Harrison's Practice: Atherosclerosis, Therapy and Prevention

Atherosclerosis, Therapy and Prevention

Definition

The process by which the medium and large arteries become thickened and hardened by the deposition of lipid-laden lesions within the vessel intima
It is the leading cause of death and disability in the developed world.
All major arteries can be affected.
- Coronary arteries: causes myocardial infarction and angina pectoris
- Central nervous system and neck arteries: causes stroke and transient cerebral ischemia
- Peripheral arteries: causes intermittent claudication and gangrene
- Splanchnic arteries: causes mesenteric ischemia
- Renal arteries: causes hypertension, or renal insufficiency secondary to renal artery stenosis or atheroembolic disease
- Patients with atherothrombotic event in 1 vascular bed are at risk for events in other vascular beds.
Early identification and modification of atherosclerosis risk factors can be hugely beneficial.
- Reduces morbidity and mortality from atherosclerosis-related diseases

Same major risk factors apply to atherosclerosis of all arterial beds.
- Cigarette smoking
- Hypertension
- Elevated low-density lipoprotein (LDL) cholesterol level
- Low high-density lipoprotein (HDL) cholesterol level
- Diabetes mellitus
- Family history of premature coronary heart disease (CHD)
  - CHD in male first-degree relative < 55 years
  - CHD in female first-degree relative < 65 years
- Age ≥ 45 years in men or ≥ 55 years in women
- Lifestyle factors
  - Obesity (body mass index ≥ 30 kg/m²)
  - Physical inactivity
  - Atherogenic diet
Emerging risk factors
- Impaired fasting glucose
- Elevated lipoprotein(a) level
- Elevated homocysteine level
- Prothrombotic factors
- Proinflammatory factors (e.g., C-reactive protein [CRP])
- Subclinical atherogenesis

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