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Calcification increases with macrophage infiltration into the lipid pool in early fibroatheroma where they undergo apoptosis and release matrix vesicles. The confluence of calcified areas involves extracellular matrix and the necrotic core, which can be identified by radiography as speckled (\u22642 mm) or fragmented (&gt;2, &lt;5 mm) calcification. The calcification in thin-cap fibroatheromas and plaque rupture is generally less than what is observed in stable plaques and is usually speckled or fragmented. Fragmented calcification spreads into the surrounding collagen-rich matrix forming calcified sheets, the hallmarks of fibrocalcific plaques. The calcified sheets may break into nodules with fibrin deposition, and when accompanied by luminal protrusion, it is associated with thrombosis. Calcification is highest in fibrocalcific plaques followed by healed plaque rupture and is the least in erosion and pathological intimal thickening. The extent of calcification is greater in men than in women especially in the premenopausal period and is also greater in whites compared with blacks. The mechanisms of intimal calcification remain poorly understood in humans. Calcification often occurs in the presence of apoptosis of smooth muscle cells and macrophages with matrix vesicles accompanied by expression of osteogenic markers within the vessel wall.<\/jats:p>","DOI":"10.1161\/atvbaha.113.302642","type":"journal-article","created":{"date-parts":[[2014,2,21]],"date-time":"2014-02-21T00:31:52Z","timestamp":1392942712000},"page":"724-736","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":451,"title":["Has Our Understanding of Calcification in Human Coronary Atherosclerosis Progressed?"],"prefix":"10.1161","volume":"34","author":[{"given":"Fumiyuki","family":"Otsuka","sequence":"first","affiliation":[{"name":"From CVPath Institute Inc, Gaithersburg, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Sakakura","sequence":"additional","affiliation":[{"name":"From CVPath Institute Inc, Gaithersburg, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyuki","family":"Yahagi","sequence":"additional","affiliation":[{"name":"From CVPath Institute Inc, Gaithersburg, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Joner","sequence":"additional","affiliation":[{"name":"From CVPath Institute Inc, Gaithersburg, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu","family":"Virmani","sequence":"additional","affiliation":[{"name":"From CVPath Institute Inc, Gaithersburg, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature06796"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/35025203"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)10279-9"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.20.5.1262"},{"key":"e_1_3_3_6_2","first-page":"321","article-title":"A dissecting view on the role of the fatty streak in the pathogenesis of human atherosclerosis: culprit or bystander?","volume":"19","author":"Velican C","year":"1981","unstructured":"Velican C. 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