Alterations in the Arterial Wall with Aging
At this meeting we have been considering a variety of factors that might be altered with aging and consequently play a role in exacerbating the development of atherosclerosis. Much of what has been considered falls into the category of “risk factors” that are present in the blood, such as changes in plasma lipoproteins, blood pressure, hormones, etc. A variety of studies have indicated that the commonly accepted risk factors can account for only a portion of the variability in cardiovascular disease. Estimates range from upwards of 50% when clinical events are considered (1) to less than 20% when extent and severity of atherosclerosis is evaluated at autopsy (2). This suggests that there are either additional, yet-to-be-described risk factors or, just as likely, that there are differences at the level of the arterial wall that influence the susceptibility to development of atherosclerosis when exposed to the same risk factors. Studies with animal models, such as pigeons, suggest these differences could be genetically mediated (3). If one accepts the possibility that differences in susceptibility and resistance to atherosclerosis may, in part, be mediated at the level of the arterial wall, then we must begin to understand the mechanisms responsible for this effect if we ever expect to fully explain individual differences in atherosclerosis. It is likely that such differences will be mediated at the levels of the cellular elements of the arterial wall.
KeywordsSmooth Muscle Cell Arterial Wall Atherosclerotic Lesion Foam Cell Plasma Lipoprotein
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