Atherosclerosis & CAD

Question 1

What is the innermost layer of an artery?

Answer 1

Tunica Intima

Question 2

What is the Tunica Intima made up of?

Answer 2

Endothelium, Subendothelium, Elastic membrane

Question 3

What does the endothelium of the Tunica Intima do?

Answer 3

It is a thromboresistant layer between blood and subendothlial tissue that modulates tone, growth, hemostasis and inflammation

Question 4

What is the middle layer of an artyer?

Answer 4

Tunica Media

Question 5

What does the Tunica Media consist of?

Answer 5

Smooth muscle cells and and elastic membrane

Question 6

What is the outer layer of an artery?

Answer 6

Tunic Externa/Adventitia

Question 7

What is the Tunica Externa made up of?

Answer 7

Composed of extracellular matrix with fibroblasts, mast cells and nerve terminals

Question 8

Describe how atherosclerosis progresses

Answer 8

1) Fatty streak forms
2) Fibrous plaque proliferates
3) Lesion develops
4) Fibrous cap develops
5) Vasa Vasorum is disrupted
6) Intraplaque hemorrhage

Question 9

Describe the pathology for first step of Atherosclerosis progression (aka Fatty Streak formation)

Answer 9

Tunica Intima and extracellular matrix thickens due to foam cells accumulating

Foam cells accumulating causes the fatty streak to form

Question 10

How do foam cells form?

Answer 10

Vascular injury causes monocyte to bind to endothelium

Monocytes cross through the endothelium and become activated macrophages

Macrophages eat the LDL which become FOAM CELLS

Question 11

Describe the pathology for step 2 of atherosclerosis progression (aka Plaque Formation)

Answer 11

The fatty streaks (from foam cells), debris and lipid-filled-connective tissue develop into plaque

Question 12

Describe the pathology of step 3 of atherosclerosis progression (aka Advanced Lesions Developing)

Answer 12

Necrotic lipid-rich core and calcified regions form as the plaque continues to build

This larger plaque is called an ‘atheroma’

Coronary arteries will respond to the atheroma by doing positive (increase vessel size) and negative (vessel shrinkage) remodeling

Question 13

Describe step 4 of atherosclerosis progression (aka Fibrous Cap Formation)

Answer 13

As the Plaque and Atheromas continue to develop, a collagen-based layer of connective tissue will cover it as the body attempts to stabilize the condition

Question 14

Describe step 5 of atherosclerosis progression (aka Vasa Vasorum is disrupted)

Answer 14

Vasa Vasorum is the term for the microvessels on the outer layer of arteries.

When the plaque expands, they will obtain their own microvessels

Question 15

Describe step 6 of atherosclerosis progression (aka Intraplaque hemorrhage)

Answer 15

The microvessels that have infiltrated the plaque can become unstable and cause ischemic events such as rupturing and eventually causing thrombosis

Question 16

When atherosclerosis develops, it can impede the availability of _____ which is needed by the vessels to dilate and constrict

Answer 16

Nitric Oxide

Question 17

What comorbidities can lower NO availability?

Answer 17

Smoking
HTN
HLD
DM

Question 18

______ plays a key role in atherosclerosis progression

Answer 18

Inflammation

Question 19

Stable plaques are formed from what kind of inflammation?

Answer 19

Chronic Inflammation

Question 20

UNstable & Ruptured plaques are formed from what kind of inflammation?

Answer 20

Active inflammation

Question 21

Atherosclerosis is usually asymptomatic until plaque causes _____% stenosis

Answer 21

Asymptomatic until 70-80% stenosis

Question 22

What is the #1 cause of death in the US and Worldwide

Answer 22

Coronary Heart Disease/Atherosclerotic CAD

Question 23

Prevalence of Coronary Heart Disease increases with _____

Answer 23

age

Question 24

Unmodifiable Risk Factors for Atherosclerosis

Answer 24

-1st degree relative has Premature Coronary Heart Disease (men<55; women<65)
-Age (men>=45; women >=55)
-Male sex

Question 25

One of the biggest modifiable risk factors

Answer 25

SMOKING

Question 26

Some lab results that are considered risk factors for Atherosclerosis

Answer 26

HIGH: CRP, TG, Homocysteine

Question 27

After one year of quitting smoking, risk of Coronary Heart Disease lower by _____%

Answer 27

50%

Question 28

Why does smoking promote atherosclerosis?

Answer 28

It increases platelet adhesiveness
Raises endothelial permeability
SNS is stimulated via nicotine

Question 29

T/F: Hypercholesterolemia has an indirect relationship with atherosclerosis

Answer 29

FALSE- they are both directly proportional

Atherosclerotic plaques contain cholesterol

Question 30

Who benefits from statins?

Answer 30

Have Clinical ASCVD
LDL >= 190
40-75 yo with DM AND LDL 70-189
40-75 yo with LDL 70-189 AND 10-yr ASCVD risk >=7.5%

Question 31

T/F: HTN does NOT cause mechanical injury to arterial walls

Answer 31

False

Question 32

T/F: Hypertension thickens heart muscle causing it to become stiff

Answer 32

True

Question 33

T/F: Persistent HTN causes plaque formation

Answer 33

True!
Endothelial injury from the increased workload causes increased inflammatory response which feeds atherosclerosis progression

Question 34

T/F: People with DM will have atherosclerosis develop earlier than someone without DM

Answer 34

True

Question 35

Which races have higher heart disease risk

Answer 35

Black>White
Mexican
American Indians
Native Hawaiians

Question 36

Who to screen for Abdominal Aortic Aneurysm? (USPSTF B)

Answer 36

Men 65-75 yo who have smoked

Question 37

Who to recommend ASA use? (USPSTF C)

Answer 37

40-59 yo with >=10% ASCVD risk

Question 38

Who to screen for BP? (USPSTF A)

Answer 38

Anyone 18+

Question 39

Who to screen for Prediabetes and T2DM? (USPSTF B)

Answer 39

35-70yo who are overweight or obese

Question 40

Who are statins recommended for? (USPSTF B)

Answer 40

40-75 who have 1+ CV Risk factors AND CVD risk >=10%