Scientific editor: Strokina OA, therapist, doctor of functional diagnostics. Practical experience since 2015.
September, 2018.
Atherosclerosis - a disease affecting arterial blood vessels (arteries) throughout the body. Atherosclerosis in the intima of arterial blood vessels are formed pockets of fat, mainly cholesterol, sediments, causing vascular lumen narrowing up to their complete blockage.
During prolonged, slow growing occlusion manifestations of atherosclerosis determines the degree of insufficiency of blood supply to body fed diseased artery. When breakage of atherosclerotic plaque can be quickly artery lumen occlusion by a thrombus and / or content decomposes fatty plaque, which leads to the formation of foci of necrosis of the organ or body part located in the basin of the affected artery. The most susceptible area of atherosclerotic lesions of the carotid artery, the heart arteries and the abdominal aorta.
Atherosclerosis - a basis of development of cardiovascular disease - the main cause of premature death in people around the world.
Causes
Risk factors that increase the likelihood of atherosclerosis:
- Smoking, regardless of the number of cigarettes;
- Age men over 40, women over 50 years of age or early menopause;
- Sugar diabetes type II;
- Arterial hypertension (Pressure equal to or greater than 140/90 mm Hg. v) or chronic administration of antihypertensive drugs.;
- abdominal obesity (Waist circumference in men ≥94 cm in women ≥88 or BMI ≥30 kg / m2);
- Familial hyperlipidemia (impaired fat balance in the blood);
- Early onset of coronary heart disease in the near relatives (heart attack or unstable angina in men younger than 55 years, women older than 65 years);
- Chronic kidney disease.
symptoms of atherosclerosis
Symptoms of disease vary depending on the preferential localization and prevalence atherosclerosis, and in most cases determined by the symptoms and consequences of circulatory disorders of tissue or organ.
Itself atherosclerotic lesions of arteries reduces their elasticity and increases vascular resistance to blood flow. Thus, this pathological process is the basis of hypertension.
The symptoms of thoracic aortic atherosclerosis and its branches:
- Pain in the sternum (lasting up to several hours or days, occasionally weakens and amplified);
- Difficulty in swallowing due to compression of the esophagus;
- Hoarseness of voice due to compression of the recurrent laryngeal nerve;
- Gradually increasing arterial hypertension;
- Linear calcification in the walls of the aortic arch in the X-ray (side view) - the most demonstrative, although a late diagnostic feature.
Symptoms of abdominal aortic atherosclerosis and its branches:
- Abdominal pain of various localization;
- Linear calcification at the bifurcation of the aorta in the chest radiograph;
- Intermittent claudication;
- Violation of sensitivity and movement in both legs;
- Blanching of the skin;
- Impotence;
- You may experience a limb gangrene.
When the affected heart, kidney, intestinal, sleepy (feed the brain) artery, is a violation of the relevant functions of vital organs:
- Atherosclerosis of the coronary arteries (the vessels supplying the heart) is a major cause of coronary heart disease, (angina, heart attack), arrhythmias.
- In atherosclerosis of the lower extremities are marked with their coldness, numbness, pain (including intermittent claudication - pain when walking, passing alone), seizures (often at night). In the event of pronounced disorders may develop venous ulcers feet, legs.
- When cerebral atherosclerosis appear dizziness, ringing in the ears or head, loss of memory, attention, up to dementia (usually in old age). The most severe complication of cerebral arteriosclerosis is ischemic stroke.
- Atherosclerosis abdominal aorta and vessels extending therefrom can lead to disruption of the function of internal organs. Clinic accompanied by pain of varying intensity depending on the degree of vascular injury. Agencies subjected ischaemia (in which blood circulation), which may lead to necrosis and tissue destruction. Affected can any body. Impotence is also a frequent symptom.
Diagnostics
Atherosclerosis - a systemic disease: as a rule, in varying degrees, affects many vessels.
First the doctor asks the patient about his complaints, how to develop symptoms, which were of the disease in man and his family. Particular attention is paid to inspection. Depending on the data obtained the physician selects appropriate diagnostic methods
- Vascular ultrasound of the neck and head. Since the carotid artery is located most closely to the skin surface, they are the most convenient in terms of inspection. In the study, the physician sees the presence or absence of changes in the vessels, their nature and extent of the lesion. This thickening may be an internal layer of the artery wall and atherosclerotic plaque in different stages of their development. and the presence of atherosclerotic lesions of other organs can be indirectly judged on the basis of these data. Simply put, if the carotid arteries by ultrasound revealed a large number of atherosclerotic plaques, it is likely that they are in the vessels of the heart and kidneys.
- Ultrasound of lower limb arteries. Through their study of the two most important indicator of atherosclerosis can be calculated body - ankle-brachial index (ratio of blood pressure on the hand and foot) and velocity pulse wave. It allows you to assess the presence and extent of vascular lesions.
For diagnosing the remaining vessels it is extremely difficult to judge, as their visualization very difficult.
Another widely available method of investigation to determine the risk of developing atherosclerosis is:
- blood chemistry:
- levels total blood cholesterol (OH),
- high lipoprotein cholesterol (HDL) And low density (LDL), triglycerides (TG) may indirectly indicate the presence of atherosclerosis.
The so-called "bad" cholesterol are LDL, TG; "Good" - HDL. Target lipid parameters are determined as a function of total cardiovascular risk, ie the patient is co-morbidities may have a higher level of LDL cholesterol and triglycerides without the risk of complications than patients with concomitant pathology. To determine the risk of complications and the need for drug treatment can only physician.
Less commonly used methods such as angiography (Eg, coronary angiography in coronary heart disease), radionuclide methods.
treatment of atherosclerosis
It is engaged in the treatment of atherosclerosis, primarily physician.
Depending on the level of lipids and total cardiovascular risk doctor may prescribe one or another method of dealing with atherosclerosis: lifestyle changes or medication.
Lifestyle modification -
It includes:
- to give up smoking;
- regular aerobic moderate exercise (walking, swimming, aerobics, tennis, etc.). It is known that they lower the triglyceride level and increase the high density lipoprotein ( "good" cholesterol). Loads should be 3-4 times a week for 30-40 minutes and be well tolerated;
-
diet to normalize cholesterol levels and weight loss:
- limiting fat intake to 35% of the total caloric value of food (in patients with concomitant diseases, such as coronary heart disease or familial hyperlipidemia percentage reduced to 10% and 7 respectively);
- simple carbohydrates (bread, sugar, etc.) should be replaced by the complex (beans, fruits, nuts, cereals);
- Also, do not forget about the general rules of diet: salt restriction to 5 g per day, eating fresh fruits and vegetables 5 servings per day, the use of fish rich in polyunsaturated fatty acids (halibut, mackerel, salmon) 2-3 times week;
- receiving limiting alcohol (possibly dry red wine consumption to 100 ml per day, but no more);
- must be avoided as far as possible the physical and mental overload.
Drug therapy of atherosclerosis -
It should be selected expert after inspection, considering and contraindications associated diseases.
The standard treatments are statins, as in addition to the reduction of atherogenic lipids, they have important property: stabilize the atherosclerotic plaque (they prevent its ulceration and thrombosis vessel).
The most commonly used:
- simvastatin (Zocor),
- atorvastatin (Lipitor),
- rosuvastatin (Crestor, Merten).
Among the latest developments is allocated a drug that inhibits cholesterol absorption in the gut - Ezetemib, Ezetrol.
Also useful fibrates, eg fenofibrate (Traykor) indication for their reception is increased LDL and TG.
Other drugs for the treatment of atherosclerosis:
- vitamins A, C, E; Omacor (Preparation of polyunsaturated fatty acids)
- nicotinic acid in high doses.
Furthermore, for the treatment of atherosclerosis and disorders of lipid metabolism are used bile acid sequestrants - cholestyramine, colestipol. They bind derivatives of cholesterol in the intestine and remove them from the feces. Today, however, none of the drugs are not registered in Russia.
Forecast
Prediction is difficult to measure in atherosclerosis. Working capacity depends upon preservation of organs and functional systems with arterial lesions as well as on the presence of concomitant diseases, which may make adjustments to the treatment. Elimination of the risk factors and increasing the cultural level of the population (as the US experience) can significantly reduce mortality rates.
sources:
- Russian Society of Cardiology. The National Society for the Study of Atherosclerosis. Russian society kardiosomaticheskoy rehabilitation and secondary prevention. Diagnosis and correction of disturbances of lipid metabolism in the prevention and treatment of atherosclerosis. - Russian clinical recommendations, the V revision, Moscow. year 2012.
- European Society of Cardiology. European Society of Atherosclerosis. Recommendations for the diagnosis and treatment of dyslipidemia. - Russian cardiological magazine №5 (145), 2017.
