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The genesis of atherosclerosis and risk factors: a review
T J Tegos1, E Kalodiki, M M Sabetai
1Department of Vascular Surgery, St. Mary's Hospital, Imperial College of Science, Technology and Medicine, London, United Kingdom. t.tegos@ic.ac.uk
Insights
Atherosclerosis, a common vascular disease, involves arterial wall changes. This review details its causes, risk factors like lipids and hypertension, and lesion progression.
Area of Science:
- Cardiovascular Science
- Pathology
- Medical Science
Background:
- Atherosclerosis is a prevalent medical and surgical issue.
- It underlies major conditions like stroke and coronary artery disease.
- Understanding atherogenesis is crucial for managing these diseases.
Purpose of the Study:
- To review the microscopic features of normal arterial walls.
- To define atherosclerosis and explore five key theories of its development.
- To analyze the sequence of events in atherogenesis.
Main Methods:
- Literature review of atherosclerosis theories and risk factors.
- Analysis of the sequence of events in atherogenesis.
- Presentation of Stary's classification of atherosclerotic lesions.
Main Results:
- Detailed discussion of five atherogenesis theories: lipid, hemodynamic, fibrin incrustation, nonspecific mesenchymal, and response to injury.
- Comprehensive analysis of risk factors including age, sex, lipids, smoking, hypertension, diabetes, and obesity.
- Inclusion of less common genetic factors and Chlamydia pneumoniae.
Conclusions:
- Atherosclerosis is a complex process with multiple contributing factors.
- Understanding the pathophysiology and risk factors is essential for prevention and treatment.
- Further research into genetic and infectious links may offer new therapeutic targets.
Abstract:
Atherosclerosis constitutes the most common medical and surgical problem. This can be manifested clinically as stroke, coronary artery disease, or peripheral vascular disease. In the present review the microscopic appearance of the normal arterial wall, the definition of atherosclerosis and the five theories of atherogenesis are described. These are: the lipid theory, the hemodynamic theory, the fibrin incrustation theory, the nonspecific mesenchymal hypothesis and the response to injury hypothesis. Based on the above theories the sequence of events in atherogenesis is analyzed. The classification of the atherosclerotic lesions according to Stary (types I-VI) and their characteristics appear in a table. The epidemiology and the role of the following risk factors are presented in detail: age, sex, lipid abnormalities, cigarette smoking, hypertension, diabetes mellitus, physical inactivity, alcohol consumption, obesity, and hemostatic factors. In addition, less common genetically determined associations like homocystinuria, Tangier disease, Hutchinson-Gilford syndrome (progeria), Werner's syndrome, radiation induced atherosclerosis and the implications of Chlamydia pneumoniae on the arterial wall are discussed.