A 60 year old Swiss foundry worker with heavy air pollution at his working place was referred for a cardiovascular check-up due to unspecific chest pain a couple of weeks ago. He stopped smoking 10 years ago, has a normal blood pressure (110/75 mm Hg), LDL 3.2 mmol/l, HDL 2.0 mmol/l, no diabetes or family history of premature coronary artery disease. According to Swiss Risk Guidelines (AGLA 2014) he is in the low risk category (1.4% ten year risk), confirmed by the Framingham Risk Calculator (4.0%) and the ESC mortality risk calculator (0.9%).
The carotid examination revealed an extensive atherosclerosis with a total plaque area of 153 mm2, which corresponds to a 78 year old man (more…). Further, a massive partly mobile plaque Type IV in the aortic arch was detected. See images below.
High risk atherosclerosis with low risk chart results. The causes likeli are dysfunctional HDL, small dense LDL and air pollution. The patient was adviced to protect himself from air pollution, to take aspirin und statin and to present himself for a control in one year in the absence of new onset symptoms, otherwise rapid cardiological reassessment.
Plaque 1 original and with tracing of outer bounderies (40 mm2 plaque area)
Plaque 2 original and with tracing of outer bounderies (28 mm2 plaque area)
Partly mobile atherosclerotic plaque in the aortic arch