Arteriosclerosis - Causes, Symptoms and Treatment .MF .
Atherosclerosis - is a common, progressive disease that affects large and medium arteries due to accumulation of cholesterol in them, leading to poor circulation.
In economically developed countries, atherosclerosis is the most frequent cause of morbidity and overall mortality.
The emergence and formation of atherosclerosis play a role:
- lipid (fat) metabolism;
- hereditary genetic factor;
- the state of the vascular wall.
Cholesterol is a lipid (fats) and performs many important functions in the human body.It is the building material for the walls of the cells of the body, a part of hormones, vitamins, which are essential for normal human existence.Up to 70% of body cholesterol is synthesized in the liver and the rest comes from food.The organism is not cholesterol-free state, and a part of lipoprotein (fat and protein complex compounds) that carry it through the bloodstream from the liver tissue, while excess cholesterol - from tissues back to the liver where it is disp
main role in the development of atherosclerosis belongs to low-density lipoproteins (LDL), which carry out transport of cholesterol from the liver to the cells, it must be strictly necessary amount for exceeding its level determined by the risk of atherosclerosis.
Reverse cholesterol transport from tissues to the liver provides a high-density lipoproteins (HDL) - a class antiatherogenic lipoproteins.It cleans the surface of excess cholesterol from cells.Increased LDL cholesterol and decrease HDL cholesterol levels and increases the risk of atherosclerosis.
initial changes in the arterial wall of large and medium caliber occur at a young age and evolve to fibroadenomatoznyh plaques, which often develops after age 40.Atherosclerotic vascular already occurs in persons under 20 years in 17% of cases, up to 39 years in 60% of cases, and in 50 years or older in 85% of cases.In
middle penetrate the arterial wall cholesterol, fibrin and other substances, which subsequently form the atherosclerotic plaque.Under the influence of excess cholesterol plaque increases, and there are obstacles to normal blood flow through the vessels at the site of constriction.Decreased blood flow, inflammation develops, and may form thrombi break away, the danger of clogging of vital vessels cease delivery bodies in blood.
in the development and progression of atherosclerosis factors play a role:
- modifiable (which can be removed or corrected)
- not modifiable (can not be modified).
To modifiable factors include:
- physical inactivity,
- abuse of fat, high cholesterol food,
- personality traits and behaviors - stress type of character,
- alcohol abuse,
2. Arterial hypertension, blood pressure 140 / 90mm.rt.st.and higher.
3. Diabetes mellitus, in fasting blood glucose level over 6mmol / l.
4. Hypercholesterolemia (increased cholesterol in the blood).
5. Abdominal obesity (waist circumference in men and more bolee102sm 88cm in women).
It is not modifiable factors include:
1. Age: men over 45 even and women older than 55 years or with early menopause.
2. Male gender (men before women 10 years develop atherosclerosis).
3. Have family history of early atherosclerosis.Familial hypercholesterolemia, have a genetic basis.Myocardial infarction, stroke, sudden death in the immediate family under the age of 55 years old men and women 65 years of age.
adverse impact of risk factors lead to the violation of the integrity of the endothelium (the inner layer of blood vessels), which loses its barrier function against the background of lipid metabolism lead to the development of atherosclerosis.
symptoms of atherosclerosis.
deposition of cholesterol in the arterial wall is accompanied by compensatory her bulging outward because of this for a long time there are no obvious symptoms of atherosclerosis.But over time, the transformation of an atherosclerotic plaque from stable to unstable under the influence of systemic factors: physical exertion, emotional stress, hypertension, heart rhythm disturbances.They give rise to cracks or plaque rupture.On the surface of unstable atherosclerotic plaques are formed clots - atherothrombosis is formed, leading to a progressive narrowing of the blood vessels.There is poor circulation in the organs and tissues, there are clinical symptoms noticeable to the patient.
Depending on the location in the vascular system, atherosclerosis is the basis of such diseases:
1. Coronary heart disease (angina, myocardial infarction, sudden cardiac death, arrhythmia, heart failure).
2. Cerebrovascular disease (transient ischemic attack, ischemic stroke).
3. Atherosclerosis of the arteries of the lower extremities (intermittent claudication, gangrene of the feet and legs).
4. Atherosclerosis of the aorta.
5. Atherosclerosis of the renal arteries.
6. Atherosclerosis mesenteric arteries (intestinal infarction).
atherosclerotic process leading to the defeat of several vascular beds.At a stroke the likelihood of myocardial infarction in these patients is 3 times higher, and peripheral arterial disease increases the risk of myocardial infarction 4 times, stroke - in 3 times.
coronary atherosclerosis has many symptoms, depending on the severity of atherosclerosis, manifested angina or acute coronary insufficiency, marked by the development of myocardial infarction, heart failure.All forms of ischemic heart disease, atherosclerosis occur on the background.On the cardiac manifestations of atherosclerosis account for about half of the atherosclerotic lesions.
Atherosclerosis of the aorta often occurs after 60 years.Atherosclerosis of the thoracic aorta appear intense burning pain in the chest radiating to the neck, back, upper abdomen.With physical exertion and stress on the background of the pain increases.Unlike angina pain continues for days, occasionally strengthening and weakening.There may be a violation of swallowing, hoarseness, dizziness, fainting.For atherosclerosis of the abdominal aorta is characterized by abdominal pain, bloating, constipation.In atherosclerotic lesions of the bifurcation of the aorta (aortic separation place on the branch) develops Leriche syndrome with symptoms such as intermittent claudication, cold lower limbs, impotence, ulcers toes.Threatening complication of atherosclerosis, aortic aneurysm is (bundle) and aortic rupture.
Atherosclerosis mesenteric vessels appears sharp, burning, cutting pains in the stomach during the meal, which lasts 2-3 hours, abdominal distention, a violation of the chair.
for renal artery atherosclerosis is characterized by a persistent increase in blood pressure, changes in urine analysis.
peripheral artery disease is manifested by weakness and fatigue of the leg muscles, the feeling of coldness in the extremities, intermittent claudication (pain in the limbs occurs during walking, forcing the patient to stop).
survey in atherosclerosis.
primary diagnosis of atherosclerosis holds therapist, family physician during the annual medical check inspection.Measures blood pressure, body mass index defines, identifies risk factors (hypertension, diabetes, obesity).
1. Determination of lipid levels, after 30 years:
- total cholesterol (rate of less than 5.0 mmol / L);
- LDL cholesterol (the rate below 3.0 mmol / L);
- HDL cholesterol (the rate above 1.0 mmol / l (men) and higher than 1.2 mmol / l (women);
- triglycerides in blood plasma (the rate below 1.2 mmol / L);
- total ratiocholesterol / HDL cholesterol (atherogenic index - factor in the development of cardiovascular complications) Low risk of 2.0 to 2.9, the average risk -. 3,0do of 4.9, a high risk - more than 5.
2. Determination of risk at. patients without clinical atherosclerosis manifestations determine the individual risk for patients allows sCORE scale (systematic assessment of coronary risk), which can be used to estimate the probability of fatal cardio - vascular events (myocardial infarction, stroke) within 10 years Low risk - & lt;. 4%, moderate risk - 4-5%, high risk - 5-8%, and very high risk - & gt; 8%
if you suspect that atherosclerotic changes is a consultation of experts:.
- cardiology (coronary heart disease);
- ophthalmologist (eye fundus vascular atherosclerosis);
- neurologist (cerebral arteriosclerosis);
- nephrologist (atherosclerosis of the renal arteries);
- vascular surgeon (atherosclerosis of the lower extremities vessels, the aorta).
To clarify the extent of atherosclerotic lesions may be assigned additional instrumental methods of research:
1. Electrocardiography, with load tests, ultrasound of the heart, the aorta.
2. angiography, coronary angiography, intravascular ultrasound.This invasive methods.Identify atherosclerotic plaques, allow us to estimate the total atherosclerotic lesions.Used in patients with clinical manifestations of atherosclerosis (coronary artery disease).
3. Duplex and triplex scanning.The study of blood vessels with ultrasound imaging: carotid arteries, abdominal aorta and its branches, arteries of lower and upper limbs.Detection of atherosclerotic plaques in the arteries, evaluates the status of blood flow in the vessels.
4. Magnetic resonance imaging.Visualization artery wall and atherosclerotic plaques.
Treatment of Atherosclerosis.
1. No clinical manifestations of atherosclerosis risk patient with moderate (up to 5% by SCORE scale) and total cholesterol levels greater than 5 mmol / l recommended lifestyle modification.It includes: smoking, alcohol use, antiatherosclerotic diet, increased physical activity.Upon reaching the desired cholesterol levels (total cholesterol up to 5 mmol / L LDL cholesterol less than 3 mmol / l) re-examination should be carried out at least 1 time in 5 years.
Start treating a patient with a high risk (greater than 5% on the SCORE scale) and total cholesterol levels above 5 mmol / l should also start with recommendations on lifestyle changes for 3 months, and a re-examination at the end of this period.Upon reaching the patient's target total cholesterol levels up to 5 mmol / L and LDL cholesterol less than 3 mmol / l in the future carry out an annual monitoring lipid levels.If the risk is high (above 5% by SCORE scale), prescribed medication.
2. Patients with signs of atherosclerotic lesions at any site recommended lifestyle modification and drug therapy.
Recommendations for dieting are given to all patients with the level of cholesterol and other risk factors: obesity, hypertension and diabetes.The diet should be varied in accordance with the patient's cultural traditions.Calorie daily diet should be sufficient to achieve and maintain a healthy weight.
total fat intake should not exceed 30% of the caloric content of the diet.
is recommended to limit consumption of animal fats (butter, cream, meat, bacon), replacing them with vegetable fats.Daily consumption of fresh fruits and vegetables should be at least 400g per day.
recommended intake of lean meat and skinless poultry, dairy products, low-fat cottage cheese, bread, cereal, bran, products enriched with ω3-unsaturated fatty acids (marine and ocean fish - salmon, mackerel, tuna, etc.).Limit salt intake to 6g per day, which corresponds to 1 teaspoon.Dieting can reduce cholesterol levels up to 10%.
normalization of body weight.
Overweight and obesity, particularly abdominal (waist circumference in men and more bolee102sm 88cm in women), increases the risk of cardiovascular disease.For weight loss diet selected individually, taking into account age and comorbidities.
Physical activity in atherosclerosis.
Increased physical activity has a positive effect on patients with atherosclerosis.
patients without clinical manifestations of atherosclerosis shows exercise for 40 minutes daily.The intensity of the load must be 60% of the maximum heart rate (calculated = 220 - age).
Patients of cardio - vascular diseases requires constant dynamic mode of physical activity, taking into account the results of stress tests.Useful walking, swimming, dancing - moderate intensity 60-90minut a week.Unacceptable isometric (power) load.
recommended to use any opportunity for physical activities: walking, rarely use the car.
Smoking (active and passive), resulting in a sharp decrease in HDL (anti-atherogenic lipoprotein class), the pathological effects on the cardiovascular system, disorders of the rheological properties of blood - increases by 20% the risk of morbidity and mortality from cardiovascular complications.Smokers risk of ischemic stroke is 2 times higher than non-smokers.
safe for health of alcohol consumption - no more than 20-30 ml of pure ethanol per day for men and no more than 20 ml per day - for women only for healthy people, reduces mortality from cardiovascular complications.Alcohol consumption (12-24g per day of pure ethanol) reduces the risk of cardiovascular events (heart attack and stroke) by 20%, and the use of alcohol 5 servings (60g per day) increases the risk of cardiovascular complications by 65%.
use of drugs such as cocaine, amphetamine, heroin, cause sudden changes in blood pressure, inflammatory changes in the vascular system, leading to disruption of the blood rheology.Increases the risk of stroke 6.5 times in people 35 years and older than 35 years - 11.2 times.
Drug treatment of atherosclerosis.
Drug therapy in atherosclerosis involves the use of four groups of lipid-lowering (lipid lowering) drugs: bile acid sequestrants, nicotinic acid, fibrates, statins.These funds have a stabilizing effect on the atherosclerotic plaque, improve endothelial function (the inner lining of blood vessels), inhibit the development of atherosclerosis, greatly reducing the severity of the impact of various lipid metabolism.
Only the doctor will recommend the necessary medication and its dosage.The most commonly used statins.Statin therapy contributes to a significant reduction in mortality and prevent cardio - vascular complications.The required dose of statins are selected individually for each patient.The drug is taken once a day - in the evening before bedtime.
Accessories are important products based on fish oil, essential phospholipids.They are used only in combination with a statin.
Surgical treatment of atherosclerosis.
With the threat of atherosclerosis complications of operative treatment, which restores patency of the arteries (revascularization).In coronary heart disease for the prevention of heart attack is carried out stenting or coronary artery bypass surgery.When cerebral atherosclerosis, for the prevention of stroke is performed carotid stenting.To prevent the development of lower limb gangrene carried prosthetics main arteries.The need for and extent of surgery the surgeon sets (heart surgeon, vascular surgeon).
Surgical treatment of atherosclerosis
Surgical treatment of atherosclerosis does not provide a complete cure.It eliminates the complication, not a cause, it caused (atherosclerosis).