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== Recent research ==
Methods to increase [[high density lipoprotein]] (HDL) particle concentrations, which in some animal studies largely reverses and remove atheromas, are being developed and researched.  [[Niacin]] has HDL raising effects (by 10 - 30%) and showed clinical trial benefit in the Coronary Drug Project, however, the drug [[torcetrapib]] most effectively raising HDL (by 60%) also raised deaths by 60% and all studies regarding this drug were halted in December 2006.[http://www.nlm.nih.gov/medlineplus/news/fullstory_42459.html]
An indication of the role of HDL on atherosclerosis has been with the rare Apo-A1 Milano human genetic variant of this HDL protein. Ongoing work starting in the 1990s may lead to human clinical trials probably by about 2008, on using either synthesized Apo-A1 Milano HDL directly or by gene-transfer methods to pass the ability to synthesize the Apo-A1 Milano HDL protein.
The ASTEROID trial used a high-dose of a powerful statin, [[rosuvastatin]], and found plaque (intima + media volume) reduction; see the ''Effect of Very High-Intensity Statin Therapy'' reference below. No attempt has yet been made to compare this drug with placebo regarding clinical benefit.
Since about 2002, progress in understanding and developing techniques for modulating immune system function so as to significantly suppress the action of macrophages to drive atherosclerotic plaque progression are being developed with considerable success in reducing plaque development in both mice and rabbits. Plans for human trials, hoped for by about 2008, are in progress. Generally these techniques are termed immunomodulation of atherosclerosis.
Genetic expression and control mechanism research, including (a) the PPAR [[peroxisome proliferator activated receptors]] known to be important in blood sugar and variants of lipoprotein production and function and (b) of the multiple variants of the proteins which form the lipoprotein transport particles, is progressing.
Some controversial research has suggested a link between atherosclerosis and the presence of several different [[nanobacterium|nanobacteria]] in the arteries, e.g. [[Chlamydophila pneumoniae]], though trials of current antibiotic treatments known to be usually effective in suppressing growth or killing these bacteria have not been successful in improving outcomes.
The immunomodulation approaches mentioned above, because they deal with innate responses of the host to promote atherosclerosis, have far greater prospects for success. <ref>Stevens, Karen M.J. Douglas, Athanasios N. Saratzis and George D. Kitas Inflammation and atherosclerosis in rheumatoid arthritis Robert J. Expert Rev. Mol. Med. Vol. 7, Issue 7</ref> <ref>Mol, A 2002 _The Body Multiple: Ontology in medical practice_ London: Duke University Press</ref>


==Pathological Findings==
==Pathological Findings==

Revision as of 18:36, 22 February 2013

Template:DiseaseDisorder infobox

Atherosclerosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atherosclerosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Assessment of Cardiovascular Risk

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocadiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

ACC/AHA Guideline Recommendations

Assessment of cardiovascular risk

Secondary prevention

Case Studies

Case #1

Atherosclerosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Atherosclerosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atherosclerosis

CDC on Atherosclerosis

Atherosclerosis in the news

Blogs on Atherosclerosis

Directions to Hospitals Treating Atherosclerosis

Risk calculators and risk factors for Atherosclerosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Atherosclerosis: Gross, close-up of fatty streak and intimal thickening

    Atherosclerosis: Gross, close-up of fatty streak and intimal thickening

  • Atherosclerosis: Gross, very good example of fibrous plaques with ulceration and thrombosis

    Atherosclerosis: Gross, very good example of fibrous plaques with ulceration and thrombosis

  • Atherosclerosis: Gross, proximal left anterior descending artery showing faint fatty streaks and penetrating arteries

    Atherosclerosis: Gross, proximal left anterior descending artery showing faint fatty streaks and penetrating arteries

  • Atherosclerosis: Gross, close-up view of aorta. A plaque with ulceration and thrombosis

    Atherosclerosis: Gross, close-up view of aorta. A plaque with ulceration and thrombosis


  • Atherosclerosis: Gross, good example of plaques in aorta

    Atherosclerosis: Gross, good example of plaques in aorta

  • Atherosclerosis: Coronary artery: Gross, close-up view of excellent plaque lesion causing more than 90% occlusion

    Atherosclerosis: Coronary artery: Gross, close-up view of excellent plaque lesion causing more than 90% occlusion

  • Atherosclerosis: Gross, good example of advanced calcific atherosclerosis in aorta.

    Atherosclerosis: Gross, good example of advanced calcific atherosclerosis in aorta.

  • Atherosclerosis: Gross, very good example of calcified and ulcerated atheromatous plaques in aorta

    Atherosclerosis: Gross, very good example of calcified and ulcerated atheromatous plaques in aorta


  • Atherosclerosis: Dissecting Aortic Aneurysm: Gross, shows dilated aorta with extensive atherosclerosis dissection is seen. A small abdominal aorta, atherosclerotic aneurysm is present. A good picture for association of dilation with dissection

    Atherosclerosis: Dissecting Aortic Aneurysm: Gross, shows dilated aorta with extensive atherosclerosis dissection is seen. A small abdominal aorta, atherosclerotic aneurysm is present. A good picture for association of dilation with dissection

  • Atherosclerosis: Gross, close-up, an excellent view but appearance much like that of syphilitic aortitis

    Atherosclerosis: Gross, close-up, an excellent view but appearance much like that of syphilitic aortitis

  • Atherosclerosis: Gross, an excellent example of ulcerated lesions with many mural thrombi

    Atherosclerosis: Gross, an excellent example of ulcerated lesions with many mural thrombi

  • Atherosclerosis: Gross, very good example of plaque lesion and small mural thrombi

    Atherosclerosis: Gross, very good example of plaque lesion and small mural thrombi


  • Atherosclerosis: Coronary artery: Gross, an excellent example of plaque, 80% occlusion, uncomplicated lesion.

    Atherosclerosis: Coronary artery: Gross, an excellent example of plaque, 80% occlusion, uncomplicated lesion.

  • Atherosclerosis: Coronary artery: Atherosclerosis and thrombotic occlusion: Gross, (an excellent example) in situ on heart

    Atherosclerosis: Coronary artery: Atherosclerosis and thrombotic occlusion: Gross, (an excellent example) in situ on heart

  • Atherosclerosis: Coarctation: Gross, adult lesion with dramatic demonstration of accelerated atherosclerosis

    Atherosclerosis: Coarctation: Gross, adult lesion with dramatic demonstration of accelerated atherosclerosis

  • Atherosclerosis: Coronary artery: Gross, cross section well shown hemorrhage into plaque and thrombosis

    Atherosclerosis: Coronary artery: Gross, cross section well shown hemorrhage into plaque and thrombosis


  • Atherosclerosis: Aorta: Gross, good example of fibrous plaques

    Atherosclerosis: Aorta: Gross, good example of fibrous plaques

  • Atherosclerosis: Aorta: Gross, an excellent example of fibrous plaques and mural thrombi

    Atherosclerosis: Aorta: Gross, an excellent example of fibrous plaques and mural thrombi

  • Atherosclerosis: Aorta: Gross, thrombi at the origin of celiac axis and superior mesenteric arteries

    Atherosclerosis: Aorta: Gross, thrombi at the origin of celiac axis and superior mesenteric arteries

  • Atherosclerosis: Aorta: Gross, thrombotic occlusion extending from just below renal arteries into iliac artery

    Atherosclerosis: Aorta: Gross, thrombotic occlusion extending from just below renal arteries into iliac artery


  • Atherosclerosis: Abdominal Aneurysm Ruptured: Gross, a good example, opened kidneys in marked place. Atherosclerosis in lower thoracic aorta

    Atherosclerosis: Abdominal Aneurysm Ruptured: Gross, a good example, opened kidneys in marked place. Atherosclerosis in lower thoracic aorta

  • Atherosclerosis: Adult type coarctation with atherosclerosis in aortic arch

    Atherosclerosis: Adult type coarctation with atherosclerosis in aortic arch

  • Atherosclerosis: Abdominal Aneurysm Graft Repair: Gross natural color, close-up, an excellent example of Dacron graft that has been in place for years with pseudointima and atherosclerosis

    Atherosclerosis: Abdominal Aneurysm Graft Repair: Gross natural color, close-up, an excellent example of Dacron graft that has been in place for years with pseudointima and atherosclerosis

  • Atherosclerosis: Renal Transplant: Gross, natural color, a close-up view of severe atherosclerosis in abdominal segment of aorta and fatty streaks in descending thoracic much advanced lesions for a 22 years old male with chronic glomerulonephritis

    Atherosclerosis: Renal Transplant: Gross, natural color, a close-up view of severe atherosclerosis in abdominal segment of aorta and fatty streaks in descending thoracic much advanced lesions for a 22 years old male with chronic glomerulonephritis


Saphenous Vein Graft

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, an excellent demonstration of myofibroblastic type cells in thickened intima

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, an excellent demonstration of myofibroblastic type cells in thickened intima

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome low mag, advanced plaque with hemorrhage into atheroma and complete lumen occlusion with fresh thrombus

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome low mag, advanced plaque with hemorrhage into atheroma and complete lumen occlusion with fresh thrombus

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, low mag, early atheromata consisting of subendothelial foam cells, whole graft and fibrous intimal thickening, (102 months after CABG)

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, low mag, early atheromata consisting of subendothelial foam cells, whole graft and fibrous intimal thickening, (102 months after CABG)

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, high mag, subendothelial foam cells

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, high mag, subendothelial foam cells


  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, large athero plaque and recanalized thrombus in lumen

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, large athero plaque and recanalized thrombus in lumen

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, H&E, low mag, large and ruptured atheromatous plaque with focal hemorrhage and calcification

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, H&E, low mag, large and ruptured atheromatous plaque with focal hemorrhage and calcification

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, very complicated hemorrhagic and necrotic plaque with lumen occlusion. A recanalized thrombus and a large aneurysm at side filled with old blood and atheroma crystals

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, trichrome, low mag, very complicated hemorrhagic and necrotic plaque with lumen occlusion. A recanalized thrombus and a large aneurysm at side filled with old blood and atheroma crystals

  • Saphenous vein coronary bypass graft: Atherosclerosis: Micro, ald. fusch., complicated occlusive lesion with organized and recanalized thrombus and old hemorrhage into atheroma

    Saphenous vein coronary bypass graft: Atherosclerosis: Micro, ald. fusch., complicated occlusive lesion with organized and recanalized thrombus and old hemorrhage into atheroma

Coronary Arteries

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, good demonstration of organized and recanalized thrombus

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, good demonstration of organized and recanalized thrombus

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, very good example of marked lumen stenosis due to typical fibrous plaque with some calcifications

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, very good example of marked lumen stenosis due to typical fibrous plaque with some calcifications

  • Coronary artery: Atherosclerosis: Micro, H&E, injected artery, marked large plaque with thin fibrous cap has eroded to adventitia, the start of an aneurysm

    Coronary artery: Atherosclerosis: Micro, H&E, injected artery, marked large plaque with thin fibrous cap has eroded to adventitia, the start of an aneurysm

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of plaque with calcification and marked narrowing of lumen. 90% lumen is occluded by thrombus

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of plaque with calcification and marked narrowing of lumen. 90% lumen is occluded by thrombus


  • Coronary artery: Atherosclerosis: Micro, low mag, an excellent example of atheromatous plaque causing marked lumen obstruction. An uncomplicated plaque

    Coronary artery: Atherosclerosis: Micro, low mag, an excellent example of atheromatous plaque causing marked lumen obstruction. An uncomplicated plaque

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of athero plaque. the lumen is completely occluded

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, an excellent example of athero plaque. the lumen is completely occluded

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, a plaque with hemorrhage and organizing mural thrombus in lumen

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, a plaque with hemorrhage and organizing mural thrombus in lumen

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of plaque with old hemorrhage and marked lumen compensation

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of plaque with old hemorrhage and marked lumen compensation


  • Coronary artery: Atherosclerosis: Micro, H&E, med mag, plaque rupture with thrombosis

    Coronary artery: Atherosclerosis: Micro, H&E, med mag, plaque rupture with thrombosis

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, a good example of atheromatous plaque that appears to owe much of its mass to an organized mural thrombus

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, injected artery, a good example of atheromatous plaque that appears to owe much of its mass to an organized mural thrombus

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, typical uncomplicated fibrous plaque

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, typical uncomplicated fibrous plaque

  • Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of athero plaque with marked lumen narrowing. A small mural thrombus in lumen

    Coronary artery: Atherosclerosis: Micro, H&E, low mag, a good example of athero plaque with marked lumen narrowing. A small mural thrombus in lumen


  • Coronary artery: Atherosclerosis: Micro, low mag, hemorrhage into plaque and thrombosis

    Coronary artery: Atherosclerosis: Micro, low mag, hemorrhage into plaque and thrombosis

  • Coronary artery: Atherosclerosis: Recanalized Thrombus: Micro, low mag, H&E, lesion is nearly completely organized, small adventitial dissection probably related to bypass surgery about 24 hours before death (a good example)

    Coronary artery: Atherosclerosis: Recanalized Thrombus: Micro, low mag, H&E, lesion is nearly completely organized, small adventitial dissection probably related to bypass surgery about 24 hours before death (a good example)

  • Coronary artery: Atherosclerosis: Plaque Hemorrhage and Thrombosis: Micro, low mag, H&E, quite good photo, large plaque with hemorrhage, organizing thrombus in lumen

    Coronary artery: Atherosclerosis: Plaque Hemorrhage and Thrombosis: Micro, low mag, H&E, quite good photo, large plaque with hemorrhage, organizing thrombus in lumen

  • Coronary artery: Atherosclerosis, Severe: Micro, low mag, H&E, more than 90% stenosis, also shown a side branch

    Coronary artery: Atherosclerosis, Severe: Micro, low mag, H&E, more than 90% stenosis, also shown a side branch

Aorta

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Kidney: Atheromatous Embolus: Gross, natural color, external view of kidney with typical scarring pattern of repeated infarction and aorta with severe atherosclerosis (quite good example)

    Kidney: Atheromatous Embolus: Gross, natural color, external view of kidney with typical scarring pattern of repeated infarction and aorta with severe atherosclerosis (quite good example)

  • Aorta, Atherosclerosis: Gross, natural color, opened thoracic segment showing sessile plaques covering intima with several mural thrombi

    Aorta, Atherosclerosis: Gross, natural color, opened thoracic segment showing sessile plaques covering intima with several mural thrombi

  • Aorta, Atherosclerosis: Gross natural color view of descending thoracic and abdominal segments with expected distribution of atherosclerotic lesions in subject over 60 years old. Not much in thoracic segment and extensive plaques in abdominal segment, some with ulceration

    Aorta, Atherosclerosis: Gross natural color view of descending thoracic and abdominal segments with expected distribution of atherosclerotic lesions in subject over 60 years old. Not much in thoracic segment and extensive plaques in abdominal segment, some with ulceration

  • Thrombus: Gross natural color aorta with kidneys showing thrombotic occlusion due to atherosclerosis beginning just below renal arteries and extending into common iliac (very good example)

    Thrombus: Gross natural color aorta with kidneys showing thrombotic occlusion due to atherosclerosis beginning just below renal arteries and extending into common iliac (very good example)

Carotid Artery

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Carotid artery: Atherosclerosis: Gross, internal carotid plaque with thrombosis

    Carotid artery: Atherosclerosis: Gross, internal carotid plaque with thrombosis

  • Carotid artery: Atherosclerosis: Gross, plaque with hemorrhage in carotid bulb

    Carotid artery: Atherosclerosis: Gross, plaque with hemorrhage in carotid bulb

  • Carotid artery bifurcation, atherosclerosis

    Carotid artery bifurcation, atherosclerosis

  • Carotid artery, atherosclerosis and thrombosis

    Carotid artery, atherosclerosis and thrombosis

  • Carotid artery: Atherosclerosis: Gross, good example of carotid bulb plaque with thrombus

    Carotid artery: Atherosclerosis: Gross, good example of carotid bulb plaque with thrombus

Lung

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

    Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

  • Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

    Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

  • Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

    Lung: Pulmonary fibrosis and atherosclerosis of pulmonary artery

  • Lung: Atherosclerosis: Gross, natural color, arteries show atherosclerotic plaque lesions

    Lung: Atherosclerosis: Gross, natural color, arteries show atherosclerotic plaque lesions

Pulmonary Artery

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Pulmonary artery atherosclerosis in patient with pulmonary hypertension

    Pulmonary artery atherosclerosis in patient with pulmonary hypertension

  • Pulmonary Artery Atherosclerosis: Gross, essentially natural color, artery stained by hemolysis, small plaque lesions

    Pulmonary Artery Atherosclerosis: Gross, essentially natural color, artery stained by hemolysis, small plaque lesions

  • Atherosclerosis: Gross, natural color, close-up fatty plaques in large pulmonary artery

    Atherosclerosis: Gross, natural color, close-up fatty plaques in large pulmonary artery

  • Atherosclerosis: Micro, low mag, van Gieson, thickened intima with fatty streak type lesion and preservation of fetal medial structure, a large pulmonary artery, 4yo male with primary pulmonary hypertension

    Atherosclerosis: Micro, low mag, van Gieson, thickened intima with fatty streak type lesion and preservation of fetal medial structure, a large pulmonary artery, 4yo male with primary pulmonary hypertension

Brain

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Brain: Atherosclerosis: Gross, a good example of atherosclerosis in vessels at base of brain.

    Brain: Atherosclerosis: Gross, a good example of atherosclerosis in vessels at base of brain.

  • Brain: Basilar Artery Atherosclerosis: Gross, fixed tissue, an external view of base of brain (typical lesion)

    Brain: Basilar Artery Atherosclerosis: Gross, fixed tissue, an external view of base of brain (typical lesion)

  • Brain: Old Cystic Encephalomalacia: Gross, fixed tissue, frontal lobe lesion with frontal artery atherosclerosis

    Brain: Old Cystic Encephalomalacia: Gross, fixed tissue, frontal lobe lesion with frontal artery atherosclerosis

  • Brain: Watershed Infarct and Carotid Atherosclerosis

    Brain: Watershed Infarct and Carotid Atherosclerosis

Liver

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Kidney

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Atherosclerosis: Kidney: Atheromatous Embolus: Gross, natural color, kidney with typical scarring pattern of repeated embolism and aorta with severe atherosclerosis (a quite good example)

    Atherosclerosis: Kidney: Atheromatous Embolus: Gross, natural color, kidney with typical scarring pattern of repeated embolism and aorta with severe atherosclerosis (a quite good example)

  • Atherosclerosis: Kidney: Atrophy secondary to renal artery atherosclerosis: Gross, natural color, both kidneys one very atrophic the large left kidney weighed 220 grams and the small left one 90 gram

    Atherosclerosis: Kidney: Atrophy secondary to renal artery atherosclerosis: Gross, natural color, both kidneys one very atrophic the large left kidney weighed 220 grams and the small left one 90 gram

Spleen

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

References

See also


cs:Ateroskleróza da:Åreforkalkning de:Arteriosklerose ko:동맥경화 it:Aterosclerosi he:טרשת עורקים nl:Atheromatose no:Åreforkalkning fi:Ateroskleroosi sv:Åderförkalkning

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