Atherosclerosis
Atherosclerosis is a chronic inflammatory, lipid-driven disease of the arterial wall in which plaques narrow arteries and can rupture to cause acute thrombosis. It underlies coronary, cerebrovascular, and peripheral artery disease, and management is aggressive risk-factor control, high-intensity statins, and antiplatelet therapy, with revascularization for specific lesions.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: atherosclerosis is a chronic, progressive disease of the arterial wall in which lipid accumulation, inflammation, and fibrosis form plaques that narrow the lumen and can rupture.
- Epidemiology
The leading global cause of death, through coronary, cerebrovascular, and peripheral disease.
- Risk factors
Elevated LDL cholesterol and dyslipidemia.
- Pathophysiology
Endothelial injury and lipid entry: LDL enters and is retained and oxidized in the intima, triggering inflammation.
- Clinical features
Asymptomatic for years, with subclinical plaque.
- Differential diagnosis
Vasculitis: inflammatory arterial disease (Takayasu, giant cell arteritis) with systemic symptoms and raised inflammatory markers, distinguished by wall enhancement and long smooth stenoses rather than focal calcified plaque.
- Diagnosis
Establish clinically by ischemic syndromes and confirm with vascular and lipid assessment and imaging of plaque or ischemia: the diagnostic basis is recognizing atherosclerotic ischemic syndromes…
- Management
First-line, aggressive risk-factor modification and lipid lowering: smoking cessation, a high-intensity statin (atorvastatin 40 to 80 mg PO daily or rosuvastatin 20 to 40 mg PO daily) to a guideline…
- Complications
Myocardial infarction and stable coronary disease.
- Prognosis
Improved substantially by risk-factor control and statins.
- Prevention
Statin therapy and LDL lowering to below 70 mg/dL in established atherosclerotic disease.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Dyslipidemia
Dyslipidemia is an abnormal lipid profile, chiefly elevated LDL cholesterol, that drives atherosclerotic cardiovascular disease. Management is risk-based LDL lowering with statins as the foundation, adding ezetimibe and PCSK9 inhibitors to reach targets, alongside lifestyle change and evaluation for severe genetic forms and hypertriglyceridemia.
- Peripheral artery disease (PAD)
Peripheral artery disease is atherosclerotic narrowing of the limb arteries, most often causing exertional claudication and, when advanced, chronic limb-threatening ischemia. It is a strong marker of systemic atherosclerosis, diagnosed by the ankle-brachial index, and managed with aggressive risk-factor control, antiplatelet therapy, exercise, and revascularization for severe disease.
- Chronic stable angina
Chronic stable angina is reproducible, exertional chest discomfort from fixed coronary stenosis causing demand-related ischemia, relieved by rest or nitroglycerin. Diagnosis combines the typical anginal pattern with stress testing or coronary imaging, and treatment is antianginal and secondary-prevention medical therapy, with revascularization for refractory symptoms or high-risk anatomy.
- Atrial fibrillation
Atrial fibrillation is a supraventricular tachyarrhythmia with disorganized atrial activation and an irregularly irregular ventricular response, the most common sustained arrhythmia and a major cause of stroke. Diagnosis is by ECG showing no discrete P waves with irregular RR intervals, and management addresses rate or rhythm control, stroke prevention by CHA2DS2-VASc-guided anticoagulation, and the underlying cause.
- Vasospastic (Prinzmetal) angina
Vasospastic (Prinzmetal) angina is angina from transient epicardial coronary artery spasm, causing rest chest pain with transient ST elevation, typically at night or in the early morning. Diagnosis rests on documenting spasm or reversible ST changes, and treatment is calcium channel blockers and nitrates while strictly avoiding non-selective beta-blockers and triggers.
- Aortic dissection
Aortic dissection is a tear in the aortic intima allowing blood to split the media, creating a false lumen, and is a surgical emergency. Type A (ascending) dissection needs emergency surgery, while type B (descending) is usually managed medically with rapid heart-rate and blood-pressure control; the priority is impulse control with a beta-blocker first.
- Cholesterol embolization syndrome
Cholesterol embolization syndrome is showering of cholesterol crystals from atherosclerotic plaques into small arteries, typically after an arterial procedure or anticoagulation. It causes livedo reticularis, blue toes with preserved pulses, and acute kidney injury; management is supportive with aggressive statin therapy and avoiding further arterial insult.
- Microvascular angina
Microvascular angina is angina from coronary microvascular dysfunction with no obstructive epicardial disease, part of the INOCA spectrum. It causes exertional or rest chest pain with evidence of ischemia but normal angiography, is diagnosed by tests of coronary flow reserve, and is managed with risk-factor control and antianginal therapy.