Coronary Artery Disease

The supplied grounding supports atherosclerosis as a major cause, and also notes that coronary artery disease may derive from congenital abnormality or non-atherosclerotic causes. Chronic kidney disease is described as a major risk factor and is associated with traditional contributors such as diabetes and hypertension. The literature also links smoking and modifiable lifestyle factors to disease risk and prevention.

The pathophysiology is described as an inflammatory disorder rather than simply a cholesterol storage disease. Arterial remodeling and nonstenotic plaque biology are emphasized, and plaque disruption can occur even without critical stenosis. Macrophages are highlighted as central to plaque development, local inflammation, and thrombosis, while vascular cell migration and proliferation are also implicated.

Traditional risk factors include diabetes, hypertension, smoking, and other lifestyle-related factors used in risk prediction. Chronic kidney disease is specifically identified as a major risk factor, with additional nontraditional contributors such as inflammation, oxidative stress, and abnormal calcium-phosphorus metabolism. Genetic susceptibility is also supported by genome-wide association findings and polygenic risk score literature.

Management includes revascularization for relief of ischemia. The literature also supports aggressive management of modifiable risk factors alongside revascularization, and drug therapy is represented by antiplatelet agents such as clopidogrel and ticlopidine. Diagnostic and management approaches also include fractional flow reserve and other diagnostic imaging or diagnostic modalities.