Atherosclerosis

Atherosclerosis is a chronic inflammatory disease of the arteries characterized by the buildup of plaques that can restrict blood flow. It commonly affects large- and medium-sized arteries and underlies many cardiovascular diseases, including coronary artery disease, stroke, and peripheral arterial disease.

The disease begins with endothelial injury or dysfunction, often driven by risk factors such as high blood pressure, high cholesterol, smoking, and diabetes. Low-density lipoprotein (LDL) cholesterol accumulates in the arterial intima and becomes oxidized, attracting inflammatory cells. Macrophages ingest lipid and form foam cells, creating fatty streaks that evolve into fibrous plaques. Plaques consist of a lipid-rich core and a fibrous cap; instability or rupture can trigger thrombosis and acute vascular occlusion.

Risk factors are categorized as modifiable (high LDL cholesterol, high blood pressure, diabetes, smoking, obesity, physical inactivity, unhealthy diet) and non-modifiable (age, family history, male sex). Inflammation contributes to progression and rupture of plaques.

Clinical presentation varies by vessel involved. Many individuals are asymptomatic until significant stenosis or acute events occur. Symptoms may include angina, transient ischemic attacks, stroke, or claudication. Diagnosis relies on clinical assessment and imaging, such as carotid ultrasound, coronary calcium scoring, CT or MR angiography, and lipid testing, alongside risk factor evaluation.

Management emphasizes prevention and control of risk factors. Lifestyle modification and statin therapy are foundational, with antiplatelet therapy, antihypertensive and antidiabetic treatment as indicated. Revascularization (angioplasty, stenting, or bypass surgery) may be required for severe disease or ischemic complications. Effective risk factor management reduces progression and cardiovascular events.

Atherosclerosis remains a leading cause of cardiovascular morbidity and mortality worldwide, underscoring the importance of early detection and comprehensive prevention.