Coronary Artery Disease and Atherosclerosis in Other Vascular Districts: Epidemiology, Risk Factors and Atherosclerotic Plaque Features

Abstract

Coronary artery disease (CAD) is the main cause of morbidity and death worldwide, and atherosclerosis represents the leading pathophysiological pathway responsible for CAD. Atherosclerotic process is a complex interplay of mechanisms and mediators resulting in plaque formation, progression and destabilization, the latter being the most frequent cause of acute cardiovascular events. Considering the systemic nature of atherosclerosis, polyvascular disease involvement is possible and has been described since 1960s. Accordingly, epidemiologic studies reported that concomitant CAD and atherosclerosis in other arterial beds like carotid arteries, lower limb arteries, mesenteric and renal circulation, and aorta, is frequent and related to increased chance of future cardiovascular events. Although risk factors, atherosclerotic plaque features and mechanisms of plaque destabilization are largely shared across different sites, many studies have reported some disparities among districts. Moreover, simultaneous polyvascular disease has been associated with increased likelihood of having particular plaque characteristics depending on the affected arterial level. In this comprehensive narrative review, we aim to discuss about epidemiology of concomitant CAD and atherosclerosis in other arterial beds, and to examine differences in risk factors, plaque features and mechanisms of plaque instability between CAD and other atherosclerotic locations. Finally, we review the studies observing differences on plaque features according to involved atherosclerotic sites, focusing on CAD.

Keywords: atherosclerosis; coronary artery disease; plaque destabilization; plaque features; polyvascular disease; risk factors.

Figure 1

Prevalence of simultaneous CAD and other site arterial disease. CAD = coronary artery disease. This figure was created using BioRender.com.

Figure 2

Plaque types according to different vascular districts. CAD = coronary artery disease; FCT = fibrous cap thickness; IPH = intraplaque hemorrhage. This figure was created using BioRender.com.