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The pathophysiology of atherosclerosis
1Department of Surgery, Veterans Affairs Medical Center, George Washington University, Washington, DC, USA.
Insights
Atherosclerosis, a chronic inflammatory disease, leads to plaque buildup in arteries. Understanding its pathogenesis is key to preventing complications and developing effective treatments for vascular disease.
Area of Science:
- Vascular Surgery
- Cardiovascular Pathology
- Inflammatory Disease Mechanisms
Background:
- Atherosclerosis is a systemic arterial disease, with significant clinical impact on coronary, cerebral, and lower extremity circulations.
- It is the primary indication for vascular reconstructive surgery due to its severe complications.
- The disease process involves chronic inflammation and the formation of atherosclerotic plaques.
Purpose of the Study:
- To elucidate the pathogenesis of atherosclerosis.
- To highlight the importance of understanding this process for developing preventive and therapeutic strategies.
- To underscore the clinical significance of atherosclerotic lesions in major arterial systems.
Main Methods:
- Review of the complex series of events in atherogenesis.
- Focus on endothelial cell injury and dysfunction as the initial step.
- Description of cellular recruitment, proliferation, and matrix production leading to plaque formation.
Main Results:
- Endothelial dysfunction triggers leukocyte and vascular smooth muscle cell (VSMC) accumulation and proliferation.
- These cells contribute to excessive connective tissue matrix production, forming fibrous plaques.
- Clinical symptoms arise from complications of advanced lesions, including plaque rupture, hemorrhage, emboli, or thrombosis.
Conclusions:
- A comprehensive understanding of atherosclerosis pathogenesis is crucial.
- This knowledge is essential for devising effective prevention strategies.
- It also informs the development of novel and improved treatments for atherosclerotic vascular disease.
Abstract:
Complications resulting from advanced atherosclerosis are the most common indication for vascular reconstructive surgery. Atherosclerosis is a systemic disease affecting the entire arterial tree, but lesions involving the coronary, extracranial cerebral, and lower extremity circulations have the most clinical significance for surgeons. The pathogenesis of atherosclerosis involves a complex series of events, similar to a chronic inflammatory process, with the formation of atherosclerotic plaque as the end result. Injury to the endothelial cell of the artery, resulting in endothelial cell dysfunction, is the first step in the process. Activated endothelial cells attract leukocytes and vascular smooth muscle cells (VSMC), which accumulate and proliferate in the arterial wall. These cellular components produce an excessive amount of connective tissue matrix. The ultimate end point is the formation of a mature fibrous plaque. Symptoms occur when advanced lesions are complicated by plaque rupture, hemorrhage into the plaque, emboli, or thrombosis. A thorough understanding of the pathogenesis of atherosclerosis is essential for the development of strategies for the prevention of the disease, and for the development of new and effective treatments.