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Clinical relevance of biomarkers for the identification of patients with carotid atherosclerotic plaque: Potential role and limitations of cysteine protease legumain

      Asymptomatic carotid artery stenoses are common in the elderly population [
      • De Weerd M.
      • Greving J.P.
      • Hedblad B.
      • Lorenz M.W.
      • Mathiesen E.B.
      • et al.
      Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis.
      ]. The presence of a carotid plaque is a major risk factor for the occurrence of athero-embolic stroke [
      • Tendera M.
      • Aboyans V.
      • Bartelink M.L.
      • Baumgartner I.
      • et al.
      ESC guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the European Society of Cardiology (ESC).
      ], and is associated with a higher incidence of silent brain ischemia [
      • Moroni F.
      • Ammirati E.
      • Magnoni M.
      • D'Ascenzo F.
      • Anselmino M.
      • et al.
      Carotid atherosclerosis, silent ischemic brain damage and brain atrophy: a systematic review and meta-analysis.
      ]. Biomarkers, in addition to traditional cardiovascular risk factors, can help identify patients at risk of bearing an asymptomatic carotid artery stenosis, leading to the implementation of effective ultrasonographic screening programs [
      • Ammirati E.
      • Moroni F.
      • Norata G.D.
      • Magnoni M.
      • Camici P.G.
      Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis.
      ]. In particular, inflammatory regulators, such as interleukin-6 and tumor necrosis factor-α, were shown to predict the presence and characteristics of the plaque. On the other hand, contrasting results were reported regarding the use of C-reactive protein (CRP) to increase the accuracy for the identification of patients with carotid stenosis [
      • Ammirati E.
      • Moroni F.
      • Norata G.D.
      • Magnoni M.
      • Camici P.G.
      Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis.
      ]. Of paramount relevance is the search for novel biomarkers able to pick out patients with carotid plaque, and to be associated with the degree of stenosis or with features of plaque vulnerability.

      Keywords

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