Atherosclerosis and its prevention.
Atherosclerosis is a chronic inflammatory disease of the arteries and is the reason behind approximately 50% of all deaths in the world. The word “atherosclerosis” is a Greek word where “athere” means “soft, fatty, gruel-like” and “scler” means “hard”. It is mainly accumulation of fats, cholesterol and other substances in and on artery walls and this formation of cholesterol plaque in the walls of arteries leads to blockage of blood flow. Atherosclerosis is considered a principal cause of atherosclerotic cardiovascular disease (ASCVD) that results into heart attacks, stroke and peripheral arterial disease. Read More
Causes of Atherosclerosis
There are various factors which leads to ASCVD. The most common risk factors are hypercholesterolemia (LDL-cholesterol), hypertension, diabetes mellitus, age (male older than 45 years and female older than 55 years), male gender, family history and cigarette smoking. Some of the other factors includes a sedentary lifestyle, diets high in saturated and trans-fatty acids, obesity and some genetic mutations.
Population distribution of Atherosclerosis
The occurrence of atherosclerosis is very difficult to determine as it remains in asymptomatic condition mainly. Atherosclerosis is regard as the prime cause of cardiovascular diseases. ASCVD predominantly effect the heart and brain leading to ischemic heart disease (IHD) and ischemic stroke. IHD and stroke are the first and fifth causes of death in developed countries respectively.
As per some reports, about 75% of acute myocardial infarctions happens due to rupture of plaque. The rupture of plaque was more commonly observed in men beyond 45 years age than in women, frequently over 50 years age. This higher frequency of atherosclerosis in men than women is due to the sex hormones which protects female nonetheless is reduces after menopause. Read More
Development of atherosclerosis
The development of atherosclerotic plaque occurs due to progressive accumulation of lipid in arterial wall which initiates chronic inflammation at susceptible regions in the arteries. This process starts from the nascent fatty streaks in the arterial intima that progress into fibrous plaques and develops into complex atherosclerotic lesions which are inclined to rupture. This expansion of lesion inward leads to blockage of vessels specially coronaries.
Assessment of ASCVD risk factors
In order to assess ASCVD risk factors, lipid profile, plasma glucose, and high-sensitivity C-reactive protein (hsCRP) are estimated. The other methods for diagnosing AVACD includes ultrasound of abdomen, sonography of the carotids, electrocardiogram (ECG) specially stress ECG, computed tomography (CT) angiography and cardiovascular magnetic resonance imaging (cardiac MRI).
Treatment and management of atherosclerosisThe best way to manage ASCVD is to monitor and treat the risk factors for example elevated LDL-Cholesterol, blood pressure (BP), diabetes, etc. The patients should also practise to exercise regularly and follow healthy diet having low saturated fats, trans fats, salt and high fiber, monounsaturated fats, fatty fish, fruits, and vegetables. Patients should avoid smoking. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the used to maintain low LDL cholesterol which in turn reduces the cardiovascular events and related death. The high blood pressure can be maintained by the drug classes angiotensin-converting enzyme (ACEs) inhibitors, angiotensin II receptor blockers (ARBs), diuretics, beta-blockers, and calcium channel blockers (CCB) and vasodilators. The patients should be made knowledgeable of maintaining normal BP of 130/85. Diabetes should also be managed by diet and exercise. The aim should be to maintain the glycated hemoglobin (HbA1c) under 7%, BP less than 130/85, and LDL-cholesterol less than 100 mg/dl in primary prevention. For clinical ASCVD, revascularization procedures are suggested including angioplasties, bypass, etc. Read More