili sýnýrlý çalýþma mevcuttur.
YÖNTEM ve GEREÇLER: Çalýþmada cerrahi karotis endarterektomi materyallerinin element yapýsý ve hastalarýn klinik özellikleri incelendi. Karotis endarterektomi yapýlan 19 hastadan alýnan plaklarda indüktif-eþli plazma emisyon spektrometresi (ICP-OES) yöntemi ile element yapýsý incelendi.
BULGULAR: Hastalardan sadece iki tanesi kadýndý. Ortalama yaþ 71.9±7.2 yýl olarak bulundu. Hastalarýn %47.4'ünde diyabet ve %52.6'sýnda hipertansiyon saptandý. Sadece 1 hasta hiç sigara içmemiþti. Plaklarda sodyum (Na), magnezyum (Mg), potasyum (K), kalsiyum (Ca), fosfor (P), demir (Fe), bakýr (Cu), bor (B), manganez (Mn), çinko (Zn), alüminyum (Al), sülfür (S), krom (Cr), nikel (Ni), platin (Pt), antimon (Sb), selenyum (Se) elementleri farklý konsantrasyonda saptandý fakat arsenik (As), bizmut (Bi), kadmiyum (Cd), kobalt (Co), molibden (Mo), kurþun (Pb) seviyeleri ICP-OES sisteminin belirleme limitinin altýnda saptandý. Hastalarda varyasyon olmakla birlikte en yoðun olarak Ca ve P saptandý.
TARTIÞMA ve SONUÇ: Saptanan elementlerin aterojenik sürece katkýlarý detaylý incelenmelidir. Ca ve P'nin sýk bulunan Ca(NO3)2, CaCl2, Na2HPO4, (NH4)2HPO4 gibi tuzlarý kanda ve suda yüksek çözünürlüðe sahiptir fakat Ca10 (PO4)6(OH)2'nin (kemikteki hidroksi apatit) çözünürlüðü çok düþüktür. Kan akýmý ile aterosklerotik plak arasýnda bir hücre tabakasý olduðu için muhtemelen Ca ve P elementleri plak içine ayrý olarak gelip suda çözünmeyen kompleksler oluþturarak birikmektedir. Karotis plaklarýnda element birikmesi, bu elementleri kemik ve diyetten gelen kýsýmlarýnýn detaylý araþtýrýlmasý ile yeni önleyici ve tedavi edici yaklaþýmlar geliþtirilebilir.