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The increased cardiovascular risk associated with obstructive sleep apnoea (OSA) has been well established,1 but the mechanisms involved remain to be elucidated. The study by Lutsey et al,2 published in this issue of Thorax adds another piece to the puzzle of the link between OSA and cardiovascular risk by showing significant associations between parameters of sleep-disordered breathing and coronary atherosclerotic calcification.
The initiation and progression of atherosclerosis is characterised by an accumulation of lipids and lipoproteins within the vascular wall, leading to immune activation and the recruitment of inflammatory cells.3 The resulting atherosclerotic plaques may remain silent for a long time before plaque destabilisation occurs, leading to plaque rupture, vessel occlusion and, if in a coronary artery, myocardial infarction. Prognostic markers are of particular interest to identify patients at risk of plaque rupture and who …