Atherosclerosis

Abstract

Atherosclerosis is the multifactorial inflammatory disease of the vasculature that affects large- and medium-sized arterial vessels. It is the process in which lipid plaque builds up inside the lumen of arteries and restricts blood flow. It is responsible for the majority of heart attacks and strokes. The plaque is composed of a lipid-rich gruel, engorged inflammatory cells and free fats and cholesterol that become trapped in the sub-endothelial space, often with a thin overlaying vascular smooth muscle cell cap. While the first steps in the plaque development may take place in adolescence or earlier, it may be many decades for the plaque to reach full maturity and become rupture prone. Traditionally a destabilised plaque is characterised by a paucity of vascular smooth muscle cells that provide the structural support and mechanical strength, with an excess of inflammatory cells. These inflammatory cells initially attempt to resolve the lesions but later contribute to plaque expansion, such that the plaque grows in size overtime. Atheroma is also responsible for the decreased supply of oxygen to the heart that causes angina in stable patients but if the plaque ruptures is responsible for acute myocardial infarction and stroke. This chapter explores the development of the atherosclerosis and provides a historical perspective and the risk factors associated with the development of disease. The chapter investigates current research methods and clinical perspectives for the future.