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Risk factors and atherosclerotic lesions. A review of autopsy studies
Insights
This review links elevated serum cholesterol, blood pressure, and smoking to increased atherosclerotic lesions. Conversely, high-density lipoprotein cholesterol shows an inverse relationship with atherosclerosis, highlighting key cardiovascular risk factors.
Area of Science:
- Cardiovascular pathology
- Epidemiology of atherosclerosis
Background:
- Atherosclerotic lesions are a key component of cardiovascular disease.
- Understanding the relationship between risk factors and lesion development is crucial for prevention.
Purpose of the Study:
- To review the current knowledge on the association between risk factors and atherosclerotic lesions.
- To differentiate risk factors for lesions from those for clinically overt coronary heart disease (CHD).
Main Methods:
- Systematic review of autopsy studies.
- Inclusion of studies with retrospective and prospective data collection on risk factors.
- Analysis of various grading methods for atherosclerotic lesions.
Main Results:
- Positive and significant associations found between elevated serum cholesterol, blood pressure, and atherosclerotic lesions.
- Inverse relationship observed between high-density lipoprotein cholesterol and coronary/cerebral atherosclerosis.
- Significant association between cigarette smoking and aortic atherosclerosis; positive relationship with coronary atherosclerosis.
- Inconclusive findings regarding obesity and physical activity in relation to atherosclerosis severity.
Conclusions:
- Serum cholesterol, blood pressure, and smoking are significant risk factors for atherosclerotic lesions.
- High-density lipoprotein cholesterol may have a protective effect.
- Population-level risk factors can influence the prevalence of atherosclerosis over time.
Abstract:
This review assesses the current status of knowledge concerning the relationship of risk factors to atherosclerotic lesions. Risk factors for atherosclerotic lesions per se need not necessarily be identical to those related to clinically overt coronary heart disease (CHD). This review is based on 1) autopsy studies where information risk factors was gathered in a retrospective fashion; and 2) autopsy studies where information on risk factors was gathered prospectively. In spite of differences in study designs and grading methods among the studies, the general findings were similar. Elevated serum cholesterol and blood pressure are positively and significantly related to atherosclerotic lesions. High density lipoprotein cholesterol is inversely related to coronary and probably also to cerebral atherosclerosis. Almost all studies indicate a significant association between cigarette smoking and degree of aortic atherosclerosis; a positive relationship between smoking and coronary atherosclerosis is found between obesity or physical activity and the degree of atherosclerosis. Data from the Community Pathology Study in New Orleans indicate that the average extent of coronary atherosclerosis in a population may be subject to changes within a relatively short period of time; these changes might be expected to parallel changes in risk factors in the population.