Cardiovascular Disease Risk Factors

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Questions and Answers

At what age do fatty streaks begin to appear in the aortas of children?

In adolescence

After the age of 10

In the first year of life (correct)

Before birth

What is the primary component of the core of atheromatous plaques?

Triglycerides

Cholesterol and cholesterol esters (correct)

Phospholipids

Proteoglycans

What is the result of focal rupture or gross ulceration of the luminal surface of atheromatous plaques?

Hemorrhage into a plaque

An aneurysm

Patchy calcification

Thromboembolic event (correct)

What is the acknowledged major risk factor for atherosclerosis?

Hyperlipidemia Signup and view all the answers

What is the final stage of the pathogenesis of atherosclerosis?

Migration of smooth muscle cells from media into the intima Signup and view all the answers

What type of cholesterol is associated with an increased risk of atherosclerosis?

Low-density lipoprotein (LDL) Signup and view all the answers

What is the result of hemorrhage into a plaque?

Especially in the coronary arteries Signup and view all the answers

What is the typical color of atheromatous plaques?

White to whitish yellow Signup and view all the answers

What is the relationship between high-density lipoprotein (HDL) level and the risk of ischemic heart disease?

There is an inverse relationship between HDL level and the risk of ischemic heart disease Signup and view all the answers

What is the result of patchy or massive calcification of arteries?

The aorta assumes an eggshell brittleness Signup and view all the answers

What is the effect of diabetes mellitus on the incidence of myocardial infarction?

It doubles the incidence of myocardial infarction Signup and view all the answers

What is the initial stage of the pathogenesis of atherosclerosis?

Focal regions of chronic endothelial injury Signup and view all the answers

What is the main component of fatty streaks?

Lipid-filled foam cells with T lymphocytes Signup and view all the answers

What is the relationship between cigarette smoking and the incidence of atherosclerosis?

Cigarette smoking is a well-established risk factor for atherosclerosis Signup and view all the answers

What is the characteristic feature of giant cell arteritis?

Granulomatous inflammation of the inner half of the media Signup and view all the answers

What is the effect of unrestrained weight gain on cardiovascular health?

It increases the risk of cardiovascular disease by inducing hypertension, diabetes, hypertriglyceridemia, and decreasing HDL Signup and view all the answers

What is the typical site of mycotic aneurysms?

Cerebral arteries Signup and view all the answers

What is the morphology of fatty streaks?

Multiple yellow, flat spots that coalesce into elongated streaks Signup and view all the answers

What is the consequence of rupture of berry aneurysms?

Subarachnoid hemorrhage Signup and view all the answers

What is the association of syphilitic aneurysms?

Syphilis Signup and view all the answers

What is the characteristic feature of atherosclerotic aneurysms?

Enhanced accumulation of lipids Signup and view all the answers

What is the common site of giant cell arteritis?

All of the above Signup and view all the answers

What is the consequence of giant cell arteritis?

Blindness Signup and view all the answers

What is the histological feature of giant cell arteritis?

Granulomatous inflammation with multinucleate giant cells Signup and view all the answers

What is the primary location of arteries affected by Buerger's disease?

Medium sized and small arteries Signup and view all the answers

What is the main characteristic of capillary hemangiomas?

Narrow, thin-walled blood vessels Signup and view all the answers

What is the typical age range for women affected by Buerger's disease?

Below 35 years Signup and view all the answers

What is the most common location of hemangiomas?

Head and neck Signup and view all the answers

What is the characteristic of cavernous hemangiomas?

Large, dilated vascular channels Signup and view all the answers

What is the typical behavior of capillary hemangiomas in children?

They spontaneously regress at or before puberty Signup and view all the answers

What is the main complication of Buerger's disease?

Chronic ulcerations and gangrene Signup and view all the answers

What is the name of the type of hemangioma characterized by the formation of small, abscess-like structures?

Pyogenic granuloma Signup and view all the answers

What is the characteristic feature of Pyogenic granuloma?

Bleeding easily and often ulcerated Signup and view all the answers

What is the most common location for Simple (Capillary) Lymphangioma?

Head and neck region and axilla Signup and view all the answers

What is the pathological feature of Cavernous Lymphangioma?

Cavernous lymphatic spaces Signup and view all the answers

What is the characteristic feature of Angiosarcoma?

Malignant endothelial neoplasm with varied structure Signup and view all the answers

What is the predisposing factor for Angiosarcoma?

Lymphedema after radical mastectomy Signup and view all the answers

What is the gross appearance of Cutaneous Angiosarcoma?

Deceptively small, sharply demarcated, asymptomatic, often multiple red nodules Signup and view all the answers

What is the characteristic feature of Pyogenic granuloma in histology?

Striking resemblance to exuberant granulation tissue Signup and view all the answers

What is the common site for Angiosarcoma?

Skin, soft tissue, breast, and liver Signup and view all the answers

Study Notes

Atherosclerosis and Ischemic Heart Disease

Familial predisposition to atherosclerosis and ischemic heart disease is likely polygenic.
Hyperlipidemia is a major risk factor for atherosclerosis, with LDL cholesterol being the main component associated with increased risk.
HDL cholesterol has an inverse relationship with symptomatic atherosclerosis, meaning higher levels of HDL lower the risk of ischemic heart disease.
Hypertension is a major risk factor for atherosclerosis at all ages.
Cigarette smoking is a well-established risk factor for atherosclerosis, particularly in men, and accounts for the recent increase in incidence and severity in women.
Diabetes mellitus induces hypercholesterolemia and increases the predisposition to atherosclerosis, with the incidence of myocardial infarction being twice as high in diabetics as in non-diabetics.

Morphology of Atherosclerosis

Fatty streaks are precursors to atheromatous plaques, composed of lipid-filled foam cells, T lymphocytes, and extracellular lipid.
Atheromatous plaques are raised focal lesions within the intima, consisting of a core of lipid and a covering fibrous cap.
Atherosclerotic plaques have three principal components: cells, connective tissue extracellular matrix, and intracellular and extracellular lipid deposits.

Complications of Atherosclerosis

Patchy or massive calcification of arteries, leading to virtual pipe stems and brittle aortas.
Focal rupture or gross ulceration of atheromatous plaques, resulting in thromboembolic events.
Hemorrhage into a plaque, especially in coronary arteries.
Aneurysm formation.

Pathogenesis of Atherosclerosis

Focal regions of chronic endothelial injury lead to endothelial dysfunction.
Increased endothelial permeability and leukocyte adhesion occur.
Migration of monocytes into the intima and transformation into macrophages and foam cells.
Adhesion of platelets to focal areas and migration of smooth muscle cells from the media into the intima.
Enhanced accumulation of lipids both within cells and extracellularly.

Aneurysms

Atherosclerotic aneurysms usually occur in the abdominal aorta and can rupture, causing retroperitoneal hemorrhage.
Dissecting aneurysms occur in the thoracic aorta and can cause vascular occlusion and hemopericardium.
Berry aneurysms occur within the brain and can rupture, causing subarachnoid hemorrhage.
Capillary microaneurysms can occur in the retina, leading to diabetic retinopathy, or in the brain, leading to intracerebral hemorrhage.
Syphilitic aneurysms are associated with syphilis and affect the thoracic aorta.
Mycotic aneurysms result from weakening of the arterial wall due to fungal or bacterial infection, mainly affecting the cerebral arteries.

Giant Cell (Temporal) Arteritis

Giant cell arteritis is an acute and chronic, often granulomatous, inflammation of medium-sized and small arteries.
It affects the arteries in the head, particularly the temporal arteries, and can lead to blindness.
Characteristically, short segments of one or more affected arteries develop nodular thickenings with reduction of the lumen, which may become thrombosed.
Histologically, there is granulomatous inflammation of the inner half of the media, centered on the internal elastic membrane, with a mononuclear infiltrate, multinucleate giant cells, and fragmentation of the internal elastic lamina.

Buerger's Disease (Thrombo-Angiitis-Obliterans)

Buerger's disease is a disease that affects medium-sized and small arteries, mainly the tibial and radial arteries.
It is characterized by a heavy mixed inflammatory cell infiltrate, thrombosis of the lumen, and microabscesses.
Complications include chronic ulcerations and gangrene to the toes and fingers.

Benign Tumors

Hemangioma is a benign tumor characterized by an increased number of normal or abnormal vessels.
Capillary hemangioma is composed of blood vessels that resemble capillaries, narrow, thin-walled, and lined by thin endothelium.
Cavernous hemangioma is less common and is distinguished by the formation of large, dilated vascular channels.
Pyogenic granuloma is a polypoid form of capillary hemangioma that occurs as a rapidly growing exophytic red nodule.
Lymphangioma is the lymphatic analogue of hemangioma, with simple (capillary) and cavernous forms.

Angiosarcoma (Malignant Tumor)

Angiosarcoma is a malignant endothelial neoplasm that can occur in both sexes and at any age, but is more common in older adults.
It can arise in the skin, soft tissue, breast, and liver, and can also occur in the setting of lymphedema.
Grossly, cutaneous angiosarcoma may begin as deceptively small, sharply demarcated, asymptomatic red nodules, but eventually becomes large, fleshy masses of pale gray-white soft tissue.

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Description

Learn about the genetic predisposition to atherosclerosis and ischemic heart disease, and how hyperlipidemia and cholesterol levels contribute to cardiovascular risk.