The Vascular Biology of Atherosclerosis
ARMY RESEARCH INST OF ENVIRONMENTAL MEDICINE NATICK MA THERMAL AND MOUNTAIN MEDICINE DIVISION
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Cardiovascular disease is the leading cause of mortality in the United States, Europe, a vast majority of Asia, and is likely to be the greatest threat to overall health worldwide. As a major cause of cardiovascular disease, the development of atherosclerosis starts early in childhood. Despite this fact, most individuals are asymptomatic until many decades later. Autopsy studies of coronary arteries from healthy, young American soldiers killed during the Korean conflict revealed surprisingly advanced atherosclerotic lesions. Intimal lesions were discovered in more than 50 of the right coronary arteries of the youngest group 15-19 years of age. More recently, fatty streaks, an early marker of atherosclerosis, have been found in the intima of infants. More advanced atherosclerotic lesions are first identified in the intima of three primary target vessels the carotid and coronary arteries and the aorta. Although there is significant disparity in the evolution of lesion formation, ischemic coronary disease, stroke, peripheral artery disease, and transient ischemic attacks are among the clinical presentations of matured lesions and ruptured plaques. This chapter reviews the recent literature regarding the biology of atherosclerosis and considers in detail anatomical structure of the normal and diseased artery, chronic endothelial injury and lipid hypotheses, and the events that contribute to formation of the atherosclerotic lesion. The authors hope that this chapter will serve as a basic tutorial for the understanding of the biology of atherosclerosis, and provide an appreciation for the complexity of this disease by introducing new and exciting research contributions to this area.
- Medicine and Medical Research