ATHEROSCLEROSIS: PATHOGENESIS, RISK FACTORS, AND MODERN MANAGEMENT STRATEGIES
Abstract
Atherosclerosis, a chronic progressive arterial disease characterized by lipid deposition and plaque formation, remains the leading cause of cardiovascular morbidity and mortality worldwide. This systematic review examines the pathophysiological mechanisms involving endothelial dysfunction, inflammatory responses, and smooth muscle cell migration that drive atheroma development. We analyze modifiable (hyperlipidemia, hypertension, diabetes, smoking) and non-modifiable (age, gender, genetics) risk factors, with meta-analysis showing 80% prevalence in adults >60 years. Clinical manifestations typically emerge only after 50-70% arterial occlusion, presenting as coronary artery disease (30-45% cases), cerebrovascular accidents (20-25%), or peripheral artery disease (15-20%). Diagnostic advancements, including lipid profiling (LDL >130 mg/dL, increasing risk 3-fold) and vascular ultrasound, improve early detection. Contemporary management combines statins (reducing events by 25-35%), antiplatelet therapy, and lifestyle modifications. Emerging therapies targeting inflammatory pathways show promise in recent trials. Prevention through dietary optimization (Mediterranean diet reducing risk by 30%), regular exercise, and smoking cessation remains paramount in combating this global health challenge.
References
1. Libby, P., Buring, J. E., Badimon, L., Hansson, G. K., Deanfield, J., Bittencourt, M. S., Tokgözoğlu, L., & Lewis, E. F. (2019). Atherosclerosis. Nature Reviews Disease Primers, 5(1), 56. https://doi.org/10.1038/s41572-019-0106-z
2. Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A., ... Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on managing Blood Cholesterol. Journal of the American College of Cardiology, 73(24), e285-e350. https://doi.org/10.1016/j.jacc.2018.11.003
3. Ridker, P. M., Everett, B. M., Thuren, T., MacFadyen, J. G., Chang, W. H., Ballantyne, C., Fonseca, F., Nicolau, J., Koenig, W., Anker, S. D., Kastelein, J. J. P., Cornel, J. H., Pais, P., Pella, D., Genest, J., Cifkova, R., Lorenzatti, A., Forster, T., Kobalava, Z., ... CANTOS Trial Group. (2017). Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. New England Journal of Medicine, 377(12), 1119-1131. https://doi.org/10.1056/NEJMoa1707914
4. Ference, B. A., Ginsberg, H. N., Graham, I., Ray, K. K., Packard, C. J., Bruckert, E., Hegele, R. A., Krauss, R. M., Raal, F. J., Schunkert, H., Watts, G. F., Borén, J., Fazio, S., Horton, J. D., Masana, L., Nicholls, S. J., Nordestgaard, B. G., van de Sluis, B., Taskinen, M. R., ... Catapano, A. L. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal, 38(32), 2459-2472. https://doi.org/10.1093/eurheartj/ehx144
5. World Health Organization. (2021). Global status report on noncommunicable diseases 2021. https://www.who.int/publications/i/item/9789240042561
6. Gaddey, H. L. (2022). Internal Medicine: Clinical Cases in Primary Care. Elsevier.
7. Cleveland Clinic. (2023). Atherosclerosis. https://my.clevelandclinic.org/health/diseases/16753-atherosclerosis
8. Mayo Clinic Staff. (2023). Arteriosclerosis / atherosclerosis. https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis
9. Stary, H. C. (2021). Atlas of Atherosclerosis Progression and Regression (2nd ed.). CRC Press.
10. Haverich, A., & Boyle, E. C. (2022). Atherosclerosis: Pathogenesis and Microvascular Dysfunction. Journal of Vascular Research, 59(1), 1-15. https://doi.org/10.1159/000519678
