A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association.

Abstract

The compositions of lesion types that precede and that may initiate the development of advanced atherosclerotic lesions are described and the possible mechanisms of their development are reviewed. While advanced lesions involve disorganization of the intima and deformity of the artery, such changes are absent or minimal in their precursors. Advanced lesions are either overtly clinical or they predispose to the complications that cause ischemic episodes; precursors are silent and do not lead directly to complications. The precursors are arranged in a temporal sequence of three characteristic lesion types. Types I and II are generally the only lesion types found in children, although they may also occur in adults. Type I lesions represent the very initial changes and are recognized as an increase in the number of intimal macrophages and the appearance of macrophages filled with lipid droplets (foam cells). Type II lesions include the fatty streak lesion, the first grossly visible lesion, and are characterized by layers of macrophage foam cells and lipid droplets within intimal smooth muscle cells and minimal coarse-grained particles and heterogeneous droplets of extracellular lipid. Type III (intermediate) lesions are the morphological and chemical bridge between type II and advanced lesions. Type III lesions appear in some adaptive intimal thickenings (progression-prone locations) in young adults and are characterized by pools of extracellular lipid in addition to all the components of type II lesions.

Calcified structures associated with human skeletal remains: Possible atherosclerosis affecting the population buried at Amara West, Sudan (1300–800BC)

“…Early stages of atherosclerosis prior to atheroma formation are considered clinically silent and can already occur in children (Stary et al, 1994). Morbidity and mortality due to ischemia or thrombosis are only linked to the advanced stages and are usually seen from the third decade of life onwards where fibrous or calcified plaques are present (Stary et al, 1995).…”

“…Such calcifications are very common features of atherosclerosis in modern clinical studies and are considered pathognomonic for atherosclerosis (Stary et al, 1995). Atherosclerosis can occur in all major and medium-sized arteries (Lam, 2012).Early stages of atherosclerosis prior to atheroma formation are considered clinically silent and can already occur in children (Stary et al, 1994). Morbidity and mortality due to ischemia or thrombosis are only linked to the advanced stages and are usually seen from the third decade of life onwards where fibrous or calcified plaques are present (Stary et al, 1995).…”

Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults

“…One of the major risk factors for CVD is dyslipidemia, which precipitates atherosclerotic change in vessels 2. In this context, strategies for lowering cholesterol, such as statins have shown to reduce cardiovascular events in meta‐analysis 3, 4.…”

Role of macrophage and smooth muscle cell apoptosis in association with oxidized low-density lipoprotein in the atherosclerotic development

“…1 Macrophages and smooth muscle cells become foam cells as a result of lipid phagocytosis, and a fatty streak, a macroscopically identifiable intimal lesion, is formed in the affected intima. 2 Fatty streak can develop into advanced lesions, such as atheroma, and subsequently complicated lesions over several decades. 1,3,4 Various risk factors, such as hypertension, hypercholesterolemia, cigarette smoking, diabetes mellitus, genetic alterations, and familial predisposition affect the progression of atherosclerosis.…”