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Pathogenesis of atherosclerosis

Xue-Qiao Zhao, MD, FACC
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Peter Libby, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Atherosclerosis is a pathologic process that causes disease of the coronary, cerebral, and peripheral arteries [1,2]. The basic aspects of the pathogenesis of atherosclerosis will be reviewed here. Forms of accelerated arteriopathies, such as restenosis following percutaneous coronary intervention with stenting and coronary transplant vasculopathy differ in pathogenesis and are discussed separately. (See "Intracoronary stent restenosis" and "Pathogenesis of and risk factors for cardiac allograft vasculopathy".)


Atherosclerosis begins in childhood with the development of fatty streaks (table 1). The advanced lesions of atherosclerosis occur with increasing frequency with aging [3-5]. The following points demonstrate the frequency of atherosclerosis in Western populations and its progression with age:

In an autopsy study of 2876 men and women aged 15 to 34 years who died of non-cardiac causes, all individuals had aortic fatty streaks [6].

In another autopsy study of 760 young (age 15 to 34 years) victims of accidents, suicides, or homicides, advanced coronary atheromata were seen in 2 and 0 percent of men and women aged 15 to 19, and 20 and 8 percent of men and women aged 30 to 34 [5].

In a study of 260 peri-renal aortic patches collected during organ transplantation, the first three decades of life were characterized by intimal thickening and xanthomas. The fourth, fifth, and sixth decades were characterized by more complicated plaques of pathological intimal thickening, early and late fibroatheromas with thin fibrous caps, ruptured plaques, healed rupture, and fibrotic calcified plaques [7].


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