Calcium can be both good and bad in atherosclerosis. While calcium burden is a significant predictor of future cardiovascular events, papers on plaque rupture do not always discuss calcification. The document discusses several past studies that have shown calcium can be present deep within plaques, near the lipid core and necrotic areas. This suggests calcium is sometimes located in areas prone to rupture rather than only being present in stable, fibrotic regions. The location and extent of calcium deposits may help determine whether it indicates a more stable or high-risk plaque.

1. Calcium in atherosclerosis
Why it is sometimes good and
sometimes bad

2. The Calcium and VP paradox
• Ca burden is significant predictor of future
cardiovascular events
• Ca rupture papers often do not refer to
calcification

3. PubMed
davies mj atherosclerosis
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4. PubMed
davies mj atherosclerosis calcium
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]

5. PubMed
falk e atherosclerosis
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6. PubMed
falk e atherosclerosis calcium
No items found.

7. 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

8. • 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.”

15. Rabbit calcification

16. CD68
CD31