Significant stenosis of the left anterior descending artery in a young woman without cardiovascular risk and with above-average physical activity (original) (raw)
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Atherosclerosis: Its affinity for different coronary arteries and their sites
IP Innovative Publication Pvt. Ltd, 2017
Atherosclerosis of coronary arteries is a common phenomenon seen to be prevalent worldwide. The advent of coronary arteriography has made it possible, in vivo, to indicate the localization, extent and severity of disease. The left anterior descending artery (LAD) is said to be the most commonly involved vessel in coronary atherosclerosis. In the present study, angiographic evaluation of the coronary arteries was done to find out the artery most commonly involved in atherosclerosis and also the most common site of the artery showing occlusion. Out of 350 cases studied, 213 showed occlusion. LAD was the most commonly involved artery to show occlusion [162 cases,76%] followed by right coronary artery (RCA) [92 cases, 43%]. Irrespective of the vessels involved, the proximal segment of the arteries was the site where disease tend to cluster.
A Review Article on Atherosclerosis
The reduction of infectious diseases that affect children and young adults is largely responsible for rise in life expectancy. Our population is ageing, and chronic infectious diseases, particularly those of the cardiovascular system, are becoming increasingly prevalent. Arteriosclerosis causes an artery to stiffen. The three recognised lesions are atherosclerosis, Monckeberg medial calcific sclerosis, and arteriolosclerosis, and each has a unique origin, clinical course, and pathological effects. The most common cause of death is arteriosclerosis. Many studies have been done to identify and measure the risk factors for this disease. In essence, many of these studies have advanced our knowledge of the causes of arteriosclerosis, including high-cholesterol diets, hypertension, smoking, and inactivity. In addition to genetic dyslipidemia, hypertension, and diabetes, environmental risk factors like diet, smoking, stress, and a sedentary lifestyle can affect the development of atherosclerosis. Protective factors associated with parasite infestations and environmental disorders may also have an impact. Peripheral artery disease (PAD) is now more prevalent throughout the world. Limited pain-free walking distance (intermittent claudication) or tissue ulceration are two signs that PAD should be treated. Endovascular therapy has replaced open surgical surgery as the preferred type of treatment in many arterial regions because it is less intrusive. There is still no mention of treating the common femoral artery (CFA) in this. It is widely established that the presence of obstructive coronary lesions like angina or myocardial infarction is clinically correlated with the blood level of low-density lipoprotein (LDL) cholesterol.
Epidemiology and pathology of coronary artery disease: I. Method of study
Journal of Chronic Diseases, 1960
*Since 1954, when these matters were under consideration. two groups of investigators have succeeded in producing myocardial infarcts in animals: (I) Myasnikov. employing cholesterol feeding and physical strew2 and (2) Thomas and Hartroft using high fat diets plus chemical additives.3 504 Volume 12 Number 5 EPIDEMIOLOGY OF CORONARY ARTERY DISEASE I SOS the disease when myocardial damage was present, atherosclerosis in the coronar). arteries usually escaped his detection; and (3) the complete disease process had not been satisfactorily reproduced in animals. Considering this set of circumstances, the group reached several tentative conclusions. First, an epidemiologic study appeared justified, since (a) the disease was of high incidence and thus warranted a population approach, and (b) a study of its ecology, the primary concern of epidemiologists, might reveal that it was associated with certain characteristics or activities in a manner suggesting a causal relationship. Second, an approach appeared promising in which attention would he tlirected toward coronary artery atherosclerosis in its varying degrees of severityin relation to degree of exposure to epidemiologic variables, an approach that would require cooperative study by the pathologist and the epidemiologist. This method would have the major advantage of bringing a large portion of the spectrum of the disease under study, presumably ranging from little or no involvement of the coronary arteries to severe arterial disease and myocardial complications. Such an approach would necessarily be based upon the assumption that coronar>r arter!. atherosclerosis plays a major part in the etiology of coronar\. heart disease. Data from this study bearing upon this assumption are presented in a later section. A study design that would bring into focus the full range of gradations of atherosclerosis would make it possible to identify individuals in whom the disease was clearly absent. According to the evidence of necropsy studies,4,5 individuals without atherosclerosis* are generally believed to constitute a small minorit) among middle-aged and elderly males. If such "noncase" individuals were identified and utilized as a control group, presumably they would contrast more sharpl;, with severe "cases" in terms of etiological factors than would a clinically selected "noncase" group in which a large proportion of individuals with diseased arteries would necessarily be included. In this design, the "case" group would be composed of individuals with gradations of coronary artery atherosclerosis from subclinical stages to clinically manifest disease. "Noncases" have been particularly elusive as subjects for study in that they are not only apparently relatively rare among older males, but are also not clearly identifiable clinically. It appeared especiall!desirable, therefore, to identify these "noncases" with precision so that differences between cases and controls, in epidemiologic attributes, would stand out more BEADENKOPF ET AL.
2010
Background: Increasing age and cholesterol levels, male gender, and family history of early coronary heart disease (CHD) are associated with early onset of CHD in familial hypercholesterolemia (FH). Objective: Assess subclinical atherosclerosis by computed tomography coronary angiography (CTCA) and its association with clinical and laboratorial parameters in asymptomatic FH subjects. Methods: 102 FH subjects (36% male, 45 ± 13 years, LDL-c 280 ± 54 mg/dL) and 35 controls (40% male, 46 ± 12 years, LDL-c 103 ±18 mg/dL) were submitted to CTCA. Plaques were divided into calcified, mixed and non-calcified; luminal stenosis was characterized as >50% obstruction. Results: FH had a greater atherosclerotic burden represented by higher number of patients with: plaques (48% vs. 14%, p = 0.0005), stenosis (19% vs. 3%, p = 0.015), segments with plaques (2.05 ± 2.85 vs.0.43 ± 1.33, p = 0.0016) and calcium scores (55 ± 129 vs. 38 ± 140, p = 0.0028). After multivariate analysis, determinants of plaque presence were increasing age (OR = 2.06, for age change of 10 years, CI95%: 1.38-3.07, p < 0.001) and total cholesterol (OR = 1.86, for cholesterol change by 1 standard deviation, CI95%: 1.09-3.15, p = 0.027). Coronary calcium score was associated with the presence of stenosis (OR = 1.54; CI95%: 1.27-1.86, p < 0.001, for doubling the calcium score). Male gender was directly associated with the presence of non-calcified plaques (OR: 15.45, CI95% 1.72-138.23, p = 0.014) and inversely with calcified plaques (OR = 0.21, CI95%: 0.05-0.84, p = 0.027). Family history of early CHD was associated with the presence of mixed plaques (OR = 4.90, CI95%: 1.32-18.21, p = 0.018). Conclusions: Patients with FH had an increased burden of coronary atherosclerosis by CTCA. The burden of atherosclerosis and individual plaque subtypes differed with the presence of other associated risk factors, with age and cholesterol being most important. A coronary calcium score of zero ruled out obstructive disease in this higher risk population.
Coronary Artery Disease: Pathogenesis,Progression of Atherosclerosis and Risk Factors
2018
Figure 1: Atherosclerotic lesion in a human artery. Atherosclerosis is derived from the Greek words 'athera' meaning soft gruel-like (porridge-/mush-/paste-like) fatty deposit and 'sclerosis' which means hardening. Atherosclerosis is a pathological process that affects large-and medium-sized arteries and causes coronary artery disease (angina pectoris and myocardial infarction), cerebrovascular disease (ischemic stroke and vascular dementia) and peripheral vascular disease (intermittent claudication and gangrene) [3]. Atherosclerosis is a chronic cumulative disease progressing over years. It is characterized by atherosclerotic plaques formed in the wall of the vessels, consisting of necrotic cores, calcified regions, accumulated modified lipids, and inflamed smooth muscle cells (SMCs), endothelial cells, leukocytes, and foam cells (Figure 1). Lesions begin early as fatty streaks and progress into pathologic lesions under the influence of both genetic and lifestyle insults [4,5]. Panel A shows a cross-sectioned coronary artery from a patient who died of a massive myocardial infarction. It contains an occlusive thrombus superimposed on a lipid-rich atherosclerotic plaque. The fibrous cap covering the lipid-rich core has ruptured (area between the arrows), exposing the thrombogenic core to the blood. Trichrome stain was used, rendering luminal thrombus and intraplaque hemorrhage red and collagen blue. Panel B is a high-power micrograph of the area in Panel A indicated by the asterisk and
Journal of Cardiovascular Medicine, 2011
The aim of our study was to assess the atherosclerotic burden in patients with the first symptoms of coronary artery disease (CAD). The study population consisted of 100 consecutive patients (new-onset severe angina or myocardial infarction) and 70 age and sex matched asymptomatic volunteers. Functional and morphologic atherosclerotic markers were sought in carotid, brachial and femoral arteries of all individuals by means of highresolution ultrasonography, whereas coronary arteriography was performed in the CAD patients only. A total of 347 coronary lesions [230 (66%) obstructive] were discovered in the CAD patients as well as 105 peripheral plaques [26 (25%) obstructive]. The mean percentage diameter stenosis of the culprit coronary lesion was 83.8 W 15.8%, the mean vessel score 1.7 (range 0-3), the mean stenosis score 19.8 (range 1.5-89.0), and the mean extent score 49.1% (range 10-65%). Endotheliumdependent vasodilation, as assessed by the brachial flowmediated response (FMR), was reduced by 50% in the CAD patients (P < 0.001 vs. controls). Furthermore, endotheliumindependent vasodilation was significantly impaired in all investigated peripheral arteries of the CAD patients (P < 0.05-0.001 vs. controls). Intima-media thickness (IMT) was increased in the carotid arteries of the CAD patients by 43%, in brachial arteries by 20% and in femoral arteries by 57% (P < 0.01-0.001 vs. controls). Decreased FMR or increased carotid IMT was found to be independent risk factors for the CAD, and they correlated with the coronary vessel and extent scores. In conclusion, the atherosclerotic process was quite advanced in coronary as well as peripheral arteries of our patients with the first clinical presentation of CAD.
2018
Contact address: Rugină Mihaela, MD, PhD „Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania. E-mail: rugina.mihaela@gmail.com 1 „Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania INTRODUCTION Atherosclerosis is a pathological process that starts in the early decades of human life as fatty-streaks and evolves throughout the life of an individual. The contributing risk factors which also accelerate the intimal thickening are hypertension, smoking, diabetes mellitus, obesity, dyslipidemia and family history of cardiovascular disease1. Clinical complications of atherosclerosis are dependant of the arteries involved. Coronary atherosclerosis is the leading cause of angina pectoris and acute coronary syndromes, cerebrovascular atherosclerosis causes transient cerebral ischemia and stroke while atherosclerosis of the lower extremity vessels causes claudication and acute or chronic limb ischemia2.