Manifestations of atherosclerosis in various vascular regions. Similarities and differences regarding epidemiology, etiology and prognosis]

Pathologic studies have demonstrated that atherosclerosis involves the whole arterial vessel tree. In the Framingham study, cardiovascular risk factors could be defined with different prognostic value for the development of atherosclerosis in various vascular regions. The prognosis of patients with atherosclerosis in coronary, carotid or leg arteries is worse compared to a normal population. Moreover, patients with symptomatic lesions in one vascular bed often have additional asymptomatic atherosclerotic lesions in other vascular regions. Patients with atherosclerosis in multiple vascular regions have a worse prognosis than patients with atherosclerosis in one vascular bed only. In a study of 804 patients, we could show a significantly higher incidence of cardiovascular events (death, myocardial infarction, stroke) in patients with coronary artery disease (CAD) and additional lesions in peripheral arteries (leg, carotid) during a 3.2-year follow-up compared to those with CAD only. Local and systemic inflammatory processes in the arterial vessel wall are considered to play an important role with regard to plaque instability. It has been suggested, that besides the symptomatic atherosclerotic lesion, multiple stable or unstable lesions are present in the whole arterial vessel tree predicting the patient's prognosis. Chronic infections with multiple pathogens ("concept of infectious burden") probably play an important role by triggering these inflammatory processes. Therefore, systemic therapeutic regimes are necessary for the treatment of patients with atherosclerosis. The platelet aggregation inhibitors improve the prognosis of patients with atherosclerosis in all vascular areas. Another important therapeutic regime is the use of statins, which seem to be not only effective in lipid lowering but also in plaque stabilization.