Coronary Artery Disease: A Pediatric Perspective

Abstract

Atherosclerosis is a process which leads to the developments of obstructive coronary artery disease. It is a complex pathologic process which takes shape over an extended period of time. Endothelial factors and plasma constituents such as cholesterol in its various structural forms have been implicated.Atherosclerosis is a slow process and takes years to develop. Recent evidence cited by Berenson. et al (NEJM 1998; 338:1650) has shown that the extent of fatty streaks and fibrous plaques (hallmark of established atherosclerosis) in aorta and especially coronary artery increase with age. Furthermore, risk factor such as smoking, body mass index, systolic and diastolic blood pressure, serum concentration of total cholesterol, LDL and IIDL cholesterol singly but especially when combined were strongly associated with extent of lesions within the coronary arteries of children.Therefore, unless a key is discovered in the 2P century which would unlock the geneticand envfronmental secrets that produce atherosclerosis, we would continue the preventive strategy of risk factors modffication.