Learn everything you need to know about a major CVD - Atherosclerosis

1. SURESHNI FERNANDO

2. WHAT IS
ATHEROSCLEROSIS?
• An intimal progressive disease of
large and elastic arteries.
• A chronic inflammatory disease.
• Plaque build up in the arteries
narrowing the lumen.
• Plaque = Fatty streak + fibrous cap.
• Common locations – abdominal
aorta, coronary artery, popliteal
artery, circle of willis.

3. EPIDEMIOLGY
Figure 1: Worldwide death rate of CVDs in 2015 (Adapted from: Roth et al., 2017).
• Atherosclerosis, the leading cause of CVD, was responsible for
32% of the 54 million deaths worldwide in 2013.
• In 2015, out of 422 million cases of CVD, 17 million deaths
occurred.

4. ETIOLOGY
PREVENTABLE
• Weight
• Diet
• Smoking
NON-
PREVENTABLE
• Increasing age
• Being a male
NON-PROVEN
• Stress
• Hormones
• Obesity
Hypertension and Hyperlipidaemia
RISK FACTORS

5. SYMPTOMS
• Tightness of chest / Angina
• Dizziness
• Loss of appetite
Loss of appetite
Tightness of chest
Dizziness

6. PATHOPHYSIOLOGY
HYPERTENSION
TURBULENT FLOW
i SOD
h ROS
HYPERLIPIDEMIA
h LDL
h MACROPHAGES
h ROS
i NO
VASOCONSTRICTION
TURBULENT FLOWENDOTHELIAL SHEARING

7. Figure 2: Formation of atherosclerotic plaque (Adapted from: de Winther et al., 2005).
ROS
FIBROUS CAP
FATTY STREAK

8. PREVENTION
• Consuming a healthy diet
• Daily exercise
• Quit smoking

9. DIAGNOSIS
• Lipid profile – a measure of HDL, LDL, total cholesterol and
triglycerides in blood.
• Ultrasound scan - a catheter-based examination that depicts
coronary luminal size and the thickness of the wall.
• Angiogram - injection of an iodinated contrast agent through a
catheter, that is visible through x-ray.
Figure 3: Diagnostic methods; A-Intravascular Ultrasound scan, B-Angiogram
(Ibañez, Badimon and Garcia, 2009).
A B
Normal artery Artery with plaque Normal artery Artery with plaque

10. TREATMENT
• Statins, Aspirin, Angiotensin-converting enzyme (ACE) inhibitor
• Angioplasty
• Stenting
• Bypass grafting
Figure 4: Surgical treatment methods; A-Angioplasty, B-Stents, C-Bypass grafting
(University of Minnesota, 2019).
A B C
to unblock arteries

11. REFERENCES
Aziz, M. and Yadav, K. S. (2016) ‘Pathogenesis of atherosclerosis a review’, Medicinal and Clinical
Reviews, 2(22) [Online]. DOI: 10.21767/2471-299X.1000031 (Accessed: 7 October 2019).
Baumer, Y., McCurdy, S., Jin, X., Weatherby, T. M., Dey, A. K., Mehta, N. N., Yapa, J. K., Kruth, H. S. and
Boisvert, W. A. (2019) ‘Ultramorphological analysis of plaque advancement and cholesterol
crystal formation in Ldlr knockout mouse atherosclerosis’, Atherosclerosis, 287, pp. 100-111
[Online]. DOI: 10.1016/j.atherosclerosis.2019.05.02 (Accessed: 7 October 2019).
de Winther, M. P. J., Kanters, E., Kraal, G. and Hofker, M. H. (2005) ‘Nuclear factor κB signaling in
atherogenesis’, Thrombosis, and Vascular Biology, 25 pp. 904–914 [Online]. DOI:
10.1161/01.ATV.0000160340.72641.87 (Accessed: 9 October 2019).
HDL LDL Cholesterol (no date) Prevention of atherosclerosis – useful tips. Available at:
https://www.cholesterol-hdl-ldl.com/prevention-of-atherosclerosis.html (Accessed: 10
October 2019).
Herrington, W., Lacey, B., Sherliker, P., Armitage, J. and Lewington, S. (2016) ‘Epidemiology of
atherosclerosis and the potential to reduce the global burden of atherothrombotic disease’,
Circulation Research, 118(4), pp. 535–546 [Online]. DOI:
10.1161/CIRCRESAHA.115.307611Circulation Research. (Accessed: 7 October 2019).
Ibañez, B., Badimon, J. J., and Garcia, M. J. (2009) ‘Diagnosis of atherosclerosis by imaging’, The
American Journal of Medicine, 122(1), pp. S15–S25 [Online]. DOI:
10.1016/j.amjmed.2008.10.014 (Accessed: 13 October 2019).
Lee, J. and Cooke, J. P. (2011) ‘The role of nicotine in the pathogenesis of atherosclerosis’,
Atherosclerosis, 215(2), pp. 281–283, PMC [Online].DOI:
10.1016/j.atherosclerosis.2011.01.003 (Accessed: 13 October 2019).

12. REFERENCES
National heart, lung and blood Institute (2019) Atherosclerosis. Available at:
https://www.nhlbi.nih.gov/health-topics/atherosclerosis (Accessed: 13 October 2019).
Rafieian-Kopaei, M., Setorki, M., Doudi, M., Baradaran, A. and Nasri. H. (2014) ‘Atherosclerosis:
process, indicators, risk factors and new hopes’, International Journal of Preventive Medicine,
5(8), pp. 927–946, PMC [Online]. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258672/ (Accessed: 7 October 2019).
Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., Ahmed, M., Aksut, B.
(2017) ‘Global, regional and national burden of cardiovascular diseases for 10 causes, 1990
to 2015’, Journal of the American College of Cardiology, 70(1), pp. 1-25 [Online]. DOI:
10.1016/j.jacc.2017.04.052 (Accessed: 11 October 2019).
Sasso, G. L., Schlage, W. K., Boué, S., Veljkovic, E., Peitsch, M. C. and Hoeng, J. (2016) ‘The Apoe−/−
mouse model: a suitable model to study cardiovascular and respiratory diseases in the
context of cigarette smoke exposure and harm reduction’, Journal of Translational Medicine,
14, pp. 146 [Online]. DOI: 10.1186/s12967-016-0901-1 (Accessed: 7 October 2019).
University of Minnesota (2019) ‘Device tutorial’, Atlas of Human Cardiac Anatomy. Available at:
http://www.vhlab.umn.edu/atlas/device-tutorial/stents/index.shtml (Accessed: 13
October 2019).
Uzhova, I., Fuster, V., Fernández-Ortiz, A., Ordovás, J. M., Sanz, J., Fernández-Friera, L., López-
Melgar, B., Mendiguren, J. M., Ibáñez, B., Bueno, H. and Peñalvo, J. L. (2017) ‘The importance
of breakfast in atherosclerosis disease: insights from the PESA study’, Journal of the
American College of Cardiology, 70(15), pp. 1833-1842, Elsevier [Online]. DOI:
10.1016/j.jacc.2017.08.027 (Accessed: 13 October 2019).