ATHEROSCLEROSIS
What Is Atherosclerosis?
Atherosclerosis is a disease of the arteries, the blood vessels that carry blood from the heart to the rest of the body. It is characterized by an accumulation of fatty deposits, or plaques, along the vessel walls. These plaques can harden, rendering the vessel walls brittle, and narrow
the vessel diameter, thus limiting blood flow. The plaque surface can stimulate blood clots to form; these clots either block blood flow at the site of the plaque, or flow through the body and become lodged in a smaller vessel. Large plaques are unstable and are prone to rupture; if this occurs, pieces of the fatty deposit are released into the blood and similarly may occlude vessels down stream. The consequences of atherosclerosis are many and severe, depending on which arteries are affected, and whether or not clots or rupture occur. Most significantly, atherosclerosis is the leading cause of heart attack and stroke. When the coronary arteries (the heart’s arteries) are involved, the condition is known as coronary artery disease.
What Causes Atherosclerosis? The major risk
factors for atherosclerosis are (1) high blood pressure (2) high cholesterol (3) cigarette smoking (4) diabetes mellitus and (5) family history of heart
disease or stroke. Also significant are
male sex, obesity, and sedentary lifestyle.
The debate about alcohol intake continues to rage; there is some evidence that
moderate alcohol intake (1 drink/day) may in fact be protective; more
conclusively, it has been shown that heavy drinking can contribute to arterial
disease.
What Are The Signs And Symptoms Of Atherosclerosis? Atherosclerosis is a silent killer. Typically,
a person with atherosclerosis will have no symptoms at all until the blood
vessels are critically narrowed, or until a clot forms or rupture occurs. In fact, 70% occlusion of an artery is
generally required before blood flow is significantly limited; the effects are
then felt as tissues are deprived of blood.
Common early signs of severe arterial narrowing include angina (chest
pain), and pain
in the calves on exertion, both relieved by rest. As the arteries become further narrowed,
heart attack, stroke, or even sudden death may result.
Treatment: Prevention is by far the most effective
means of reducing atherosclerotic build up and its deadly consequences. Lifestyle
adjustments to modify preventable risk
factors are preferred over pharmaceutical measures. Quitting smoking dramatically reduces heart attack and stroke risk. Cholesterol and fats in the blood are best
lowered by eating a diet low in
saturated fat and high in fibre, exercising regularly, and maintaining a healthy weight. Similarly, exercise
and weight loss can help to lower blood pressure. Cholesterol and blood pressure-lowering drugs may be considered when lifestyle alone is not enough. The jury is still out on the efficacy of
anti-oxidants, red wine, vitamin E, and other “naturalistic” therapies. Aspirin
(ASA) taken in small doses daily has been proven unequivocally to reduce the
risk of heart attack and stroke; however, it acts not by reducing
atherosclerosis, but by inhibiting the formation of blood clots.
What Is the Significance Of Atherosclerosis In Women? The popular media are
beginning to recognize that atherosclerosis is not just a disease of concern to
men.
Atherosclerotic heart disease and stroke remain the number one cause of
death in the developed world, in both men and women. Generally women are affected 10 years later
in life than are men; after menopause,
women’s risk increases dramatically. Hormone replacement therapy has a
proven role in risk reduction; however, it is dangerous in women at risk for
breast cancer, and is not for everyone. Conversely, there is some evidence
linking oral contraceptive use to
the development of atherosclerosis.
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