Which group of risk factors promotes atherosclerosis?

• A. Metabolic syndrome
• B. Hyperkalemia
• C. Dehydration
• D. Anemia

Answer: (A)

A cluster of interconnected metabolic abnormalities drives the development of atherosclerosis. When insulin resistance dominates in metabolic syndrome, there’s higher circulating triglycerides, lower HDL, and more free fatty acids reaching the liver, which increases VLDL production and yields smaller, denser LDL particles that are prone to oxidation and uptake by macrophages in the arterial wall. Endothelial dysfunction is worsened by hypertension, which adds mechanical stress and promotes failed nitric oxide signaling. Adipose tissue inflammation from central obesity releases cytokines that create a chronic pro-inflammatory, pro-thrombotic environment, with higher fibrinogen and PAI-1. This combination accelerates endothelial injury, lipid deposition, macrophage recruitment, foam cell formation, and plaque progression.

Hyperkalemia isn’t a primary driver of atherosclerosis; dehydration can transiently affect blood flow but doesn’t establish atherogenic plaques; anemia reduces oxygen carrying capacity but isn’t a key factor in plaque formation.