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Study on the onset of atherosclerotic lesions in human coronary arteries
Insights
The earliest signs of atherosclerosis in coronary arteries appear around age 5. This study details the progression of these initial atherosclerotic lesions in children.
Area of Science:
- Cardiovascular Pathology
- Pediatric Cardiology
- Histopathology
Background:
- Atherosclerosis is a leading cause of cardiovascular disease globally.
- Understanding the early development of atherosclerotic lesions is crucial for prevention strategies.
- The natural history of early lesions in pediatric populations remains incompletely understood.
Purpose of the Study:
- To reconstruct the natural history of the initial atherosclerotic lesions in the coronary arteries of young individuals.
- To identify the critical age period for the transition from normal arterial growth to atherosclerotic involvement.
- To characterize the morphological changes associated with the formation of early atherosclerotic lesions.
Main Methods:
- Light microscopic examination of coronary arteries from 300 fetuses, neonates, infants, and children.
- Histopathological analysis to identify and classify early atherosclerotic lesions.
- Correlation of lesion incidence and morphology with age groups.
Main Results:
- The critical period for the onset of atherosclerotic involvement was observed around 5 years of age.
- Fibrous plaques were found in 2% of subjects aged 6-10 and 4% aged 11-15 years.
- Gelatinous plaques and fatty streaks appeared in 6% of subjects aged 11-15 years, primarily in proximal coronary segments.
Conclusions:
- Early atherosclerotic lesions develop through distinct histopathological processes, including insudation and histolysis.
- Fibrous plaques originate in specific arterial areas like bifurcations, while gelatinous plaques and fatty streaks affect proximal segments.
- This study provides critical insights into the early stages of atherosclerosis in children, highlighting the importance of early detection and intervention.
Abstract:
The coronary arteries of 300 fetuses, neonates, infants and children were examined by light microscope in an effort to reconstruct the natural history of the first atherosclerotic lesions. The critical period for the passage from processes of growth and remodelling to atherosclerotic involvement appeared in this series at the age of 5 years. The incidence of the earliest lesions was distributed as follows: fibrous plaques in 2% of the subjects 6--10 years old and 4% of the subjects 11--15 years old; gelatinous plaques and fatty streaks in 6% of the subjects 11--15 years old. Indirect evidence was obtained that certain branch pads or cushions acted as precursors of the first fibrous plaques. Their conversion into atherosclerotic lesions was induced by insudation, histolysis (elastolysis, collagenolysis, ground substance depletion and degenerative cell changes), followed by nodular proliferation of smooth muscle cells and abundant neoformation of ground substance and collagen fibers. The onset of the first gelatinous plaques was also preceded by insudation and histolysis followed by swelling necrosis. The appearance of the first fatty streaks seemed to be not preceded by particular structural changes. The first fibrous plaques developed only in bifurcation and emergence areas, whereas the first gelatinous plaques and fatty streaks involved the proximal segments of the main coronary vessels.