Author Ольга Кияница
Atherosclerosis is a condition in which fatty deposits accumulate on the walls of the arteries, which can more or less restrict blood flow. At the early stage of the development of the disease, the symptoms are practically absent, but later a whole “bunch of diseases” may occur.
If earlier this disease was more preferable in older people, today it is diagnosed at a relatively young age (men younger than 55 years old or women younger than 65 years old).
Despite progress in the diagnosis and treatment of atherosclerosis, the condition continues to affect many people. The definition of this disease at a relatively young age is particularly difficult. Further, serious complications can affect the health and markedly worsen the patient’s quality of life.
Video: Cholesterol and atherosclerosis. Vascular Atherosclerosis Symptoms and Treatment
Description of atherosclerosis
Atherosclerotic cardiovascular disease (AHD) is caused by the accumulation of cholesterol plaques in the arteries and often causes:
- acute coronary syndrome;
- peripheral arterial disease;
- myocardial infarction;
Atherosclerosis is the leading cause of morbidity and mortality in the United States. Dyslipidemia, diabetes mellitus (DM), obesity, inactive lifestyle, hypertension, smoking, and family history are the main risk factors for atherosclerosis . Definition in patients with a 10-year risk associated with the occurrence
ASCA is fundamental to determining the need to lower cholesterol.
Lipid testing, including total cholesterol, low density lipoprotein cholesterol (LDL-C or LDL), high density lipoprotein cholesterol (HDL-C or HDL cholesterol) and triglycerides, is traditionally part of the risk assessment for AHD. Testing is also used for screening and monitoring. Unconventional new markers, such as apolipoproteins, lipoprotein particles and highly sensitive C-reactive protein (hsCRP), are also gaining recognition in terms of evaluating patients at high risk.
The mechanism of atherosclerosis
With ACH, arteries (blood vessels that carry oxygen-containing blood from the heart to other parts of the body) become narrowed because the fat (represented by cholesterol) is deposited on the inner walls of the blood vessels and then germinates with fibrous tissue, calcified. Thus, an atherosclerotic plaque is formed.
Increasing the size of the plaque leads to a narrowing of the artery lumen. This causes a decrease in oxygen intake and impaired blood supply to the affected organ (for example, heart, eyes, kidneys, lower limbs, intestines, or brain structures). The plaque can eventually completely block the artery, causing ischemia and tissue death. According to this principle most often develops a heart attack or stroke.
- When the arteries of the heart (coronary arteries) are affected by atherosclerosis, a person can develop angina, heart attack, congestive heart failure or abnormal heart rhythms (arrhythmias).
- With atherosclerosis of the cerebral arteries, a person increases the risk of stroke, called transient ischemic attack. In extreme cases, death of the brain tissue occurs, that is, a stroke.
Vascular atherosclerosis is a progressive condition that can begin in childhood. Fat deposits are often accumulated in the aorta (the largest blood vessel that supplies blood to both the upper and lower parts of the body) shortly after birth.With a hereditary predisposition to high levels of cholesterol in the blood, the condition may begin to deteriorate after 20 years and gradually become more pronounced by the 40s and 50s.
Inside the vessels lipid deposits are deposited by type of cholesterol, which prevent blood flow. They are dangerous complete clogging of the vessel.
Causes of atherosclerosis
The exact cause of atherosclerosis has not been fully elucidated, however, the risk factors for the development and progression of ACHA have been identified. Risk factors can be divided into modifiable, which can be changed, and those that are not amenable to correction (unmodified).
Risk factors that can be changed:
- High blood pressure.
- High levels of cholesterol in the blood, especially low-density lipoprotein (LDL).
- Cigarette smoking
- Lack of physical activity.
Food with excess consumption of fatty meat, dairy products, eggs and fast foods (McDonalds syndrome) and low in the diet of fruits, vegetables and fish is important.
Risk factors that cannot be changed:
- Elderly age.
- Male (women are less likely to develop AHD, but only before menopause).
- The presence of a close relative who had a heart disease or stroke at a relatively young age (genetic predisposition, especially in the presence of familial hypercholesterolemia, that is, elevated cholesterol levels).
Additionally, it is noted that Africans have an increased risk of an excessive and early increase in blood pressure, leading to premature stroke, heart attack, congestive heart failure and death.
Video: Atherosclerosis - how and why vascular occlusion occurs
Symptoms of atherosclerosis
Arteriosclerosis often causes no symptoms until the lumen of the affected artery is narrowed to a critical value or completely blocked.
Symptoms of atherosclerosis vary greatly and can be presented as minor signs (at an early stage of the disease) and as a clinic for a heart attack or stroke (when the lumen of the artery is partially or completely blocked). Sudden cardiac death can also be the first symptom of coronary heart disease.
Symptoms depend on the location of the arteries affected by atherosclerosis.
If the coronary arteries feeding the heart are affected, then the person may develop:
- chest pain;
Chest pain (as with stenocardia) due to insufficient blood flow to the heart muscle, as a rule, is felt under tension and disappears at rest. In the classic version, angina is a heavy, squeezing and depressing feeling in the middle of the chest.Rarely, angina may occur at rest. Most often this indicates a more unstable atherosclerotic plaque and, possibly, a threat of a heart attack.
Many types of chest pain are not due to the development of angina pectoris, including muscle and ligament pain in the chest, damaged lungs surrounding the heart, as well as a painful esophagus that passes through the chest behind the heart.
If the carotid or vertebral arteries supplying the brain are affected, the person can determine:
- loss of speech;
- difficulty swallowing;
- paralysis of the body part (usually the right or left part).
The lesion of the arteries supplying the lower limbs causes peripheral vascular disease. In particular, the patient may have severe pain in the legs, which usually occurs when walking and passes during stopping (intermittent claudication).When the disease is severe, the pain can be felt even at rest and / or at night. In this variant of the disease, the skin on the legs becomes dystrophic, there is a wound, often poorly healing, which, if left untreated, leads to amputation.
Involvement in the atherosclerotic process of the renal arteries causes symptoms of high blood pressure. In severe cases, renal failure occurs.
When do I need to see a doctor?
You should consult your doctor if there are risk factors for atherosclerosis, especially if you have any unexplained symptoms that indicate a blockage of the artery.
If a person has been diagnosed with atherosclerosis of the coronary vessels, before beginning any treatment program related to the exercises, you should undergo a medical consultation.
After collecting complaints, the doctor may prescribe the following tests:
- Physical examination , which includes measuring height and weight, as well as blood pressure in both hands, followed by determination of body mass index (BMI) and measurement of waist circumference.
- Auscultation — Uncharacteristic sounds or turbulence over blocked arteries in the neck, abdomen, and legs that can sometimes be heard with a stethoscope are heard. Blocked arteries in the heart are not determined by this method.
- Lipid profile - used to check the level of total cholesterol in the blood, low-density lipoprotein (LDL) or high-density lipoprotein (HDL). Triglycerides are also defined, especially in people with diabetes.
- Measuring blood glucose to screen for diabetes mellitus, especially if the patient is obese, has high blood pressure, high lipid levels, and / or a family history of diabetes.
- Standard ECG - register the speed and regularity of the heart rhythm. The study may indicate a previous heart attack. A patient with several severely blocked arteries may have a completely normal ECG.
- Stress ECG - doing exercise on a treadmill or stationary bike, while constantly recording ECG, blood pressure and respiration. In individuals suffering from atherosclerosis, this test may indicate a decrease in blood supply to the heart caused by a lack of oxygen. If the patient cannot exercise, then a chemical stimulant is used.
- Nuclear stress test - is the introduction of a radioactive substance into the bloodstream, followed by obtaining an image of the heart muscle at rest and immediately after exercise. Images give an idea of myocardial perfusion. If there is a disease of the coronary artery, the blood supply during exercise is reduced in the affected area. The test is more sensitive than stress ECG, and with its help is guaranteed to determine the location of the blocked artery. This diagnostic method is also much more expensive than ECG.
- Echocardiography is a study based on the evaluation of a moving image of the heart, which is visualized on the screen using ultrasound equipment. If the area of the heart is weakened due to a heart attack, you can detect the damage site and determine the size of the lesion. EchoCG also reveals problems with heart valves, any fluid in the pericardium, congenital changes of the heart. The pressure inside the heart cavities is also evaluated.
- Echocardiography with exercise is an alternative to nuclear stress test. EchoCG only analyzes the movement of the left ventricle. In the absence of blood flow, the ischemic area stops working. Then, with rest and resolution of ischemia, the muscle begins to move again.
- Angiography of the affected artery is performed in cases where the symptoms are absent and / or the above studies cannot be performed for some reason. This is an invasive procedure performed by a cardiologist in the catheterization ward. A special radiopaque dye is fed into the arteries through a thin tube or catheter, which is introduced into the body under local anesthesia, usually in the groin area. Then produce serial x-rays to visualize the arteries. As a result, the presence of any narrowing is most reliably determined.
Angiography is the most specific study to evaluate coronary artery disease.
Treatment of atherosclerosis
There are various medical effects tactics. For example, if there are no significant signs of discomfort in atherosclerosis, then treatment may be limited to lifestyle changes and proper nutrition. In more complex cases, depending on the indications and contraindications perform:
- angioplasty and other surgical intervention.
The most affordable home remedies for the treatment of atherosclerosis
Lifestyle change plays an important role in slowing the progression of the atherosclerotic process, so the following recommendations should be implemented:
- Eat low cholesterol foods.
- Increase the consumption of fruits and vegetables.
- There is a fish at least twice a week.
- Stop smoking.
- Lose weight if you are overweight.
- Exercise, agreed with your doctor.
- It is important to maintain the level of glucose and glycated hemoglobin (HbA1c) in the blood at an acceptable level, which may require taking the appropriate drugs.
When you stop smoking cigarettes, the risk of developing atherosclerosis is quickly and significantly reduced. It is important to know that the likelihood of developing coronary heart disease in people who have recently quit smoking is similar to the likelihood of non-smoking in two years.
Smoking cigarettes lowers good cholesterol (high density lipoprotein or HDL cholesterol) and increases the amount of bad cholesterol. However, smoking is even more dangerous for people who are at risk for heart disease.
Against the background of tobacco consumption, the amount of carbon monoxide in the blood increases, which in turn contributes to the intimal damage of the arterial wall. It also facilitates the formation of plaques. In addition, smoking narrows the arteries, which further reduces the amount of blood flowing to the cells.
Drug treatment of vascular atherosclerosis
The goal of treatment is to improve blood flow in the affected parts of the body. This can be used tactics to reduce risk factors that can be changed using the following steps:
- Take drugs to normalize blood pressure , if there is hypertension.
- They will use medications to normalize the level of glucose in the blood , which primarily concerns patients with diabetes.
- Use means to reduce the level of lipids , especially if there is an increase in their concentration. These drugs help to reduce the concentration of LDL cholesterol and triglycerides and increase the amount of HDL cholesterol. Statins are the most commonly used drugs that reduce the level of “bad” lipids, which is confirmed by the results of clinical trials over the past 11 years.
Additionally, aspirin should be regularly used by persons with established atherosclerosis of any arteries, as well as in the presence of a high risk (according to analyzes of predisposing factors) of the development of this disease.Acetylsalicylic acid inhibits platelet sticking.
Medications for the treatment of atherosclerosis
Medicines used to lower cholesterol in the blood are generally divided into five categories:
- Statins . Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), simvastatin (Zocor) and rosuvastatin (Crestor) are commonly used. Statins inhibit an enzyme that controls the rate of production of cholesterol in the body. Tablets are usually taken once a day and begin after the tried diets and exercise have not yielded the expected results.
- Sequestrants of bile acids . In particular, cholestyramine (Questran, Questran Light, Prevalite, LoCholest), colestipol (Colestid) and wheel wheels (Welchol) are used. These drugs contribute to the binding of cholesterol bile acids in the intestines, which are then excreted from the body with feces. Thus, medications reduce the absorption of consumed cholesterol from the intestines. However, they can cause diarrhea, so many patients do not tolerate them.
- Cholesterol absorption inhibitors . Ezetimibe (Zetia) is most commonly used, which selectively reduces cholesterol absorption. This drug is often combined with statins.
- Nicotinic acid or niacin is a water-soluble vitamin PP, which significantly increases the concentration of HDL cholesterol (“good” cholesterol) and lowers LDL cholesterol (“bad” cholesterol). Intensive cleaning of the stomach is the most common side effect.
- Fibrates : gemfibrozil (Lopid) and fenofibrate (Tricor) are usually used from this pharmacological group. They are primarily effective in lowering the level of triglycerides and “bad” cholesterol and, to a lesser extent, increase the level of “good” cholesterol.
Surgical treatment of atherosclerosis
Balloon angioplasty - during this procedure, a catheter with a balloon at the end is used to open blocked or narrowed arteries. A catheter (thin tube) is inserted into the body through a blood vessel in the groin area and moves up to the blocked artery. When the narrowed part of the vessel is reached, the balloon is inflated, due to which the plaque is pressed against the arterial wall. As a result, the lumen of the affected artery increased in diameter and improves blood flow through a previously blocked area. A side effect of the procedure may consist in damage to the vessel wall by the opening balloon, which provokes proliferative changes in the endothelium with repeated stenosis of the vessel and the development of connective tissue.
Stenting - during this minor surgery, a metal tube called a stent is placed in the artery. With its help, the lumen of the vessel, opened after successful dilatation, can be maintained as such for a long time. The stent supports the arterial walls and does not allow them to close, which prevents collapse or compaction of damaged areas of the endothelium.Some stents are covered with special preparations that help prevent the proliferation of the endothelium and the re-blocking of the affected artery. After stenting, the patient is asked to take medication to prevent platelet buildup on the metal surface.
If lifestyle changes and medications do not help alleviate the symptoms of atherosclerosis, and / or angioplasty with stenting for technical reasons cannot be performed, then use the method of creating workarounds for the blood flow.
Bypass surgery - arteries or veins from other parts of the body are used to perform this operation, which allows a path to bypass the blocked artery for the bloodstream. It improves blood circulation in the descending parts of the circulatory system.
An operation performed on the coronary arteries is called aorto-coronary artery bypass surgery. In bypass surgery of the arteries of the lower extremities, specially designed tubes (grafts) of tissue, dacron or plastic are used, by which the bypass paths are performed.
Prevention and prognosis of atherosclerosis
It is possible to prevent the development of atherosclerosis by reducing / eliminating modifiable (changeable) risk factors that are determined in each particular case separately (there may be high blood pressure, high blood glucose levels, high blood cholesterol levels, cigarette smoking, obesity, lack of or lack of physical activity ).
You should eat healthy foods that are low in saturated fat and rich in fruits, herbs, and vegetables.
If there is frequent emotional stress, then you need to find ways to reduce or control it. For this, both traditional methods of exposure and medicines can be used after prior consultation with a doctor.
Fortunately, taking steps to eliminate some of the risk factors helps to change other predisposing conditions. For example, exercise promotes weight loss for an obese person, which in turn helps to reduce cholesterol and blood pressure.
The prognosis of atherosclerosis
Predictive conclusion in atherosclerosis is variable. In some cases, many people with critical limitation of blood flow in vital organs, such as the heart and brain, survive and continue to live for many years. On the other hand, sudden cardiac death may be the first clinical manifestation of atherosclerosis.
Thus, the individual characteristics of a person should be taken into account with the control of his general condition and the identification of his own risk factors. The prognosis is also influenced by the quality of measures used to prevent vascular atherosclerosis.
Video: The whole truth about the treatment of atherosclerosis
Atherosclerotic plaque can form in various parts of the cardiovascular system. One of the forms of pathology is atherosclerosis of the aorta of the heart, to know what it is for everyone who has a predisposition to diseases of the heart and blood vessels. When an illness is detected, the patient is necessarily treated, which helps prevent the development of serious complications.
With age, a person increases the risk of developing various diseases, including atherosclerosis of the lower extremities. This pathology does not immediately manifest itself, but if untreated, serious complications can occur. To prevent health problems, it is important to know the specifics of the course of the disease, as well as the principles of its diagnosis, therapy and prevention.
Clogged arteries with cholesterol and other pathological substances leads to the development of various cardiovascular diseases. These conditions in turn increase the risk of death, especially in old age. If the violation is at the initial stage, then treatment of atherosclerosis with folk remedies may be effective.