Modifiable: smoking, diabetes, hypertension, hypercholesterolaemia, physical inactivity, obesity and diet

Pathophysiology

Endothelial damage attracts leukocytes, lipids and smooth muscle cells to the intima, resulting in formation of a fatty streak, and eventually an atherosclerotic plaque

Complications

Unstable atherosclerotic plaques are prone to rupture, thrombosis, embolism, haemorrhage and aneurysm formation

Clinical significance

Cardiovascular

• Stable angina
  
• Acute coronary syndrome

Peripheral vascular disease
Renal artery stenosis and infarction
Aneurysm

Management

Lifestyle modification
Monitor existing conditions such as hypertension, diabetes
Statin therapy (atorvastatin)

7.2 Definition

Atherosclerosis is a complex disease process affecting principally medium- to large-sized arteries that normally results in luminal stenosis which may be progressive over time. Pathologically, there is focal accumulation within the intimal layer of the arterial wall of cells, lipids, fibrous tissue, and complex proteoglycans, eventually resulting in the formation of an atherosclerotic plaque. As they advance, these plaques also accumulate calcium, giving rise to the colloquial term ‘hardening of the arteries’.

7.3 Risk factors

• Non-modifiable:
  
  
  
  • older age
    
  • male and post-menopausal female
    
  • family history

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