eMedicine Specialties > Cardiology > Atherosclerosis and Risk Factors
Atherosclerosis: Follow-up
Updated: Aug 4, 2009
Follow-up
Prognosis
- The prognosis of atherosclerosis depends on a number of factors, including systemic burden of disease, the vascular bed(s) involved, and the degree of flow limitation. Wide variability exists, and clinicians appreciate that many patients with critical limitation of flow to vital organs may survive many years, despite a heavy burden of disease. Conversely, myocardial infarction or sudden cardiac death may be the first clinical manifestation of atherosclerotic cardiovascular disease in a patient who is otherwise asymptomatic with minimal luminal stenosis and a light burden of disease.
- Much of this phenotypic variability is likely to be determined by the relative stability of the vascular plaque burden. Plaque rupture and exposure of the thrombogenic lipid core are critical events in the expression of this disease process and determine the prognosis. The ability to determine and quantify risk and prognosis in patients with atherosclerosis is limited by the inability to objectively measure plaque stability and other predictors of clinical events.
Patient Education
- The most effective and probably the most cost-efficient means of reducing the burden of disease secondary to atherosclerosis in the general population is primary prevention. The role of diet and exercise in the prevention of atherosclerotic cardiovascular disease has been well established. Education of the general population regarding healthy dietary habits and regular exercise will reduce the prevalence of multiple coronary heart disease risk factors. Medical therapies aimed at improving blood pressure control and various lipid parameters are appropriate for the prevention of first coronary heart disease events, if these risk factors are refractory to lifestyle interventions.
- For excellent patient education resources, visit eMedicine's Cholesterol Center, Statins Center, Circulatory Problems Center, and Stroke Center. Also, see eMedicine's patient education articles High Cholesterol, Understanding Your Cholesterol Level, Lifestyle Cholesterol Management, Chest Pain, Coronary Heart Disease, Heart Attack, Angina Pectoris, and Stroke.
Miscellaneous
Medicolegal Pitfalls
- As previously noted, clinical sequelae of atherosclerosis are hard to predict because of the nonlinear rate of progression of this systemic disease. Address the underlying causes of atherosclerosis in an attempt to slow this process and stabilize the existing plaque burden. Failure to do so results in predictable clinical events in the same or other vascular beds, and this is a common cause of medical/legal error. For example, a patient with limb claudication can be assumed to have significant atherosclerotic plaque burden in multiple vascular beds, including the coronary and cerebral vessels. In evaluating preoperative risk in such a patient, pay particular attention to careful risk stratification and medical or interventional efforts to reduce this risk.
Special Concerns
- Familial hypercholesterolemia
- Familial hypercholesterolemia is an autosomal dominant disorder caused by a defect in the gene for the hepatic LDL receptor. In the United States, heterozygous familial hypercholesterolemia occurs in approximately 1 in 500 individuals and typically results in symptomatic coronary heart disease by the fifth decade of life in men and sixth decade of life in women. In the United States, homozygous familial hypercholesterolemia occurs in approximately 1 in 1 million individuals, and total cholesterol may exceed 1000 mg/dL and result in symptomatic coronary heart disease by the second decade of life.
- Treatment options include combination drug therapy, although drug therapy alone often is inadequate because of the relative or absolute deficiency of hepatic LDL receptors. Lipid apheresis is an effective means of reducing circulating lipid levels and coronary heart disease events. Liver transplantation has been performed on young patients with severe disease and patients experiencing very early onset of symptomatic coronary artery disease.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous James L Orford, MBChB and Andrew P Selwyn, MD, MA, FACC, FRCPto the development and writing of this article.
More on Atherosclerosis |
| Overview: Atherosclerosis |
| Differential Diagnoses & Workup: Atherosclerosis |
| Treatment & Medication: Atherosclerosis |
 Follow-up: Atherosclerosis |
| References |
| « Previous Page |
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Further Reading
Keywords
MI, transient ischemic attack, TIA, stroke, atheroembolism, coronary heart disease, coronary artery atherosclerosis, atherosclerotic disease of the carotid artery, peripheral vascular disease, ischemia, atherosclerosis, hyperlipidemia, coronary artery disease, CAD, cerebrovascular disease, abdominal aortic aneurysm, cigarette smoking, hyperhomocystinemia, hyperglycemia, sudden cardiac death, stable angina pectoris, intermittent claudication, mesenteric angina, impotence, nonhealing ulceration, infection of the extremities, paresthesias, visceral ischemia, epigastric pain, periumbilical postprandial pain, pulsatile abdominal mass, digital necrosis, gastrointestinal bleeding, retinal ischemia, cerebral infarction, renal failure, xanthelasma, xanthomata, tachycardia, hypotension, hypertension, diminished carotid pulses, carotid artery bruits, focal neurological deficits, decreased peripheral pulses, peripheral arterial bruits, peripheral cyanosis, gangrene, ulceration, peripheral embolism, circulatory collapse, livedo reticularis, cholesterol embolization, atherosclerotic cardiovascular disease, diabetes mellitus, obesity, hypercholesterolemia, C-reactive protein, CRP, lipoprotein (a)
