NATURAL HISTORY AND PATHOPHYSIOLOGY Coronary heart disease (CHD) develops as a consequence of decreased blood flow to the myocardium due to coronary atherosclerosis (CAD). CAD begins as fatty streaks in the coronaries and other arterial beds quite early in life, with fatty streaks and some raised lesions identified in various autopsy studies in men in their late teens and early 20s and women by late 20s and early 30s. The development of atherosclerosis appears to follow a complex pathway:
1. Endothelial dysfunction is caused by a number of factors such as cigarette smoking, hypertension, and hyperlipidemia.This permits entry of various blood components into the arterial intimal layer. These components ordinarily roll along the endothelial layer and do not damage the artery.