Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200211
Jornal Vascular Brasileiro
Review Article

Arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg: qual a diferença?

Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis: what is the difference?

Vanessa Prado dos Santos; Geanete Pozzan; Valter Castelli Júnior; Roberto Augusto Caffaro

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Resumo

Resumo: A principal causa de óbito na contemporaneidade são as doenças cardiovasculares. Arteriosclerose, aterosclerose, arteriolosclerose e arteriosclerose de Monckeberg são termos frequentemente utilizados como sinônimos, mas traduzem alterações distintas. O objetivo desta revisão foi discutir os conceitos de arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg. O termo arteriosclerose é considerado mais genérico, significando o enrijecimento e a consequente perda de elasticidade da parede arterial, abarcando os demais tipos. A aterosclerose é uma doença inflamatória secundária a lesões na camada íntima, que tem como principal complicação obstrução crônica e aguda do lúmen arterial. A arteriolosclerose se refere ao espessamento das arteríolas, particularmente relacionada à hipertensão arterial sistêmica. Já a esclerose calcificante da média de Monckeberg designa a calcificação, não obstrutiva, da lâmina elástica interna ou da túnica média de artérias musculares. As calcificações vasculares, que incluem lesões ateroscleróticas e a esclerose calcificante da média de Monckeberg, vêm sendo estudadas como um fator de risco para a morbimortalidade cardiovascular.

Palavras-chave

aterosclerose, arteriosclerose, arteriolosclerose, esclerose calcificante da média de Monckeberg, calcificação vascular

Abstract

Cardiovascular diseases are the main cause of death in contemporary times. Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg’s arteriosclerosis are terms that are often used interchangeably, but they refer to different vascular pathologies. The objective of this study is to review the concepts of atherosclerosis, atherosclerosis, arteriosclerosis and Monckeberg medial calcific sclerosis (MMCS). The term arteriosclerosis is more generic, meaning the stiffening and consequent loss of elasticity of the arterial wall, and encompasses the other terms. Atherosclerosis is an inflammatory disease secondary to lesions in the intimal layer and whose main complication is acute and chronic obstruction of the arterial lumen. Arteriolosclerosis refers to thickening of arterioles, particularly in association with systemic arterial hypertension. MMCS refers to non-obstructive calcification in the internal elastic lamina or the tunica media of muscular arteries. Vascular calcifications, which include atherosclerotic lesions and MMCS, have been studied as a risk factor for cardiovascular morbidity and mortality.

Keywords

atherosclerosis; arteriosclerosis; arteriolosclerosis; Monckeberg medial calcificsclerosis; vascular calcification.

References

Roth GA, Abate D, Abate KH, et al, and the GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. http://dx.doi.org/10.1016/S0140-6736(18)32203-7. PMid:30496103.

2 Brant LCC, Nascimento BR, Passos VMA, Duncan BB, Bensenõr IJM, Malta DC et al. Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: estimates from the Global Burden of Disease. Rev Bras Epidemiol. 2017;20(20, Suppl. 1):116-28. http://dx.doi.org/10.1590/1980-5497201700050010. PMid:28658377.

3 Massa KHC, Duarte YAO, Chiavegatto Filho ADP, Massa KHC, Duarte YAO, Chiavegatto Filho ADP. Analysis of the prevalence of cardiovascular diseases and associated factors among the elderly, 2000-2010. Cien Saude Colet. 2019;24(1):105-14. http://dx.doi.org/10.1590/1413-81232018241.02072017. PMid:30698245.

4 Singer C. Uma breve história da anatomia e fisiologia desde os Gregos até Harvey. Campinas, SP: UNICAMP; 1996. 234 p.

5 Wilting J. Integrated Vascular Anatomy. In: Lanzer P, Topol EJ, editors. Pan Vascular Medicine: integrated clinical management. Berlin, Heidelberg: Springer; 2002. p. 50-75. http://dx.doi.org/10.1007/978-3-642-56225-9_4.

6 Johnson RC, Leopold JA, Loscalzo J. Vascular Calcification: Pathobiological Mechanisms and Clinical Implications. Circ Res. 2006;99(10):1044-59. http://dx.doi.org/10.1161/01.RES.0000249379.55535.21. PMid:17095733.

7 Fishbein GA, Fishbein MC. Arteriosclerosis: rethinking the current classification. Arch Pathol Lab Med. 2009;133(8):1309-16. http://dx.doi.org/10.5858/133.8.1309. PMid:19653731.

8 Essential Evidence Plus. EBM: Levels of Evidence - Essential Evidence Plus [Internet]. [cited 2021 Mar 17]. Available from: https://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford

9 Libby P, Ridker PM, Hansson GK, and Leducq Transatlantic Network on Atherothrombosis. Inflammation in Atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54(23):2129-38. http://dx.doi.org/10.1016/j.jacc.2009.09.009. PMid:19942084.

10 Wolf D, Ley K. Immunity and Inflammation in atherosclerosis. Circ Res. 2019;124(2):315-27. http://dx.doi.org/10.1161/CIRCRESAHA.118.313591. PMid:30653442.

11 Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJP, et al. Rosuvastatin to prevent vascular events in men and women with Elevated C-Reactive Protein. N Engl J Med. 2008;359(21):2195-207. http://dx.doi.org/10.1056/NEJMoa0807646. PMid:18997196.

12 Lusis AJ. Atherosclerosis. Nature. 2000;407(6801):233-41. http://dx.doi.org/10.1038/35025203. PMid:11001066.

13 Instituto Brasileiro de Geografia e Estatística. Tábua completa de mortalidade para o Brasil [Internet]. Rio de Janeiro: IBGE; 1991 [citado 2020 jul 29]. https://biblioteca.ibge.gov.br/index.php/biblioteca-catalogo?view=detalhes&id=73097

14 Malta DC, Duncan BB, Schmidt MI, Machado ÍE, Silva AG da, Bernal RTI, et al. Prevalência de diabetes mellitus determinada pela hemoglobina glicada na população adulta brasileira, Pesquisa Nacional de Saúde. Rev Bras Epidemiol. 2019;22(Suppl. 2):1-13.

15 Kannel WB, McGee DL. Diabetes and cardiovascular disease: The FraminghamStudy. JAMA. 1979;241(19):2035-8. http://dx.doi.org/10.1001/jama.1979.03290450033020. PMid:430798.

16 Ribeiro ALP, Duncan BB, Brant LCC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular health in Brazil. Circulation. 2016;133(4):422-33. http://dx.doi.org/10.1161/CIRCULATIONAHA.114.008727. PMid:26811272.

17 Stary HC, Chandler AB, Glagov S, Guyton JR, Insull W, Rosenfeld ME, et al. A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. Circulation. 1994;89(5):2462-78. http://dx.doi.org/10.1161/01.CIR.89.5.2462. PMid:8181179.

18 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20(5):1262-75. http://dx.doi.org/10.1161/01.ATV.20.5.1262. PMid:10807742.

19 Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. Arterioscler Thromb Vasc Biol. 1995;15(9):1512-31. http://dx.doi.org/10.1161/01.ATV.15.9.1512. PMid:7670967.

20 Stary HC. Natural history and histological classification of Atherosclerotic lesions: an update. Arterioscler Thromb Vasc Biol. 2000;20(5):1177-8. http://dx.doi.org/10.1161/01.ATV.20.5.1177. PMid:10807728.

21 Finn AV, Nakano M, Narula J, Kolodgie FD, Virmani R. Concept of vulnerable/Unstable plaque. Arterioscler Thromb Vasc Biol. 2010;30(7):1282-92. http://dx.doi.org/10.1161/ATVBAHA.108.179739. PMid:20554950.

22 Santos VP, Caffaro RA, Pozzan G, Saieg MA, Castelli V Jr. Comparative histological study of atherosclerotic lesions and microvascular changes in amputated lower limbs of diabetic and non-diabetic patients. Arq Bras Endocrinol Metabol. 2008;52(7):1115-23. http://dx.doi.org/10.1590/S0004-27302008000700007. PMid:19082299.

23 Narula N, Dannenberg AJ, Olin JW, Bhatt DL, Johnson KW, Nadkarni G et al. Pathology of peripheral artery disease in patients with critical Limb Ischemia. J Am Coll Cardiol. 2018;72(18):2152-63. http://dx.doi.org/10.1016/j.jacc.2018.08.002. PMid:30166084.

24 Martinez‐Lemus LA. The dynamic structure of Arterioles. Basic Clin Pharmacol Toxicol. 2012;110(1):5-11. http://dx.doi.org/10.1111/j.1742-7843.2011.00813.x. PMid:21989114.

25 Andrade ZA. O problema da hepatite crônica na esquistossomose mansônica. Rev Soc Bras Med Trop. 1967;1(1):19-26. http://dx.doi.org/10.1590/S0037-86821967000100004.

26 Burchfiel CM, Tracy RE, Chyou P-H, Strong JP. Cardiovascular risk factors and hyalinization of renal arterioles at autopsy: the Honolulu heart program. Arterioscler Thromb Vasc Biol. 1997;17(4):760-8. http://dx.doi.org/10.1161/01.ATV.17.4.760. PMid:9108792.

27 Kono K, Fujii H, Nakai K, Goto S, Watanabe S, Watanabe K, et al. Relationship between type of Hypertension and Renal Arteriolosclerosis in chronic glomerular disease. Kidney Blood Press Res. 2016;41(4):374-83. http://dx.doi.org/10.1159/000443440. PMid:27327274.

28 Ninomiya T, Kubo M, Doi Y, Yonemoto K, Tanizaki Y, Tsuruya K, et al. Prehypertension increases the risk for renal arteriosclerosis in autopsies: the Hisayama Study. J Am Soc Nephrol. 2007;18(7):2135-42. http://dx.doi.org/10.1681/ASN.2007010067. PMid:17582160.

29 Ighodaro ET, Abner EL, Fardo DW, Lin A-L, Katsumata Y, Schmitt FA, et al. Risk factors and global cognitive status related to brain arteriolosclerosis in elderly individuals. J Cereb Blood Flow Metab. 2017;37(1):201-16. http://dx.doi.org/10.1177/0271678X15621574. PMid:26738751.

30 Hill GS. Hypertensive nephrosclerosis. Curr Opin Nephrol Hypertens. 2008;17(3):266-70. http://dx.doi.org/10.1097/MNH.0b013e3282f88a1f. PMid:18408477.

31 Zhang H, Zhang C, Liu Y, Gao W, Wang S, Fang X, et al. Influence of dual‐specificity proteinphosphatase 5 on mechanical properties of rat cerebral and renal arterioles. Physiol Rep. 2020;8(2):e14345. http://dx.doi.org/10.14814/phy2.14345. PMid:31960618.

32 Amann K. Media calcification and intima calcification are distinct entities in chronic kidney disease. Clin J Am Soc Nephrol. 2008;3(6):1599-605. http://dx.doi.org/10.2215/CJN.02120508. PMid:18815240.

33 Micheletti RG, Fishbein GA, Currier JS, Fishbein MC. Mönckeberg sclerosis revisited: a clarification of the histologic definition of Mönckeberg sclerosis. Arch Pathol Lab Med. 2008;132(1):43-7. http://dx.doi.org/10.5858/2008-132-43-MSRACO. PMid:18181672.

34 Monckeberg JG. Uber die reine Mediaverkalkung der Extremitaetenarterien und ihr Verhalten zur Arteriosklerose. Virchows Arch Pathol Anat. 1903;171(1):141-67. http://dx.doi.org/10.1007/BF01926946.

35 Rocha-Singh KJ, Zeller T, Jaff MR. Peripheral arterial calcification: Prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv. 2014;83(6):E212-20. http://dx.doi.org/10.1002/ccd.25387. PMid:24402839.

36 Gherman D, Dumitrescu CI, Ciocan A, Melincovici CS. Histopathological changes in major amputations due to diabetic foot – a review. Rom J Morphol Embryol. 2018;59(3):699-702. PMid:30534807.

37 Velescu A, Clara A, Martí R, Ramos R, Perez-Fernandez S, Marcos L et al. Abnormally high ankle–Brachial Index is Associated with All-cause and Cardiovascular Mortality: The REGICOR Study. Eur J Vasc Endovasc Surg. 2017;54(3):370-7. http://dx.doi.org/10.1016/j.ejvs.2017.06.002. PMid:28754427.

38 Santos VP, Alves C, Fidelis R, Fidelis C, Araújo Filho J. Comparative study of the Ankle-Brachial Index in diabetic and non-diabetic patients with critical limb ischemia. J Vasc Bras. 2015;14(4):305-10. http://dx.doi.org/10.1590/1677-5449.03115.

39 Yee Ho C, Shanahan CM. Medial arterial calcification. Arterioscler Thromb Vasc Biol. 2016;36(8):1475-82. PMid:27312224.

40 Chowdhury MM, Makris GC, Tarkin JM, Joshi FR, Hayes PD, Rudd JHF, et al. Lower Limb Arterial Calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity. PLoS One. 2017;12(9):e0182952. http://dx.doi.org/10.1371/journal.pone.0182952. PMid:28886041.

41 Neves PO, Andrade J, Monção H, Neves PO, Andrade J, Monção H. Coronary artery calcium score: current status. Radiol Bras. 2017;50(3):182-9. http://dx.doi.org/10.1590/0100-3984.2015.0235. PMid:28670030.

42 Bugnicourt J-M, Leclercq C, Chillon J-M, Diouf M, Deramond H, Canaple S, et al. Presence of intracranial artery calcification is associated with mortality and vascular events in patients with ischemic stroke after hospital discharge: a cohort study. Stroke. 2011;42(12):3447-53. http://dx.doi.org/10.1161/STROKEAHA.111.618652. PMid:21940971.

43 Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive CoronaryAngiography) trial. J Am Coll Cardiol. 2008;52(21):1724-32. http://dx.doi.org/10.1016/j.jacc.2008.07.031. PMid:19007693.

44 Budoff MJ, Young R, Burke G, Jeffrey Carr J, Detrano RC, Folsom AR, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39(25):2401-8. http://dx.doi.org/10.1093/eurheartj/ehy217. PMid:29688297.

45 Anderson JJB, Kruszka B, Delaney JAC, He K, Burke GL, Alonso A, et al. Calcium Intake from diet and supplements and the risk of coronary artery calcification and its progression among olderadults: 10-Year follow-up of the multi-ethnic study of Atherosclerosis (MESA). J Am Heart Assoc. 2016;5(10). http://dx.doi.org/10.1161/JAHA.116.003815. PMid:27729333.

46 Lee SM, An WS. Supplementary nutrients for prevention of vascular calcification in patients with chronic kidney disease. Korean J Intern Med. 2019;34(3):459-69. http://dx.doi.org/10.3904/kjim.2019.125. PMid:31048656.
 


Submitted date:
11/06/2020

Accepted date:
04/06/2021

60d4c388a953955e20739643 jvb Articles

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