Cardiology · USMLE Step 1 and Step 2

Atherosclerosis Risk Factors song

Atherosclerosis Risk Factors, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Atherosclerosis Risk Factors

Full song on YouTube ↗Spotify ↗

Key points in this song10

Atherosclerosis begins with endothelial injury, leading to LDL oxidation, foam cell formation from macrophages, and fatty streak development — the earliest visible lesion.
Non-modifiable risk factors include advanced age, male sex, and family history of premature coronary artery disease (first-degree relative <55 in males, <65 in females).
Hypertension accelerates atherosclerosis by causing endothelial shear stress and upregulating NADPH oxidase, increasing reactive oxygen species and LDL oxidation.
Diabetes mellitus promotes atherosclerosis via glycation of LDL, making it more atherogenic, and by increasing advanced glycation end-products (AGEs) that stiffen vessel walls.
Smoking is the single most preventable risk factor; it reduces HDL, increases LDL oxidation, promotes platelet aggregation, and causes endothelial dysfunction via carbon monoxide and free radicals.
Dyslipidemia — elevated LDL and low HDL — is the most directly causal modifiable risk factor; LDL >190 mg/dL or HDL <40 mg/dL in males significantly increases cardiovascular risk.
Hyperhomocysteinemia (seen in B6, B9, B12 deficiencies or CBS deficiency) damages endothelium directly and is an independent risk factor for premature atherosclerosis.
Metabolic syndrome (central obesity, hypertriglyceridemia, low HDL, hypertension, hyperglycemia — 3 of 5 criteria) dramatically amplifies atherosclerotic cardiovascular disease (ASCVD) risk.
C-reactive protein (CRP) is a marker of systemic inflammation and an independent predictor of ASCVD; statins reduce CRP levels independent of their LDL-lowering effects (JUPITER trial).
Lipoprotein(a) [Lp(a)] is a genetically determined, independent risk factor for atherosclerosis that is not significantly reduced by statins and requires niacin or PCSK9 inhibitors for reduction.