Coronary Atherosclerosis: Morphological Characteristics of Pathological Changes

Coronary atherosclerosis is primarily categorized into two types of plaques—hard and soft—each with distinct features that influence cardiovascular health. Understanding these differences is essential for diagnosing and managing heart disease effectively.

Hard Plaques

1. Calcified Plaques

Calcified plaques are among the hardest types and are typically associated with advanced age. These plaques resemble small stones both in texture and composition, forming within the coronary arteries and contributing to vessel stiffness and reduced blood flow. They are commonly seen in elderly patients and are often detected through imaging techniques like CT scans.

2. Fibrous Plaques

Fibrous plaques are classified as intermediate in terms of hardness. They are the most prevalent type of atherosclerotic plaque and are primarily composed of connective tissue and smooth muscle cells. These plaques tend to develop gradually over time and are considered more stable compared to softer, lipid-rich plaques.

Soft Plaques

Also known as lipid-rich plaques, soft plaques have a consistency similar to butter or cream. They are composed largely of cholesterol, inflammatory cells, and a thin fibrous cap. Despite their smaller volume in some cases, they are considered high-risk due to their vulnerability to rupture, which can trigger sudden cardiac events.

Clinical Implications of Plaque Types

When acute cardiovascular events occur, such as heart attacks, they are often linked to the formation of blood clots at the site of a ruptured plaque. This is particularly common with soft plaques, which are more prone to disruption. The resulting thrombosis can severely obstruct blood flow, leading to myocardial infarction and other life-threatening conditions.