arteriosclerosis - doctor2017.jumedicine.com · arteriosclerosis...
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Dr. Nisreen Abu ShahinAssociate Professor of Pathology
Pathology Department University of Jordan
ARTERIOSCLEROSIS
Modifiedby Nour Hussein
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Normal blood vesselsA= arteryV= vein
Thicker
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Artery (A) versus vein (V)
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ARTERIOSCLEROSIS• Arteriosclerosis ="hardening of the
arteries" • arterial wall thickening and loss of
elasticity. • Three patterns are recognized, with
different clinical and pathologic consequences: we will talk about
1,2 very bireifty3 concentrate
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1-Arteriolosclerosis• affects small arteries and arterioles• associated with hypertension and/or
diabetes mellitus
Media Muscular ofArtery
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2- Mönckeberg medial calcific sclerosis
• calcific deposits in muscular arteries• typically in persons > age 50 • radiographically visible (x-rays, etc…)• palpable vessels • do not encroach on vessel lumen and are
usually not clinically significant
whileeakinsdeposits
if Arby is subQ
No Narrowing
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2-Mönckeberg medial calcificsclerosis
HB E
Not segnificant on its ownShould be known to not
misinterpret
it as something else
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3-Atherosclerosis• Greek word="gruel" ,"hardening,"
• most frequent and clinically important pattern of arteriosclerosis
• characterized by intimal lesions =atheromas(a.k.a. atherosclerotic plaques)
• atheromatous plaque = raised lesion with a core of lipid (cholesterol and cholesterol esters) covered by a firm, white fibrous cap
isme
fat deposition inside intima
Precursor
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Pathogenesis
• not fully understood• ? inflammatory process in endothelial cells
of vessel wall associated with retained low-density lipoprotein (LDL) particlesÆ ? a cause, an effect, or both, of underlying inflammatory process
LDL
Inflammation
LDL HDL hemember H as in healthy
LowDdensity HighDensity
Classified in regard with their Affinityto deposit inside
DL HighAffinity Badwalls of Blood Vessels HDL Low Affinity Good
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• initiation of inflammatory processÆ LDL particles and their content are susceptible to oxidation by free radicalsÆ endothelial activation
I
inflammation cascade ofevents inthe wall of the intimacausing narrowing in the lumen of
Bloodvessel
free Radicals
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The major components of a well-developed intimalatheromatous plaque Both Layers
giveAtheromasPrecursor lesion
2 partsUpper
LDL
KFW needle shop
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Atheromatous plaque
JYellow Needleshaped
Wqite
Needleshape
Remaining
originalLumen
Necrolicecenter
significant NarrowingsignificantEffectischemia downstreamtissues
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Formation of atheromatousplaque
Adults
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Formation of atheromatousplaque
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ftO
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Atherosclerosis: progression complications
T Atheroma 1Thrombi
completeocclusionofBloodFlow
754closed
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Vulnerable vs stable plaque
Thick fat coreThin fibrous capMore inflammation
Thin fat coreThick fibrous capless inflammation
p Progression
nightbreakandleadtocomplications
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Major RisksLesser, Uncertain, or Non-quantitatedRisks
Non-modifiable (non-controllable) ObsesityIncreasing age Physical inactivityMale gender Stress ("type A personality)Family history Postmenopausal estrogen deficiency
Genetic abnormalities High carbohydrate intakeLipoprotein(a)
Potentially modifiable (Controllable) Hardened (trans)unsaturated fat intake
HyperlipidemiaHypertension Chlamydia pneumoniae infection
Cigarette smokingDiabetesC-reactive protein (inflammation)
Risk Factors for Atherosclerosis
Minor0
How can we Modify
JI fo IEgfnunity
Quitsmoking
Antiinflammatory
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Major Risk Factors for atherosclerosis
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• Epidemiology ….• Multiple risk factors have a multiplicative
effect: 2 risk factors increase the risk 4X. • E.g. if 3 risk factors are present (e.g.,
hyperlipidemia, hypertension, and smoking), the rate of myocardial infarction is increased 7X.
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1-age• ages 40 to 60, incidence of MI in men increases 5 x • Death rates from IHD rise with each decade
2-Gender• Premenopausal* Æ protected against
atherosclerosis compared with age-matched men.• After menopauseÆ incidence of atherosclerosis-
related diseases increases
• * unless they are otherwise predisposed by diabetes, hyperlipidemia, or severe hypertension.
Major Non modifiable
Mates independentfactor
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3-Genetics • familial predisposition is multifactorial. • Either :1- familial clustering of other risk factors- e.g. HTN or DMor :2- well-defined genetic derangements in
lipoprotein metabolism- e.g. familial hypercholesterolemia
Mutations
Patient mightnot havedefinitegeneticmutations including Lipoprotein
However they might have familial clusteringof risk factors
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Additional Risk Factors for atherosclerosis
• 20% of cardiovascular events occur in the absence of identifiable risk factors:
- Hyperhomocystinemia- Metabolic syndrome- Lipoprotein a levels- Factors Affecting Hemostasis (Elevated levels of procoagulants; Clonal
hematopoiesis)- Others:-lack of exercise -competitive, stressful lifestyle ("type A" personality) -obesity-High carbohydrate intake
x