3. DEFINITION
• Atherosclerosis (also known as
Arteriosclerosis) or hardening of
the arteries, is an inflammatory
disease that results in scarring of
the artery walls, primarily from
long term buildup of fatty deposits
and calcifications.
4.
5. Learning Objective
Risk factor of atherosclerosis ? How are
they regulate ?
How do they risk factor contribute to the
pathogenesis of atherosclerosis?
(Summarize)
Clinic manifestations of atherosclerosis .
24. Clinical manifestations
• The clinical signs and symptoms resulting
from atherosclerosis depend on the organ or
tissue affected. The consequences of
atherosclerosis are:
Myocardial infarction
Ischemic heart disease(IHD)
Cardiovascular accident ( Transient ischemic
attack or stroke).
Subarachnoid hemorrhage may result.
Peripheral arterial diseases.
Aneurysms.
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29. Pain and severe cramp in the right calf on
exercise
Absent pulses of the right arterioles
of the right foot and ankle.
Bruits over arteries
Dry skin
30. Low skin temperature of the right
foot.
Atrophy
lack of hair on right lower leg and
foot
32. Medical management:
Anti-cholesterol medications: Example: Statins. (Atorvastatin, fluvastatin,
Lovastatin).
Tab Atorvastatin10mg PO OD
Anti-platelet medications:Tab. Aspirin 75mg PO OD.,
Tab. Clopidogrel 75mg PO OD.
Thrombolytic therapy: Inj. Streptokinase .
Beta blockers: E.g. Metaprolol, Atenolol, propanolol.
Tab. Metaprolol 12.5 mg PO OD.
Angiotensin-converting enzyme (ACE) inhibitors: E.g. enalapril.
Tab. Enalapril 2.5mg or 5mg. depending on the blood pressure.
Calcium channel blockers: E.g. Tab. Amlodipine 2.5mg, 5mg or 10 mg dose can
be adjusted according to the blood pressure.
Diuretics: E.g. Tab. Frusemide 20mg
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33. Steps for Prevention
• Adopt a low-fat, low salt, high fibre diet. Take
extra pains to avoid foods high in saturated fat
and cholesterol.
• If you Smoke, QUIT!
• Know your blood pressure. If it’s high, get it
down.
• Get moderate exercise – a 30 minute walk,
swim, or bicycle ride – daily if possible.
• Find a relaxation program that you enjoy.
• Get checked by a cardiologist if a family history is
existing.
Permanent factors
Increasing age.
Male gender.
Family history of early coronary heart disease.
Co-existing conditions
Hypertension.
Diabetes mellitus .
Hyperlipidaemia.
Lifestyle, social and environmental factors
Cigarette smoking.
Lack of regular physical exercise.
Diet:
Lack of fruit and vegetables.
High-fat –
High alcohol intake
Psychosocial factors
Age: Atherosclerosis is primarily a disorder of middle and later life. The arteries become less elastic and more susceptible to arteriosclerosis with age.
. In men, the risk increases after age 45. In women, the risk increases after age 55.
CAD rates increase with age. Atherosclerosis is rare in childhood,
except in familial hyperlipidaemia, but is often detectable
in young men between 20 and 30 years of age. It is
almost universal in the elderly in the West. Atheromatous
lesions in the elderly are often complicated by calcification.
Men are more affected than women. After the menopause the rates in men and women are equal.
Gender
Men have a higher incidence of coronary artery disease than
premenopausal women. However, after the menopause, the
incidence of atheroma in women approaches that in men.
The reasons for this gender difference are not clearly understood,
but probably relate to the loss of the protective effect
of oestrogen.
CAD is often found in several members of the same family.
Because the disease is so prevalent and because other risk
factors are familial, it is uncertain whether family history, per
se, is an independent risk factor. A positive family history is
generally accepted to refer to those in whom a first-degree
relative has developed ischaemic heart disease before the
age of 50 years.
Family history of early heart disease. Your risk for atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
Diabetes mellitus
Diabetes, an abnormal glucose tolerance or raised fasting
glucose, is strongly associated with vascular disease.
Diabetes substantially increases the risk of CAD. Men with
type 2 diabetes have a two- to four-fold greater annual risk
of CAD, with an even higher (3–5-fold) risk in women with
type 2 diabetes.
Diabetes not only increases the risk of CAD but also magnifies
the effect of other risk factors for CAD such as raised
cholesterol levels, raised blood pressure, smoking and
obesity.
Hypertension
Both systolic and diastolic hypertension are associated with
an increased risk of CAD. Both drug treatment and lifestyle
changes – particularly weight loss, an increase in physical
activity and a reduction in salt and alcohol intake – can
effectively lower blood pressure.
It is estimated that 14% of deaths from CAD in men and
12% of deaths from CAD in women are due to a raised blood
pressure (defined as a systolic blood pressure of ≥140 mmHg,
or a diastolic blood pressure of ≥90 mmHg) and that 6% of
deaths from CAD in the UK could be avoided if the numbers
of people who have high blood pressure were to be reduced
by 50%.
Cigarette smoking: Smoking doubles the risk of heart disease and accelerates arterial disease in the legs.
Tobacco use decreases the level of high-density lipoprotein (HDL) cholesterol—the “good” cholesterol—and increases the level of low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol. Smoking increases the level of carbon monoxide in the blood, which may increase the risk of injury to the lining of the artery‘s wall.
Overweight or obesity. The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height.
Smoking
In men, the risk of developing CAD is directly related to the
number of cigarettes smoked (see p. 807). It is estimated that
about 20% of deaths from CAD in men and 17% of deaths
from CAD in women are due to smoking. Evidence suggests
that each person stopping smoking will reduce his/her own
risk by 25%. The risk from smoking declines to almost
normal after 10 years of abstention.
Diet and obesity
Diets high in fats are associated with ischaemic heart
disease, as are those with low intakes of antioxidants (i.e.
fruit and vegetables). Supplementation with antioxidants has
been shown to be unhelpful in RCTs (
It is estimated that up to 30% of deaths from CAD are due
to unhealthy diets (see p. 200). The dietary changes which
would help to reduce rates of CAD include a reduction in fat,
particularly saturated fat intake, a reduction in salt intake and
an increase in carbohydrate intake. The consumption of fruit
and vegetables should be increased by 50%, to about 400 g/
day, which is equivalent to at least five daily portions (see
Box 5.2).
There is overwhelming evidence from clinical trials that
modification of the diet has a significant impact on the risk
of CVD in both the primary and secondary prevention
settings.
Weight. Patients who are overweight and those who are
obese have an increased risk of CAD. It is estimated that
about 5% of deaths from CAD in men and that 6% of such
deaths in women are due to obesity (a body mass index (BMI)
of >30 kg/m2).
The adverse effect of excess weight is more pronounced
when the fat is concentrated mainly in the abdomen. This is
known as central obesity (visceral fat) and can be identified
by a high waist/hip ratio.
Lack of physical activity. A lack of physical activity can worsen other risk factors for atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight and obesity.
Sedentary lifestyle
Lack of exercise is an independent risk factor for CAD equal
to hypertension, hyperlipidaemia and smoking. Regular exercise
probably protects against its development
