Complex aortic plaque: Clinical manifestations, diagnosis, and management strategies

Calcification of the aorta illustrates a complex interaction of not only atherosclerosis but also two other important systemic diseases of inflammation and altered bone metabolism, directly impacting large vessel calcification. Large vessel calcification has been demonstrated to share stimulatory as well as inhibitory mechanisms with bone metabolism, sharing common regulatory processes with osteoporosis. Bone morphogenic proteins are present, as secretory cytokines, in large vessel atherosclerotic plaques. Aortic calcification highlights the different processes and cells involved in determining the susceptibility of calcification of large vessels. Medial calcification, more common in medium and large vessels, occurs separately from intimal calcification. This is due to both the smooth cell genetic lineage as well as the systemic stimulus for calcification. In addition to obstructive vascular pathology, stiffening of the aorta increases cardiovascular stress, worsens diastolic heart failure, and contributes to arrhythmias.