Most coronary artery disease (CAD) results from atherosclerosis, a progressive inflammatory disorder of the arterial wall.
Underlying causes
•
Atherosclerosis causes CAD in most patients. Rare causes include aortitis, vasculitis and autoimmune connective tissue diseases.
•
Atherosclerosis is characterised by focal, lipid-rich deposits of atheroma in the arterial wall.
Development and clinical consequences
•
Lipid deposition begins early in life and tends to occur at sites of altered arterial shear stress, such as arterial bifurcations. These deposits are associated with abnormal endothelial function.
•
Atheroma may remain clinically silent until it becomes large enough to impair tissue perfusion.
•
Ulceration and disruption of an atherosclerotic lesion may cause thrombotic vessel occlusion or distal embolisation.
Evidence of early disease
•
Impaired arterial function has been detected in high-risk children and adolescents, including cigarette smokers and those with familial hyperlipidaemia or hypertension.
•
Early arterial lesions have been found in victims of accidental death during the second and third decades.