Polyvascular Atherosclerosis: Diagnostic and Prognostic Burden

ATHEROSCLEROSIS is a progressive disease process of the large and medium sized arteries that involves the gradual accumulation of lipids, infl ammatory cells, and fi brous elements in plaques located in the vessel walls. Its pathogenesis is multifactorial, involving numerous, well known risk factors, and genetic predisposition. Some of those risk factors are modifi able (i.e., cigarette smoking, obesity, physical inactivity, elevated LDL cholesterol, reduced HDL cholesterol, hypertension, and diabetes mellitus), but some of them are not (i.e., age, gender, family history). Intensive research during the past decades has shown that atherosclerosis is a systemic disease that aff ects diff erent vascular territories simultaneously (polyvascular disease, PVD). Th erefore, individuals with one manifestation of atherosclerosis are more likely to have concomitant disease in other vascular territories. Th e process of atherosclerotic plaque formation begins early in the life, and it continuous to progress causing clinical manifestations decades later. Studies have shown that a substantial number of patients were asymptomatic prior to the acute atherosclerotic event, which itself caries a large portion of mortality and morbidity burden of atherosclerotic disease. Indeed, cardiovascular disease is the leading cause of death around the world, accounting for 50% of all mortality in developed countries, up to 85% in low and middle income countries.