Atherosclerosis

Abstract

For the past decade, cardiovascular disease (CVD) has been the leading cause of death and disability worldwide, and in most cases, atherosclerosis is the dominant underlying pathologic process. Atherosclerosis is characterized by subendothelial accumulation of lymphocytes, lipid-filled macrophages, and inflammation-induced migration of vascular smooth muscle cells slowly forming a fibroinflammatory lipid plaque. Over time, the plaque progressively weakens and occludes the vessel; however, with continued inflammation and hemodynamic changes, atheromas can dangerously manifest as ischemia (acute or chronic) or aneurysmal disease. This review discusses the economic impact, historical background, and pathogenesis of atherosclerosis, as well as normal arterial biology, risk factors, and screening. Tables outline physiologic properties of nitric oxide in native vessels, selected cellular and chemical mediators and their role in atherogenesis, current risk factors for peripheral arterial disease (PAD) development, and diagnosis criteria for diseases that confer increased PAD risk. Graphs demonstrate mortality due to PAD, PAD prevalence, and the economic impact of CVD. Illustrations depict normal vessel anatomy, blood flow with plaque at carotid bifurcation, the superficial femoral artery (SFA) with plaque, and the progression of atherosclerotic changes. A flow chart for atherogenesis, photograph of a human carotid endarterectomy specimen, and angiogram showing the classic occluding lesion of the SFA are also provided. This review contains 9 figures, 5 tables, and 91 references.