Origin of atherosclerosis in childhood and adolescence
Origin of atherosclerosis in childhood and adolescence
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DOI：
10.1093/ajcn/72.5.1307s
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发表时间：
2000-11-01
影响因子：
7.1
通讯作者：
Strong, JP
中科院分区：
文献类型：
--
作者：
McGill, HC;McMahan, CA;Strong, JP
动脉粥样硬化开始于儿童时期，作为胆固醇及其酯的沉积物，称为脂肪条纹，在大肌肉动脉的内膜中。在某些人和某些动脉部位，更多的脂质积聚并被纤维肌帽覆盖，形成纤维斑块。纤维斑块的进一步变化使其易于破裂，这是一种加速闭塞性血栓形成和临床表现疾病（心源性猝死、心肌梗死、中风或外周动脉疾病）的事件。在成人中，非HDL-胆固醇浓度升高、HDL-胆固醇浓度降低、高血压、吸烟、糖尿病和肥胖与晚期动脉粥样硬化病变和临床表现动脉粥样硬化疾病风险增加相关。控制这些危险因素是预防动脉粥样硬化疾病的主要策略。为了确定这些危险因素是否也与年轻人的早期动脉粥样硬化有关，我们检查了约3000例15-34岁死于意外伤害、他杀或自杀的尸检者的动脉和组织。右冠状动脉和腹主动脉的脂肪条纹和隆起病变（纤维斑块和其他晚期病变）的程度与非HDL-胆固醇浓度、高血压、糖耐量受损和肥胖呈正相关，与HDL-胆固醇浓度呈负相关。腹主动脉粥样硬化也与吸烟呈正相关。这些观察结果表明，通过控制成人冠状动脉疾病的危险因素来长期预防动脉粥样硬化及其后遗症应该开始于青春期和青年期。
Atherosclerosis begins in childhood as deposits of cholesterol and its esters, referred to as fatty streaks, in the intima of large muscular arteries. In some persons and at certain arterial sites, more lipid accumulates and is covered by a fibromuscular cap to form a fibrous plaque. Further changes in fibrous plaques render them vulnerable to rupture, an event that precipitates occlusive thrombosis and clinically manifest disease (sudden cardiac death, myocardial infarction, stroke, or peripheral arterial disease). In adults, elevated non-HDL-cholesterol concentrations, low HDL-cholesterol concentrations, hypertension, smoking, diabetes, and obesity are associated with advanced atherosclerotic lesions and increased risk of clinically manifest atherosclerotic disease. Control of these risk factors is the major strategy for preventing atherosclerotic disease. To determine whether these risk factors also are associated with early atherosclerosis in young persons, we examined arteries and tissue from approximate to 3000 autopsied persons aged 15-34 y who died of accidental injury, homicide, or suicide. The extent of both fatty streaks and raised lesions (fibrous plaques and other advanced lesions) in the right coronary artery and in the abdominal aorta was associated positively with non-HDL-cholesterol concentration, hypertension, impaired glucose tolerance, and obesity and associated negatively with HDL-cholesterol concentration. Atherosclerosis of the abdominal aorta also was associated positively with smoking. These observations indicate that long-range prevention of atherosclerosis and its sequelae by control of the risk factors for adult coronary artery disease should begin in adolescence and young adulthood.