Atherosclerosis and coronary heart disease

Coronary heart disease is the largest cause of morbidity and mortality in the UK. The disease develops by the interaction of a variety of environmental agents in people who may be genetically susceptible. Some of the environmental agents can be favourably altered by adjustments to lifestyle, particularly by stopping smoking, increasing exercise levels and controlling the diet. Coronary heart disease is manifested by a number of symptoms due to the partial or complete occlusion of the coronary arteries by a fibrous plaque. The processes of plaque formation can begin very early on in life and progress through various stages. The process may be initiated by injury to the endothelial lining but can also occur in areas without obvious injury. Diagnosis of coronary heart disease is largely by electrocardiographic measurements and a variety of imaging modalities and laboratory investigations. Treatment centres upon the medical control of the symptoms, or surgical intervention in the form of a coronary bypass operation or by coronary angioplasty.