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      Correlation of lifetime progress of atherosclerosis and morphologic markers of severity in humans: new tools for a more sensitive evaluation

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          Abstract

          OBJECTIVES:

          To describe the morphological features of atherosclerosis in the aortas of autopsied patients (ranging from young adults to the elderly), thus providing new tools for a more sensitive morphological evaluation.

          METHOD:

          We collected 141 aorta samples. We assessed the macroscopic degree of atherosclerosis, thickness of the intima and media, lipid and collagen depositions in the intima, and the infiltration of mast cells into the layers of the aorta. We correlated the findings with gender, age, race and cause of death.

          RESULTS:

          The degree of atherosclerosis was significantly higher in the elderly. The aorta was thicker in the elderly and in cases with a cardiovascular cause of death. The thickness of the intima was significantly greater in the elderly, in males and in cases with a cardiovascular cause of death. The lipid content in the intima of the aorta was significantly higher in Caucasians. Older people and men had a significantly higher number of mast cells.

          CONCLUSION:

          A macroscopic evaluation is a good indicator of the severity of atherosclerosis, but a more detailed analysis, namely evaluating the thickness of the layers of the aorta and the number of mast cells, may further elucidate the changes in the constituents of this vessel.

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          Most cited references93

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          Endothelial aging.

          Aging is considered to be the major risk factor for the development of atherosclerosis and, therefore, for coronary artery disease. Apart from age-associated remodeling of the vascular wall, which includes luminal enlargement, intimal and medial thickening, and increased vascular stiffness, endothelial function declines with age. This is most obvious from the attenuation of endothelium-dependent dilator responses, which is a consequence of the alteration in the expression and/or activity of the endothelial NO synthase, upregulation of the inducible NO synthase, and increased formation of reactive oxygen species. Aging is also associated with a reduction in the regenerative capacity of the endothelium and endothelial senescence, which is characterized by an increased rate of endothelial cell apoptosis.
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            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.

            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.
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              Distributions of diffuse intimal thickening in human arteries: preferential expression in atherosclerosis-prone arteries from an early age.

              Diffuse intimal thickening (DIT) is a thickened intima present in human arteries before atherosclerosis develops and is considered to be related to atherogenesis. The purpose of this study was to clarify the systemic and age distributions of DIT. Coronary, cerebral, carotid, subclavian, iliac and abdominal organ arteries and the aorta were examined in 72 autopsy cases (aged 36 weeks of gestation to 30 years at death). DIT was found in the coronary arteries and aorta from 36 weeks of gestation and the first year of life, respectively. The intima/media (I/M) ratio of coronary arteries showed an age-dependent increase and was much greater than that of other muscular arteries, i.e., intracranial and extraparenchymal cerebral arteries and abdominal organ arteries. Aorta also demonstrated age-dependent as well as site-dependent increases of I/M ratio; the more distal the segments, the greater the ratio. Consequently, the abdominal aorta had the largest I/M ratio within the aorta. Other elastic arteries, i.e., carotid, subclavian and iliac arteries, showed trends similar to the distal portions of the aorta. Thus, DIT was strongly expressed from an early age in arteries that are considered to be prone to atherosclerosis. These findings suggest that the development of atherosclerosis depends at least partly on the degree of DIT.
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                Author and article information

                Journal
                Clinics (Sao Paulo)
                Clinics (Sao Paulo)
                Clinics
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                1807-5932
                1980-5322
                September 2012
                : 67
                : 9
                : 1071-1075
                Affiliations
                [I ]Triângulo Mineiro Federal University (UFTM), Uberaba/MG, Brazil.
                [II ]Goiás Federal University (UFG), Instituto de Patologia Tropical e Saúde Pública, Goiania/GO, Brazil.
                Author notes

                Ferraz ML, Nascimento DM, and Rorato JP made significant contributions to the conception and data acquisition and were engaged in the design of the present study. Espindula AP, Oliveira LF, Ramalho LS, and Soares MH participated in the sequence alignment and drafted the manuscript. Cavellani CL, Oliveira FA, Pereira SA, Corrêa RR, and Teixeira VP were involved in drafting the manuscript and revising it critically for important intellectual content, providing general supervision for the research group and approving the final version for publication. All authors read and approved the final manuscript.

                E-mail: rosana@ 123456patge.uftm.edu.br Tel.: 55 34 33185428
                Article
                cln_67p1071
                10.6061/clinics/2012(09)15
                3438249
                23018306
                a2dc8b1a-6b13-4561-bbc4-3a21adeb58bd
                Copyright © 2012 Hospital das Clínicas da FMUSP

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 March 2012
                : 23 March 2012
                : 7 May 2012
                Page count
                Pages: 5
                Categories
                Basic Research

                Medicine
                elderly,morphology,atherosclerosis,age,macroscopic degree
                Medicine
                elderly, morphology, atherosclerosis, age, macroscopic degree

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