Complications of atherosclerosis are the leading cause of death
in the U.K.
Major risk factors for coronary atherosclerosis include hyperlipidemia,
hypertension, and diabetes, all of which may be familial, and smoking.
Increasing age and male sex also have predisposition to atherosclerosis.
Other risk factors include increased dietary fat (particularly cholesterol),
decreased exercise, obesity, oral contraceptive use, and stress.
Pathogenesis of atherosclerosis may be related to endothelial injury
with increased permeability to lipids, increased intimal smooth muscle
proliferation, and macrophage emigration and proliferation in the intima.
Another theory holds that smooth muscle proliferation initiates plaque
formation. Fatty lipid streaks, seen even in children, may not be precursors
to atheromatous plaques in all cases. Resultant intimal plaques can increase
in size, leading to increasing lumenal obstruction. Plaques can be complicated
by ulceration, hemorrhage, thrombosis, and calcification.
The consequences of coronary atherosclerosis can be ischemia with angina,
myocardial infarction with greater degrees of occlusion, and sudden death
from severe occlusion or thrombosis is of atheromatous plaques.