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Chapter 32: Atherothrombosis: Disease Burden, Activity, and Vulnerability

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Which of the following statements is not true?

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A. Causal and modifiable risk factors for atherosclerotic cardiovascular disease are well known but account for < 50% of heart attacks in both sexes

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B. Individual susceptibility to conventional risk factors varies greatly, and therefore their predictive value is limited

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C. Most first heart attacks occur among people with average or only slightly elevated risk factor levels

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D. Better detection of at-risk individuals may be achieved by visualizing the diseased arterial wall rather than just assessing risk factors

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E. All of the statements are true

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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 32) Causal and modifiable risk factors for atherosclerotic cardiovascular disease are well known (eg, smoking, dyslipidemia, high blood pressure, diabetes) and account for most (not less than 50%) of heart attacks in both sexes (option A).1 However, for unknown reasons, the individual susceptibility to these risk factors varies greatly, and consequently, their predictive value is limited (option B).2,3 Most first heart attacks occur among people with average or only slightly elevated risk factor levels (option C).4-6 Recurrent events still occur despite lowering of these levels,7,8 indicating that we need both better detection and better treatment of those who are destined for a heart attack. Better detection of at-risk individuals may be achieved by visualizing the diseased arterial wall rather than just assessing risk factors (option D).

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Which of the following statements is not true?

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A. Atherosclerosis is a chronic, lipid-driven inflammatory disease of the arterial wall leading to multifocal plaque development

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B. Atherosclerosis predominates at sites characterized by high and nonoscillatory endothelial shear stress

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C. The speed of disease progression varies greatly, but it usually takes decades to develop the advanced atherosclerotic lesions responsible for clinical disease

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D. Plaques are very heterogeneous in size and composition, even plaques located next to each other

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E. Most plaques remain asymptomatic, some become obstructive, and a few, if any, become vulnerable

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The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 32) Atherosclerosis is a chronic, lipid-driven inflammatory disease of the arterial wall leading to multifocal plaque development (option A),9-11 predominantly at sites characterized by low and oscillatory (not high and nonoscillatory) endothelial shear stress (bifurcations, inner wall of curvatures) and preexisting intimal thickenings (option B).12,13 The speed of disease progression varies greatly, but it usually takes decades ...

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