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Pathology – Atherosclerosis
Definition
• An inflammatory condition affecting large and medium-sized systemic arteries, marked by the development of lipid-laden plaques within the arterial wall.
Epidemiology: Nearly universally observed to varying extents in all persons as they age.
Aetiology
Risk factors encompass age, male sex, diabetes mellitus, hypertension, tobacco use, and hyperlipidemia. Men who smoke exhibit a 70% elevated mortality rate from ischemic heart disease vs to non-smokers.
Pathogenesis
Endothelial injury induces an inflammatory and fibroproliferative response in the artery, resulting in atherosclerosis, as posited by the 'response to injury' hypothesis. • The endothelium can be compromised by various causes, including as smoking, hyperglycemia, and oxidized LDL. • Oxidized LDL is especially effective in promoting atherosclerosis due to its pro-inflammatory and pro-coagulant properties. Stable plaques characterized by a minimal presence of inflammatory cells and a robust fibrous cap constrict the arterial lumen, yet are less prone to precipitating acute problems. • Unstable plaques characterized by a higher concentration of inflammatory cells possess a thin fibrous cap susceptible to erosion, fissuring, or rupture. The exposure of the highly thrombogenic lipid core to the bloodstream induces an abrupt ischemic event in the organ supplied by the affected artery
Presentation
• Stable plaques induce signs of reversible ischemia in the affected organ, such as angina pectoris and chronic lower limb ischemia. • Unstable plaques precipitate acute ischemic events, including acute coronary syndromes, stroke, and acute lower limb ischemia.
Macroscopy
Atherosclerotic plaques are yellow, lipid-rich lesions located within the walls of big and medium-sized arteries. • Superimposed thrombus has a dark brown coloration. • Predilection sites include the coronary arteries, abdominal aorta, iliac arteries, and bifurcations of the carotid artery. Histopathology • The intima is enlarged by a plaque consisting of a lipid-dense core with an overlay of fibrous tissue. • In cases of superimposed thrombosis, a fibrin-rich clot may also be present, obstructing the artery.
Definition
• An inflammatory condition affecting large and medium-sized systemic arteries, marked by the development of lipid-laden plaques within the arterial wall.
Epidemiology: Nearly universally observed to varying extents in all persons as they age.
Aetiology
Risk factors encompass age, male sex, diabetes mellitus, hypertension, tobacco use, and hyperlipidemia. Men who smoke exhibit a 70% elevated mortality rate from ischemic heart disease vs to non-smokers.
Pathogenesis
Endothelial injury induces an inflammatory and fibroproliferative response in the artery, resulting in atherosclerosis, as posited by the 'response to injury' hypothesis. • The endothelium can be compromised by various causes, including as smoking, hyperglycemia, and oxidized LDL. • Oxidized LDL is especially effective in promoting atherosclerosis due to its pro-inflammatory and pro-coagulant properties. Stable plaques characterized by a minimal presence of inflammatory cells and a robust fibrous cap constrict the arterial lumen, yet are less prone to precipitating acute problems. • Unstable plaques characterized by a higher concentration of inflammatory cells possess a thin fibrous cap susceptible to erosion, fissuring, or rupture. The exposure of the highly thrombogenic lipid core to the bloodstream induces an abrupt ischemic event in the organ supplied by the affected artery
Presentation
• Stable plaques induce signs of reversible ischemia in the affected organ, such as angina pectoris and chronic lower limb ischemia. • Unstable plaques precipitate acute ischemic events, including acute coronary syndromes, stroke, and acute lower limb ischemia.
Macroscopy
Atherosclerotic plaques are yellow, lipid-rich lesions located within the walls of big and medium-sized arteries. • Superimposed thrombus has a dark brown coloration. • Predilection sites include the coronary arteries, abdominal aorta, iliac arteries, and bifurcations of the carotid artery. Histopathology • The intima is enlarged by a plaque consisting of a lipid-dense core with an overlay of fibrous tissue. • In cases of superimposed thrombosis, a fibrin-rich clot may also be present, obstructing the artery.
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