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      A Pathological Study of the Epidemiology of Atherosclerosis in Mexico City

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          Abstract

          Objective. To examine the frequency and patterns of association of cardiovascular risk factors with atherosclerosis in five different arterial territories at post-mortem in Mexico City. Methods. We obtained five arterial territories arteries (circle of Willis, coronary, carotid, renal, and aorta) of 185 men and women 0 to 90 years of age who underwent autopsy at the Medical Forensic Service of Mexico City. We determined the prevalence and extent of atherosclerotic lesions by histopathology according to the classification of the American Heart Association as early (types I–III) and advanced (types IV–VI), and according to the degree of stenosis and correlated with cardiovascular risk factors. Results. Atherosclerotic lesions were identified in at least one arterial territory in 181 subjects (97.8%), with involvement of two ore more territories in 178 subjects (92.2%). Advanced lesions were observed in 36% and 67% of subjects under 15 and between 16 and 35 years, respectively. Any degree of atherosclerosis was associated with the presence of diabetes mellitus, hypertension, overweight, obesity, and smoking, and to a greater extent with the presence of two or more risk factors ( P < 0.001). However, emerging and advanced athersoclerosis was observed in 53% and 20% people with no risk factors. Conclusions. The study shows a high prevalence of atherosclerosis in all age groups and both sexes. There is considerable development of atherosclerotic disease in subjects without known risk factors.

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          Most cited references52

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          Beyond cholesterol. Modifications of low-density lipoprotein that increase its atherogenicity.

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            The pathogenesis of coronary artery disease and the acute coronary syndromes (1).

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              A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association.

              This report is the continuation of two earlier reports that defined human arterial intima and precursors of advanced atherosclerotic lesions in humans. This report describes the characteristic components and pathogenic mechanisms of the various advanced atherosclerotic lesions. These, with the earlier definitions of precursor lesions, led to the histological classification of human atherosclerotic lesions found in the second part of this report. The Committee on Vascular Lesions also attempted to correlate the appearance of lesions noted in clinical imaging studies with histological lesion types and corresponding clinical syndromes. In the histological classification, lesions are designated by Roman numerals, which indicate the usual sequence of lesion progression. The initial (type 1) lesion contains enough atherogenic lipoprotein to elicit an increase in macrophages and formation of scattered macrophage foam cells. As in subsequent lesion types, the changes are more marked in locations of arteries with adaptive intimal thickening. (Adaptive thickenings, which are present at constant locations in everyone from birth, do not obstruct the lumen and represent adaptations to local mechanical forces). Type II lesions consist primarily of layers of macrophage foam cells and lipid-laden smooth muscle cells and include lesions grossly designated as fatty streaks. Type III is the intermediate stage between type II and type IV (atheroma, a lesion that is potentially symptom-producing). In addition to the lipid-laden cells of type II, type III lesions contain scattered collections of extracellular lipid droplets and particles that disrupt the coherence of some intimal smooth muscle cells. This extracellular lipid is the immediate precursor of the larger, confluent, and more disruptive core of extracellular lipid that characterizes type IV lesions. Beginning around the fourth decade of life, lesions that usually have a lipid core may also contain thick layers of fibrous connective tissue (type V lesion) and/or fissure, hematoma, and thrombus (type VI lesion). Some type V lesions are largely calcified (type Vb), and some consist mainly of fibrous connective tissue and little or no accumulated lipid or calcium (type Vc).
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                Author and article information

                Journal
                Cardiol Res Pract
                Cardiol Res Pract
                CRP
                Cardiology Research and Practice
                Hindawi Publishing Corporation
                2090-8016
                2090-0597
                2014
                26 February 2014
                : 2014
                : 264205
                Affiliations
                1Resultados Médicos, Desarrollo e Investigación, SC, Boulevard Valle de San Javier, Pachuca Hidalgo 04286, Mexico
                2Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, SS. Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan 14000, Mexico
                3Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, SS. Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, Mexico City 14000, Mexico
                4Department of Pathology, Hospital General de México, SS. Dr. Balmis 148, Colonia, Doctores, Mexico City 16726, Mexico
                Author notes
                *Joel Rodríguez-Saldaña: joelrds.coatlicue@ 123456prodigy.net.mx

                Academic Editor: H. A. Katus

                Article
                10.1155/2014/264205
                3955633
                24719773
                74fb1513-d273-4340-adb1-f6cc91aa0ec7
                Copyright © 2014 Joel Rodríguez-Saldaña et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 October 2013
                : 23 December 2013
                : 11 January 2014
                Categories
                Research Article

                Cardiovascular Medicine
                Cardiovascular Medicine

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