11. Atherosclerosis

Question 1

Arteriosclerosis

Answer 1

Arterial wall thickening and loss of elasticity

Question 2

Arteriolosclerosis

Answer 2

Affects many small arteries and arterioles and associated with ischemia

Question 3

Atherosclerosis

Answer 3

Slowly progressive disease of large of medium size muscular and elastic arteries

Lesions are characterized by elevated intimal-based plaques (atheroma) composed of lipids, proliferation SMC, inflammatory cells and increased ECM

Question 4

Structure of atherosclerosis plaque

Answer 4

Fibrous cap

Necrotic center

Media

Question 5

Vulnerable plaques

Answer 5

Large areas of foam cells and lipids (larger necrotic region)

Thin fibrous capsid

Lots of inflammatory cells

Question 6

Stable plaques

Answer 6

Smaller areas of foam cells and lipid

Thick fibrous cap (more protected from rupture)

Few inflammatory cells

Question 7

ASCVD 4 major areas

Answer 7

Coronary heart disease

Cardiovascular disease

Peripheral artery disease

Aortic atherosclerosis aneurysm

Question 8

Major risk factors for atherosclerosis

Answer 8

Non modifiable

Family history
Increasing age
Male

Modifiable

Hyperlipidemia
Hypertension
Cigarette smoking
Diabetes

Question 9

Hyperlipidemia (hypercholesterolemia)

Answer 9

Associated with increased low-density lipoprotein (LDL) cholesterol (bad cholesterol) and decreased high density lipoprotein (HDL) (Good)

Question 10

Hypertension

Answer 10

Can cause injured endothelial cells secondary to blood vessel stress

Question 11

Cigarette smoking

Answer 11

Smoking decreases NO synthesis and promotes poor-inflammatory cytokines

Pro-thrombotic

Question 12

Diabetes

Answer 12

With increases in insulin it decreases bioavailability of NO

Question 13

Pathogenesis of atherosclerosis

Answer 13

1. Endothelial injury - increase vascular permeability, leukocyte adhesion and thrombosis
2. Accumulation of lipoproteins (mainly LDL) in vessel wall - fatty streak (first sign of atherosclerosis)
3. Platelets adhesion
4. Monocytes adhesion to endothelium - migrate into tissue and become macrophages and foam cells
5. Lipid accumulation both extracellular lay and within cells - release it inflammatory cytokines
6. Smooth muscle cell recruitment / proliferation and ECM production