Atherosclerosis

Atherosclerosis is hardening of the medium and large arteries with plaques. The ‘plaque’ refers to deposits of fats, cellular debris (garbage) and irregular growth of normal cells of the artery. The artery then becomes narrower, and less flexible, allowing less blood to flow. Some tissues may not receive ample blood supply needed, becoming ischemic: lacking blood and oxygen. Sometimes the area of plaque will break off, and form blood clots. This sets the stage for such situations like heart attacks and strokes.

Atherosclerosis is the basis for many different types of heart disease and is known under different names: the general term cardiovascular disease (CVD), when it involves blood vessels to the heart it is called coronary artery disease (CAD), when there is a decrease in blood and oxygen it is called ischemic heart disease- (IHD), when it involves blood flow to the abdomen, arms and legs it is peripheral artery disease – (PAD) or intermittent claudication-specially involving blood flow to the legs and producing pain during exercise, stroke and transient ischemic attacks (TIA), heart attacks or myocardial infarction (MI), high blood pressure and angina.

Scientists believe that atherosclerosis happens during the course of life; for instance, children may have areas of atherosclerosis at various parts of the body not associated with disease, and not commonly found in adults. But it is the progression of the disease during adult years that can be treated and prevented with a healthy lifestyle and diet.

There are a number of risk factors for heart disease, and many can be changed to reduce your risk of disease.

High cholesterol

There are several different fractions of compounds called cholesterol and blood lipoprotein, one of which is low density lipoprotein (LDL). LDL is the transporting device that brings cholesterol from the cells that make it, for example the liver, to the calls that use it, the cells of the blood vessels, also called endothelial cells that make up the lining of the blood vessels. One theory of heart disease hold that cholesterol deposits contribute to plaques by adding layers of LDL in the artery wall, starting tissue injury and attracting more cells to the area. The fat included in the LDL molecule can then oxidize, making an unstable situation with free radical damage and creating more injury to the artery and cementing the plaques in the vessel wall.

High homocysteine

Homocysteine is derived from the amino acid methonine metabolism from protein. It is usually involved with the production of other compounds called methyl donors that are very important to our health. When nutritional status of the B vitamins are low, normal methonine– homocysteine metabolism is interrupted, and homocysteine levels build up. The homocysteine compound then can cause oxidative damage to the LDL, especially if the LDL has been deposited in the blood vessel lining, causing more damage and leading to plaques.

Smoking

Cigarette smoke contains hundreds of chemicals. Not only are some of these chemicals carcinogenic, some are carried on the LDL molecule and deposited in the vessel itself. Smokers have a more severe amount of atherosclerosis in the blood vessels that feed the heart muscle, and therefore have a higher incidence of heart attacks.

Stress

The Type A personality: competitive, aggressive, impatient and over hostile has been linked with heart disease and heart attacks for many years now. Also people who have anxiety and stress associated with a great deal of worry also have problems with heart disease.

Exercise

A sedentary lifestyle is an independent risk factor for heart disease and the formation of plaques; it contributes to obesity which increases the risk even more.

Obesity

Being significantly overweight increases the risk for several diseases including heart disease and diabetes. Central obesity, which is fat accumulation in the waist area, is also associated with increased insulin levels, diabetes, and infertility in women.

Lowered nutritional status

Vitamins and antioxidants can not only help prevent some of the plaque formation that happens with atherosclerosis but can prevent against cancer and other chronic degenerative disease.

Diabetes 2

Diabetes is not only a condition of insulin and blood sugar, but can cause significant problems with the tissues of blood vessels. Diabetic have a greater risk for earlier and more severe level of atherosclerotic vessels changes.

High blood pressure

Otherwise known as hypertension, high blood pressure is considered by some to be the greatest risk factor for a stroke. High blood pressure is common in atherosclerosis due to the narrowing of the blood vessels, which increases the resistance the blood flow must face.

Age

As we age there is an increased of having atherosclerosis and a heart attack, but that may be more associated with the accumulation of risk factors.

Male gender

Epidemiological studies have found that more men suffer from heart disease than women, but after menopause the risk generally evens out to become equal.

Family history

Having close relatives who had heart disease or a stroke at a relatively young age has shown to be a risk factor for atherosclerotic heart disease but it is not clear whether it is genetic or from similar learned lifestyle patterns.

Many times there are no symptoms, as sometimes blood vessel blockage is usually around 90% before symptoms start to appear. Often, the first sign is a heart attack or abnormal results on blood tests.

Some people may experience chest pain known as Angina pectoralis in association with atherosclerosis. This type of pain may be a vague, heavy sensation resembling an ache or it may be a severe, intense stabbing or crushing sensation. Angina pain can travel in the shoulder, towards the arm and fingers, or even be felt in the abdomen. But not all cases of Angina are from atherosclerosis, although other causes are less common.

In many individuals with atherosclerotic heart disease there is a particular earlobe crease. It is a diagonal crease appearing at a 45° downward angle toward the shoulder. It is thought to happen from the lack of blood flow to the skin of the ear and loss of elastin, a material that keeps the ear flexible. It does not apply to Asian, Native Americans or people with the rare condition known as Beckwith’s syndrome.

Diagnosis and Pharmaceutical Interventions

Diagnosis of atherosclerosis can be made via invasive procedures such as angiography or angiogram, which can detect the narrowing of vessels but not the extent of the underlying disease as sometimes plaques are present in areas where there is still adequate blood flow. Occasionally non-invasive procedure such as Doppler ultrasonography will be performed.

If the blood vessels to the heart are suspected to be involved a stress test maybe required. This test is performed with exercise, and assesses blood flow specifically to the heart muscle itself.

Most diagnosis is made based on an assessment of a person’s risk factors and may include family history. Included in the assessment may be laboratory blood tests of fasting cholesterol, LDL, HDL and triglyceride levels, homocysteine and C-reactive protein.

The standard definition of high cholesterol is having an excess of cholesterol in the blood, usually more than 200 mg/dl (5mmol/L), although many doctors are now citing 180 mg/dl as the maximum. The levels of LDL by itself is important, as well as the ‘good’ cholesterol HDL. When both these are taken they ratio is evaluated. For the LDL/HDL ratio, the lower the number is the better, most doctors recommend a value of 3 or less.

Levels of plasma homocysteine should be 6.1- 17.0 micrograms per litre. Abnormal concentrations are classified as moderate (16-30), intermediate (31-100), and severe (greater than 100 µmol/L). Levels above 9 or 10 µmol/l warrant treatment.

Often during cardiovascular disease situations there will be inflammation as a result, so the global inflammatory marker C-reactive protein (CRP) will be elevated. It is also used a predictive test for the first cardiovascular events among men, women, the elderly, those with metabolic syndrome or diabetes, and smokers. Normal values of C-reactive protein is 1-3 grams per liter, if is higher than 10 grams per liter than a serious inflammatory process is happening and should be found. In some incidences if the CRP is that high somebody may be having a heart attack.

Pharmaceutical interventions

Since atherosclosis and heart disease can manifest in several different ways (angina, high cholesterol, high blood pressure, etc) the range of medications used is quite large. Please refer to the section listing for more medication information.

Antiplatelet drugs are geared toward keeping the blood viscosity low so that blood can flow smoothly through the vessels, reducing deposits in plaques, and keeping blood pressure normal, even when plaques are already present. Aspirin is the most common antiplatelet medication, which creates a blood thinning effect and increased bleeding times. People with a history of ulcers should not take aspirin due to the risk of internal bleeding. Aspirin has been shown to be damaging to the kidneys when habitually used.

Surgical interventions are considered to be effective at reducing the size of plaques. Angioplasty is a technique where the occluded vessel is enlarged by a balloon tipped tube at the site of a plaque. Vessels can be dilated, or some times stent is left in place. Angioplasty is done for vessels of the heart, neck (for the blood to the brain) and abdomen.

Coronary artery bypass surgery (CABS) is the most common major cardiovascular operation performed. This is a very invasive surgical procedure where the vessels of the heart get rearranged and the plaques occluded vessels gets bypassed. This procedure carries some risk, as the disease may progress despite the surgery and there is also risk of brain deterioration and stroke.

Lifestyle and Dietary Modifications

As with most conditions diet is the first and best place to start treatments. Dietary changes have been studied extensively, especially a low- fat, high fibre diet. These diets are low in saturated fat and low in trans-fatty acids (partially hydrogenated fats found in margarine and many processed foods containing vegetable oils), and higher in omega 3 fatty acids like those found in fish. It is also low in simple sugars/carbohydrate but high in complex carbohydrates and emphasizes lots of fruits and vegetables.

Fruits and vegetable contain higher amounts of antioxidants and bioflavonoids, compounds important for health and the scavenging of free radicals that contribute to the oxidation in the plaque formation.

Regular physical excise is important to reduce the risk of heart disease and stroke. By increasing blood flow and oxygen to the heart and tissues, it reduces blood pressure, reduces the chance of obesity and helps with a stressful lifestyle.

Quitting smoking is one thing you can do for your health that will help not only reduce your risk of heart disease but improve overall health. Smokers have lower levels of HDL, the ‘good’ cholesterol. Smoking is the number one risk factor associated with several chronic diseases, in including several forms of cancer, osteoporosis, and chronic obstructive pulmonary diseases.

Nutritional Factors Shown to be Beneficial

Tocotrienols/Vitamin E

Vitamin E is a general term for a chemical class known as the tocopherols and tocotrienols. These compounds are antioxidant and can help reduce the oxidation process that occurs with atherosclerotic plaques. They seem to better in a combination of mixed tocopherols instead of alpha tocopherol, which most vitamin supplements consist of alone.
Dose is 400 to 800 IU a day.

Fish Oil

Fish oils consist of omega 3 fatty acids that decrease the risk of heart disease and atherosclerosis by improving blood flow, reducing platelet aggregation and reducing triglycerides.
Dose: range from 3-5 grams a day.

CoQ10

Coenzyme Q10 is an antioxidant nutrient involved in the production of energy, and is especially good for nutrition of the heart muscle itself. It reduces oxidation of the plaques and may help normalize heart function brought on by other conditions, i.e. abnormal heart beats and cardiomyopathies.
Dose: 30-100 mg a day

Terminalia arjuna

Terminalia arjuna is an Ayurvedic herb used for over 3 centuries as a cardiac tonic. It has been shown to benefit angina, congestive heart failure and has a positive effect on high cholesterol.
Dose: 1-4 grams a day

Garlic (allium sativa)

Garlic is not only a food but good medicine! Garlic has a direct anti-atherosclerotic effect and can reduce platelet aggregation. Doses of allicin containing garlic preparations should be are typically 900 mg per day (providing 5,000 to 6,000 mcg of allicin), divided into two or three administrations.

B Vitamins Homocysteine reducing agents

Higher blood levels of vitamin B6, vitamin B12, folic acid and betaine (trimethylglycine) are associated with low levels of homocysteine and supplementing with these vitamins lowers homocysteine levels. These nutrients are best taken together to reduce homocysteine, as even though they act differently they all interact with homocysteine or one of its metabolites. Deficiencies any of these vitamins can high levels of homocysteine.
Dose: Folic acid 2.5 mg / day

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