Essay Title: 

medical biochemistry

March 26, 2016 | Author: | Posted in health and medicine, nutrition

CURRENT CONCEPT AND MACHANISMS IN THE PATHOGENESIS OF ATHEROSCLEROSIS

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PATHOGENESIS OF ATHEROSCLEROSIS

Atherosclerosis is the leading cause of death and disability in the developed world . Despite our familiarity with the disease , some of its fundamental characteristics remain poorly recognized and understood Although many generalized or systemic risk factors predispose to its development , atherosclerosis affects various regions of the circulation preferentially and yields distinct clinical manifestations depending on the particular circulatory bed affected . Atherosclerosis of the coronary [banner_entry_middle]

arteries commonly causes myocardial infarction and angina pectoris Atherosclerosis of the arteries supplying the central nervous system frequently provokes strokes and transient cerebral ischemia . In the peripheral circulation , atherosclerosis causes intermittent claudication and gangrene and can jeopardize limb viability . Involvement of the splanchnic circulation can cause mesenteric ischemia . Atherosclerosis can affect the kidneys either directly (e .g , renal artery stenosis ) or as a frequent site of atheroembolic disease

Even with in a given arterial bed , atherosclerosis tends to occur focally , typically in certain predisposed regions . In the coronary circulation , for example , the proximal left anterior descending coronary artery exhibits a particular predilection for developing atherosclerotic occlusive disease . Likewise atherosclerosis preferentially affects the proximal portions of the renal arteries and in the extracranial circulation to the brain , the carotid bifurcation . Indeed atherosclerosis lesions often form at branching points of arteries regions of disturbed blood flow . Not all manifestations of atherosclerosis result from stenotic , occlusive disease . Ectasia and development of aneurismal disease , for example , frequently occur in the aorta . The mechanisms that underlie this discontinuous anatomic distribution of atherosclerosis remain uncertain (Rodney A . White White A , Ramadan Sha ‘afi , White A . White , 1989

Atherosclerosis manifests itself focally not only in space , as just described , but in time as well . Atherogenesis in humans typically occurs over a period of many years , usually many decades . Growth of atherosclerotic plaques probably does not occur in a smooth linear fashion , but rather discontinuously , with periods of relative quiescence punctuated by periods of rapid evolution . After a generally prolonged silent period , atherosclerosis may become clinically manifest . The clinical expressions of atherosclerosis may be chronic , as in the development of stable , effort-induced angina pectoris or of predictable and reproducible intermittent claudication . Alternatively , a much more dramatic acute clinical event such as myocardial infarction , a cerebrovascular accident , or sudden cardiac death may first herald the presence of atherosclerosis . Other individuals may never experience clinical manifestations of arterial disease despite the presence of widespread atherosclerosis demonstrated post mortem

INITIATION OF ATHEROSCLEROSIS

FATTY STREAK FORMATION

An integrated view of experimental results in animal and study of human atherosclerosis suggests that the fatty streak represents the initial lesion of atherosclerosis . The formation of these early lesions of atherosclerosis most often seems to arise from focal increases in the content of lipo-protein within regions of the intima . These accumulations of lipoprotein particles may not result simply from an increased permeability or leakiness of the over lining endothelium Rather this lipoprotein may collect in the… [banner_entry_footer]

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