Composition of Carotid Plaques Differs Between Chinese and United States Patients: A Histology Study

Composition of Carotid Plaques Differs Between Chinese and United States Patients: A Histology Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Composition of Carotid Plaques Differs Between Chinese and United States Patients: A Histology Study Jingli Cao, Marina Ferguson, Jie Sun, Mi Shen, Randy Small, Daniel S. Hippe, and 14 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7005564/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2025 Read the published version in Chinese Neurosurgical Journal → Version 1 posted You are reading this latest preprint version Abstract Background: The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (U.S.) populations as do the plaque features on imaging. Objectives: The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and U.S. patients. Methods: Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10 µm thickness) at 0.5-1 mm intervals. Hematoxylin and eosin staining and Mallory’s trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups. Results: A total of 1,152 histological sections from 75 Chinese patients and 1,843 sections from 111 U.S. patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p=0.046) and a larger percent wall volume (median: 74% vs. 70%, p=0.018) than the U.S. group. After adjusting for confounding factors, carotid plaques in the Chinese population were more likely to have more lipid pools (β=10.0%, 95%CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β=8.4%, 95%CI: 4.5 to 12.7%), and less late IPH (β=-8.2%, 95%CI:-11.3 to-5.4), and fewer fibrous cap disruptions (45% vs. 67%, p=0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did U.S. plaques (20% vs 2.7%, p<0.001). Conclusions: The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which could enhance the gap in racial pathology comparison, indicating a need for a different management approach. Carotid artery Atherosclerotic plaques Histology Carotid endarterectomy Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2025 Read the published version in Chinese Neurosurgical Journal → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7005564","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484531577,"identity":"290efdca-5600-4505-afbe-8d0c43f788e8","order_by":0,"name":"Jingli Cao","email":"","orcid":"","institution":"China National Clinical Research Center for Neurological Diseases, Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingli","middleName":"","lastName":"Cao","suffix":""},{"id":484531578,"identity":"15fe7579-dc3a-4976-8e60-b718143fd292","order_by":1,"name":"Marina Ferguson","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Ferguson","suffix":""},{"id":484531579,"identity":"59f69cad-3bf0-405e-ab49-f7f6e8a4db2b","order_by":2,"name":"Jie Sun","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Sun","suffix":""},{"id":484531580,"identity":"9f32884b-996a-4f3d-8833-3ff65e7351a3","order_by":3,"name":"Mi Shen","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mi","middleName":"","lastName":"Shen","suffix":""},{"id":484531581,"identity":"f20ba207-f21b-472e-a56d-a5f35e2bd900","order_by":4,"name":"Randy Small","email":"","orcid":"","institution":"University of Washington","correspondingAuthor":false,"prefix":"","firstName":"Randy","middleName":"","lastName":"Small","suffix":""},{"id":484531582,"identity":"e3f06fad-1aaa-42fd-a530-1940bac224f3","order_by":5,"name":"Daniel S. 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Study\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Carotid artery, Atherosclerotic plaques, Histology, Carotid endarterectomy","lastPublishedDoi":"10.21203/rs.3.rs-7005564/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7005564/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The clinical manifestations of cerebrovascular disease are known to differ between the Chinese and United States (U.S.) populations as do the plaque features on imaging. Objectives: The aim of this study was to investigate and compare the histological features of excised carotid plaques from Chinese and U.S. patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Carotid endarterectomy specimens collected from two prospective studies were included. The entire plaque was serially sectioned (10 µm thickness) at 0.5-1 mm intervals. Hematoxylin and eosin staining and Mallory’s trichrome staining were performed. The morphology and components of the plaques were measured and compared between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 1,152 histological sections from 75 Chinese patients and 1,843 sections from 111 U.S. patients were analyzed. The Chinese group had significantly smaller minimum lumen diameters (median: 1.1 vs. 1.3 mm, p=0.046) and a larger percent wall volume (median: 74% vs. 70%, p=0.018) than the U.S. group. After adjusting for confounding factors, carotid plaques in the Chinese population were more likely to have more lipid pools (β=10.0%, 95%CI: 4.9 to 15.9%), more recent intraplaque hemorrhage (IPH; β=8.4%, 95%CI: 4.5 to 12.7%), and less late IPH (β=-8.2%, 95%CI:-11.3 to-5.4), and fewer fibrous cap disruptions (45% vs. 67%, p=0.061). Chinese plaques were more homogeneous and had a higher percentage of plaques with features of xanthomas than did U.S. plaques (20% vs 2.7%, p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The histology of Chinese plaques differs significantly from that of U.S. plaques, suggesting substantial differences in the pathophysiology of atherosclerotic cerebrovascular disease between Chinese and North American populations, which could enhance the gap in racial pathology comparison, indicating a need for a different management approach.\u003c/p\u003e","manuscriptTitle":"Composition of Carotid Plaques Differs Between Chinese and United States Patients: A Histology Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 06:39:04","doi":"10.21203/rs.3.rs-7005564/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0dff4d6a-a055-4b71-8cfc-4423137ab94c","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:07:29+00:00","versionOfRecord":{"articleIdentity":"rs-7005564","link":"https://doi.org/10.1186/s41016-025-00408-4","journal":{"identity":"chinese-neurosurgical-journal","isVorOnly":false,"title":"Chinese Neurosurgical Journal"},"publishedOn":"2025-10-09 15:57:16","publishedOnDateReadable":"October 9th, 2025"},"versionCreatedAt":"2025-07-14 06:39:04","video":"","vorDoi":"10.1186/s41016-025-00408-4","vorDoiUrl":"https://doi.org/10.1186/s41016-025-00408-4","workflowStages":[]},"version":"v1","identity":"rs-7005564","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7005564","identity":"rs-7005564","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}