Atherosclerosis for PA
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Atherosclerosis for the Physician Assistant Licensing Exam
Atherosclerosis
- Definition:
- Atherosclerosis is a chronic disease where plaques form within arterial walls, narrowing arteries and reducing blood flow.
- Plaques consist of lipids, cholesterol, calcium, and inflammatory cells, which can lead to ischemic complications like myocardial infarction (MI) and stroke.
- Risk Factors:
- Non-modifiable: Age, male gender, family history.
- Modifiable:
- Hyperlipidemia: High LDL cholesterol is strongly associated with plaque development.
- Hypertension: Causes endothelial injury, accelerating plaque formation.
- Smoking: Increases oxidative stress, endothelial dysfunction, and inflammation.
- Diabetes: Promotes vascular inflammation and plaque progression.
- Obesity: Associated with metabolic syndrome, which includes hypertension and dyslipidemia.
Pathophysiology
- Endothelial Injury:
- Begins with endothelial damage due to hypertension, smoking, or high LDL, increasing vessel wall permeability and attracting inflammatory cells.
- Endothelial dysfunction reduces nitric oxide (NO), impairing vasodilation and promoting leukocyte adhesion.
- Plaque Formation:
- LDL infiltrates the endothelium and oxidizes, forming oxidized LDL (oxLDL), which attracts monocytes that differentiate into macrophages and form foam cells.
- Foam cells accumulate, creating fatty streaks that can evolve into mature plaques with fibrous caps.
- Plaque Rupture:
- Stable Plaques: Thick fibrous caps and less lipid, leading to stable angina.
- Vulnerable Plaques: Thin fibrous caps with large lipid cores, prone to rupture and thrombus formation, causing MI or stroke.
Clinical Manifestations
- Coronary Artery Disease (CAD): Presents as stable angina or MI.
- Peripheral Artery Disease (PAD): Causes claudication or ischemic rest pain in the legs.
- Cerebrovascular Disease: Plaque in carotid or cerebral arteries can lead to transient ischemic attacks (TIA) or stroke.
Management
- Lifestyle Modifications: Healthy diet, regular exercise, and smoking cessation.
- Pharmacologic Therapy:
- Statins: First-line to lower LDL and stabilize plaques.
- Antiplatelet Therapy: Aspirin or clopidogrel to prevent clotting events.
- Antihypertensive Therapy: ACE inhibitors or beta-blockers to lower blood pressure.
Key Points
- Atherosclerosis:
- Chronic disease with plaque formation leading to ischemic complications like CAD, PAD, and stroke.
- Main risk factors: hyperlipidemia, hypertension, smoking, and diabetes.
- Pathogenesis:
- Begins with endothelial injury and LDL infiltration, progressing to plaque formation.
- Plaque rupture can lead to thrombotic events (e.g., MI, stroke).
- Management:
- Lifestyle changes and statins are primary; antiplatelet therapy and antihypertensives reduce cardiovascular risk.