Wasilewski Jarosław, Czaja-Ziółkowska Monika Zofia, Gąsior Mariusz
3 Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Postepy Kardiol Interwencyjnej. 2023 Sep;19(3):195-201. doi: 10.5114/aic.2023.131471. Epub 2023 Sep 27.
The etiology of atherosclerosis is still unknown, but there are several hypotheses trying to explain this complex disease. Most consider atherosclerosis as a cholesterol storage disease. However, hypercholesterolemia is not a cause but a risk factor. Besides, like other well-known systemic risk factors, it does not explain the uneven distribution of atheromatous plaques in the vasculature. Atherosclerotic lesions develop mainly at vulnerable "risk points" of the arterial wall such as curvatures and near side branches, and predominantly in the left anterior descending (LAD), while the left circumflex (LCx) artery is relatively spared. Furthermore, atheromatous plaques are present mainly in the proximal segments in the LAD and LCx, in contrast to the right coronary artery (RCA), where plaques are more evenly distributed. The hemodynamic theory explains to some extent the distribution of atherosclerotic lesions and considers atherosclerosis as a reactive biological response of endothelial cells to wall shear stress. In this review, we discuss the interplay of concentration of low-density lipoproteins at the luminal surface and local hemodynamic forces (disturbed flow) that reduce wall shear stress in the process of plaque formation. Moreover, we present the distribution of atheromatous plaques in the coronary arteries in autopsy studies and imaging methods such as cardiac computed tomography angiography and invasive coronary angiography.
动脉粥样硬化的病因尚不清楚，但有几种假说试图解释这种复杂的疾病。大多数人认为动脉粥样硬化是一种胆固醇储存疾病。然而，高胆固醇血症不是病因，而是一个危险因素。此外，与其他众所周知的全身危险因素一样，它并不能解释动脉粥样硬化斑块在脉管系统中分布不均的现象。动脉粥样硬化病变主要发生在动脉壁的易损“风险点”，如弯曲处和分支附近，且主要发生在左前降支（LAD），而左旋支（LCx）动脉相对较少受累。此外，动脉粥样硬化斑块主要存在于LAD和LCx的近端节段，而右冠状动脉（RCA）的斑块分布更为均匀。血流动力学理论在一定程度上解释了动脉粥样硬化病变的分布，并将动脉粥样硬化视为内皮细胞对壁面剪切应力的一种反应性生物学反应。在这篇综述中，我们讨论了管腔表面低密度脂蛋白浓度与局部血流动力学力（紊乱血流）之间的相互作用，这些力在斑块形成过程中会降低壁面剪切应力。此外，我们还介绍了尸检研究以及心脏计算机断层扫描血管造影和有创冠状动脉造影等成像方法中冠状动脉内动脉粥样硬化斑块的分布情况。
