What is the typical progression of coronary artery atherosclerosis?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Coronary artery atherosclerosis is the single most common cause of death in men and women in the United States. It is the principal cause of coronary artery disease (CAD), in which atherosclerotic changes are present within the walls of the coronary arteries. CAD is a progressive disease process that generally begins in childhood and manifests clinically in middle to late adulthood.

The word "atherosclerosis" is of Greek origin and literally means focal accumulation of lipid (ie, athere [gruel]) and thickening of arterial intima (ie, sclerosis [hardening]). Atherosclerosis is a disease of large and medium-sized muscular arteries and is characterized by the following:

  • Endothelial dysfunction

  • Vascular inflammation

  • Buildup of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall

Atherosclerotic buildup results in the following:

  • Plaque formation

  • Vascular remodeling

  • Acute and chronic luminal obstruction

  • Abnormalities of blood flow

  • Diminished oxygen supply to target organs

By impairing or obstructing normal blood flow, atherosclerotic buildup causes myocardial ischemia. (See Pathophysiology.)

Approximately 14 million Americans have CAD. Each year, 1.5 million individuals develop acute myocardial infarction (AMI), the most deadly presentation of CAD, and more than 500,000 of these individuals die. (See Epidemiology.)

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