The Natural History of Atherosclerosis

The atherosclerotic process is associated with the aging process. Having been documented in the autopsies of ancient mummies, atherosclerosis appears to be universal in humans throughout the history of mankind. This natural history can be documented in every human.

The natural history of atherosclerosis begins at birth. The arteries are patent and clean at birth. Atherosclerosis begins in childhood ( by the age of 10) as deposits of cholesterol and its esters, referred to as fatty streaks, in the intima of large muscular arteries.


In some people and at certain arterial sites, more lipid accumulates and is covered by a fibromuscular cap to form a fibrous plaque. Further changes in fibrous plaques render them vulnerable to rupture, an event that precipitates occlusive thrombosis and clinically manifest disease (sudden cardiac death, myocardial infarction, stroke, or peripheral arterial disease).

In adults, the fibrous plaque invades a large part of the artery, damaging the artery to the extent of precipitating a clinical event. This stage of the disease is called "Clinical Lesions".  Elevated non-HDL-cholesterol concentrations, low HDL-cholesterol concentrations, hypertension, smoking, diabetes, and obesity are associated with advanced atherosclerotic lesions and increased risk of clinically manifest atherosclerotic disease.


The figure below shows the natural history of atherosclerosis against the ageing process:

The development of the fatty streak in childhood is depicted as a reversible process. In adolescence, some fatty streaks accumulate more lipid and begin to develop a fibromuscular cap, forming the lesion termed a fibrous plaque. In subsequent years, fibrous plaques enlarge and undergo calcification, hemorrhage, ulceration or rupture, and thrombosis. Thrombotic occlusion precipitates clinical disease, depending on which artery is affected.

Reference:
http://www.indiana.edu/~k562/athero.html

Posted in: Atherosclerosis, History of Atherosclerosis