Atherosclerosis (Coronary Artery)

Shown is a typical eccentric atherosclerotic plaque. A central necrotic core shows dystrophic calcification.  Note the fibrous cap and that the media is thinned throughout most of the circumference.

Atherosclerosis is a type of arteriosclerosis, and is one of the leading causes of illness and death in the United States. It involves the thickening and hardening of arteries, and usually affects large and medium-sized arteries. The process may begin in childhood and often progresses when people grow older. The damage begins in the innermost layer of the artery or endothelium. Elevated plama cholesterol and triglyceride levels, high blood pressure, diabetes, and tobacco smoke are major risk factors for arterial wall damage. Plaques (fats, cholesterol, platelets, cellular waste products, calcium and other substances) are deposited in the damaged endothelium. These deposits further stimulate the cells in the artery walls to produce factors that promote the proliferation of smooth muscle cells and the accumulation of lipids. As a consequence, artery's diameter may shrink, resulting in disturbances in blood flow and oxygen delivery to tissues. The complications of atherosclerosis include CVA, HTN, CAD, mesenteric ischemia, and/or peripheral vascular disease. Treatment should be individualized with the identification of specific risk factors. Lifestyle modification (e.g., exercise and diet) should be encouraged. Complete lipid profile and blood glucose/HgA1C will further guide medical therapy by instituting lipid lowering agents (e.g., statins) or oral hypoglycemic agents (e.g., sulfonylurea or metformin). Liver and kidney functions need to be assessed prior to starting on these pharmacologic regimen.