ABSTRACT
The most common cause of morbidity and mortality in Europe and the United States is atherosclerosis, a clinical entity that most physicians will deal with frequently in their practice. Atherosclerosis is a complex process that is thought to be initiated by a “response to injury” of the endothelium (Ross, 1997). The specific injuries that precipitate atherogenesis are not known, although risk factors have been identified. These include hypercholesterolemia, hypertension, diabetes mellitus, and tobacco use. Another important risk factor is a family history of premature atherosclerosis (i.e., first-degree relatives who have incurred myocardial infarction or stroke under the age of 60). This risk factor likely represents predisposing genetic factors that have not yet been elucidated. In addition to these traditional risk factors, there is accumulating evidence that elevated plasma levels of lipoprotein(a) and homocysteine also accelerate the process of atherosclerosis. Finally, obesity, type A personality, and sedentary lifestyle predispose to adverse vascular events (e.g., myocardial infarction).
