Atherosclerosis

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Atherosclerosis
Dr. Venkatesh M. Shashidhar Senior Lecturer in
Pathology Fiji School of Medicine
A Commitment to Excellence
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Definition

• Chronic inflammatory disorder of intima of large
  blood vessels characterised by formation of
  fibrofatty plaques called atheroma.
• Hardening of arteries - Arteriosclerosis

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Introduction

• Disease of large elastic arteries - Intima
• Chronic inflammation
• Hardening and destruction.

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Introduction

• Major cause of IHD, MI, Stroke Aortic disease
  - Major cause of
• Incidence is decreasing since 1995 - West
• Better understanding Change in life style.

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Pathogenesis

• Unknown.
• Initial intimal injury
• Intimal thickening with inflammation,
• Central necrosis, Lipid accumulation
• Fibrosis, smooth muscle proliferation Atheroma.
• Obstruction and / or destruction of vessel
• Complications - Thrombosis, embolism, aneurism,
  dissection rupture.

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Common Sites

• Aorta, Carotid Iliac. (large vessels)
• Major Vessels - Heart, Brain Kidney.
• Coronary
• Renal
• Abdominal
• Limbs

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Morphology

• Fatty Dots
• Fatty Streaks
• Atheromatous Plaque
• Fibrofatty Plaque
• Cells, Matrix Lipid deposit.
• Complications
• Ulceration, Rupture,Hemorrhage, Thrombosis
• Atheroemboli or cholesterol emboli.

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Structure of Atheroma
Fibrous Cap Necrotic center Cholesterol
Cry. Macrophages
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American H.A. Classification

• Type I Fatty dots - Foam cells
• Type II Fatty streak
• Type III Extracellular lipid pool
• Type IV Atheroma Core of lipid
• Type V Fibroatheroma Fibrotic layer
• Type VI Complicated
• Hemorrhage, thrombus, haematoma etc.

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Stages of Atheroma - Aorta
Stage VI III II
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Fatty Streaks - Aorta
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Coronary Atherosclerosis
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Coronary Thrombosis With Infarction
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Coronary Narrowing in Atherosclerosis
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Atheroma Aorta
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Atheroma Aorta
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Atheroma Coronary Artery
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Atheroma Coronary Artery
Calcification
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Atheroma Coronary Artery
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Atheroma with Thrombosis
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Angiogram - Embolism Infarction
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Thrombo-embolism
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Subarachnoid Haemorrhage
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Hyperlipidemia

• Hypercholesterolemia Risk
• Hypertriglyceridemia - less significant
• LDL Increased risk
• HDL lowers the risk Reverse transport
• Mobilises the cholesterol from tissues to liver.

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Good Fats

• Mono unsaturated fats
• Poly unsaturated fats
• Omega-3 fatty acids (Fish)
• Lower LDL, Increase HDL
• Anti-atherogenic effect
• Japan and Greenland.

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Dyslipoproteinemias

• Increased LDL
• Decreased HDL
• Increased chylomicron remnants IDL
• Abnormal Lipoproteins - Lp(a)
• Altered LDL bound to apo-A, shown to be more
  correlated with atherogenecity.
• Related to chronic inflammation thrombotic
  factors.
• Oxidant injury. (anti-oxidants)

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Cholesterol Transport
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Risk Factors

• Non modifiable
• Age middle to late.
• Sex Males, complications
• Genetic - Hyperchol.
• Family history.

• Potentially Modifiable
• Hyperlipidemia HDL/LDL ratio.
• Hypertension.
• Smoking.
• Diabetes.

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Thank you