The Pathophysiology of Atherosclerosis of the Coronary Arteries and the Changes that Predispose to Ischemic Heart Disease

Abstract

Each year, over a million Americans have myocardial infarctions and over a half a million die from ischemic heart disease and its complications. During the past decade, both the incidence of myocardial infarction and the mortality of ischemic heart disease have decreased. It is unclear why the former has occurred, although it is suggested to be a consequence of the recognition of the major risk factors of coronary artery disease and the public health measures applied to reduce these risk factors. The decline in mortality of acute myocardial infarction is partially explained by the introduction of new medical and surgical therapies directed toward its major complications. Despite these apparently successful interventions, ischemic heart disease remains the number one cause of mortality in Western man. Although a great deal has been learned about the major cause of ischemic heart disease, i.e., coronary atherosclerosis, this disease remains an enigma, both in its pathogenesis and in the biology of its complications [1].