Atherosclerotic Vascular Disease Conference

Abstract

The existence of atherosclerosis has been recognized for >500 years; as a pathological condition, it has been recognized for >150 years. Understanding of atherosclerotic vascular disease (AVD) has evolved most dramatically over the past 25 years with the growth of the field of vascular biology.1 Numerous studies have described this disease as a diffuse and progressive process with a variable distribution and clinical presentation that is dependent on the regional circulation involved. Factors that may influence these differences include the size and structure of the affected artery, local and regional flow, changes in microcirculatory alterations, and end-organ damage. This report discusses the general concepts of atherosclerosis, pathophysiology, microcirculatory disturbances, regional responses to atherosclerosis and ischemia, and recommendations for future research, programs, and advocacy. Atherosclerosis involves several highly interrelated processes, including lipid disturbances, platelet activation, thrombosis, endothelial dysfunction, inflammation, oxidative stress, vascular smooth cell activation, altered matrix metabolism, remodeling, and genetic factors.2 This sequence is shown schematically in Figure 1 and described in detail below. Figure 1. The 7 stages of development of an atherosclerotic plaque. First LDL moves into the subendothelium and is oxidized by macrophage and SMCs (1 and 2). Release of growth factors and cytokines attracts additional monocytes (3 and 4). Foam cell accumulation and SMC proliferation result in growth of the plaque (6, 7, and 8). Risk factors play an important role in initiating and accelerating the complex process of atherosclerosis. Risk factors for atherosclerosis are also the primary method of risk assessment and the target for therapeutic intervention in the prevention of premature vascular disease. Interestingly, the impact of these risk factors on disease development and progression in the peripheral vasculature are not the same as those in the coronary vessels and may represent an avenue of investigation to explain variations in clinical presentation …