Otsuka Fumiyuki, Fuster Valentin, Narula Jagat, Virmani Renu
CVPath Institute, Gaithersburg, MD, USA.
Mt Sinai J Med. 2012 Nov-Dec;79(6):641-53. doi: 10.1002/msj.21353.
Atherosclerotic vascular disease not only remains the leading cause of death in the Western countries, but it has become the most common cause of morbidity and mortality in the low- and middle-income countries as well. Therefore, better understanding of the pathogenesis of atherosclerotic disease and its prevention are of fundamental importance. It is well known that it affects sequentially the aorta followed by coronary, carotid, peripheral, and intracerebral arteries, with some individual variability. The mechanisms of progression are similar in each of the beds, with increasing lipid accumulation in the arterial wall along with macrophages and T-cell infiltration, paucity of smooth-muscle cell proliferation and collagen deposition, and endothelial-cell dysfunction and hypercoagulability playing an important role at the time of acute manifestations of the disease. Fundamental to this inflammatory process is the presence of classic risk factors, regardless of the involved territory. Therefore, the concept of palliative treatment must be reserved for only those who have progressed beyond preventive measures.
动脉粥样硬化性血管疾病不仅仍是西方国家的主要死因，在低收入和中等收入国家也已成为发病和死亡的最常见原因。因此，更好地了解动脉粥样硬化疾病的发病机制及其预防至关重要。众所周知，它依次影响主动脉，随后是冠状动脉、颈动脉、外周动脉和脑内动脉，存在一些个体差异。每个部位疾病进展的机制相似，动脉壁脂质积聚增加，伴有巨噬细胞和T细胞浸润，平滑肌细胞增殖和胶原蛋白沉积减少，以及内皮细胞功能障碍和高凝状态在疾病急性表现时起重要作用。无论涉及哪个部位，这一炎症过程的根本是存在经典危险因素。因此，姑息治疗的概念必须仅保留给那些已超出预防措施阶段的患者。
