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The Role of Cholesterol Crystals in Plaque Rupture Leading to Acute Myocardial Infarction and Stroke

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Cholesterol Crystals in Atherosclerosis and Other Related Diseases

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

It is now evident that cholesterol crystals (CCs) in atherosclerotic plaques are not innocent bystanders but rather active contributors to plaque growth and rupture. Bench experiments have revealed that as cholesterol undergoes phase transition from a liquid to a solid crystalline it rapidly expands to occupy a greater volume. When this process occurs within the core of an atherosclerotic plaque the rapid volume expansion can lead to disruption of the plaque architecture resulting in rupture and/or erosion. The ability for CCs to disrupt fibrous tissue has been demonstrated in both in vitro and ex vivo studies using various microscopic techniques and a modified tissue preparation method that avoids ethanol in order to preserve CCs. In specimens of coronary arteries of patients who died with myocardial infarction, CCs were found to be perforating the fibrous caps of ruptured plaques. Furthermore, crystals in the interstitial space can be recognized as a foreign body by the innate immune system that then triggers an inflammatory response contributing to plaque destabilization. Following plaque rupture, CCs released into the circulation can scrape the endothelial surface causing arterial spasm, obstruct the microcirculation, and trigger a local tissue inflammation that altogether cause a combined ischemic and inflammatory tissue injury. Thus, CCs continual formation and growth plays a critical role throughout the atherosclerotic process, up to and including their role in causing myocardial infarction while further aggravating muscle injury.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA

    George S. Abela

  2. Visalia Cardiovascular and Medical Center, Visalia, CA, USA

    Kusai Aziz

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  1. George S. Abela
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  2. Kusai Aziz
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Correspondence to George S. Abela .

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Editors and Affiliations

  1. Department of Medicine, Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA

    George S. Abela

  2. The Heart and Vascular Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Stefan Mark Nidorf

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Abela, G.S., Aziz, K. (2023). The Role of Cholesterol Crystals in Plaque Rupture Leading to Acute Myocardial Infarction and Stroke. In: Abela, G.S., Nidorf, S.M. (eds) Cholesterol Crystals in Atherosclerosis and Other Related Diseases. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-41192-2_10

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  • DOI: https://doi.org/10.1007/978-3-031-41192-2_10

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