ATHEROSCLEROSIS AND CORONARY HEART DISEASE

ATHEROSCLEROSIS AND CORONARY HEART DISEASE


Robbins and Angell (1976) define atherosclerosis as follows : “ Basically, the disorder comprises the development of focal atheromas, within the intima and inner portion of the media. As the disorder advances, the atheromas undergo a variety of complications calcification, internal hemorrhages, ulceratin, and sometimes superimposed thrombosis” [1]. Atherosclerosis (ath-er-o-skler-O-sis) is a disease in which plaque (plak) builds up on the insides of your arteries. [See images].

Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. The flow of oxygen-rich blood to your organs and other parts of your body is reduced. This can lead to serious problems, including heart attack, stroke, or even death. Some people with atherosclerosis have no signs or symptoms. They may not be diagnosed until after a heart attack or stroke.

Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, and pelvis. As a result, different diseases may develop based on which arteries are affected [2].

1. Coronary artery disease (CAD). This is when plaque builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart. When blood flow to your heart is reduced or blocked, it can lead to chest pain and heart attack. CAD also is called heart disease, and it's the leading cause of death in the United States.
2. Carotid (ka-ROT-id) artery disease. This happens when plaque builds up in the carotid arteries. These arteries supply oxygen-rich blood to your brain. When blood flow to your brain is reduced or blocked, it can lead to stroke.
3. Peripheral arterial disease (PAD). This occurs when plaque builds up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis. When blood flow to these parts of your body is reduced or blocked, it can lead to numbness, pain, and sometimes dangerous infections.

In about 99 % of cases, coronary artery disease is due to atherosclerotic changes. Atherosclerotic vascular disease, in particular, coronary heart disease (CHD), is a major cause of human morbidity and mortality in both industrialised and developing countries. These results support the proposal that early control of risk factors is likely to prevent or delay progression of atherosclerosis and prevent or delay the onset of CHD. [1,3]. The CHD risk factors are associated with lipids in arterial tissue just as they are associated with gross and microscopic lesions [4,5,6,7].

The Incidence of CHD

In the UK, for example, nearly 170,000 people die each year as a result of CHD (25% of all deaths). Similarly, in the USA, CHD causes around 700,000 (40% of) deaths each year. However, there are very wide variations in the incidence of CHD worldwide. For instance, data from the World Health Organization (WHO) MONItoring of trends and determinants in CArdiovascular disease (MONICA) study assessing CHD and risk factors in 38 populations from 21 countries show that age-standardised annual cardiovascular event (fatal and non-fatal) rates (during 1985–1987) in men ranged from 76/100,000 in Beijing, China to 915/100,000 in North Karelia, Finland, and in women, from 30/100,000 in Catalonia, Spain to 256/100,000 in Glasgow, UK. Also, while CHD mortality rates in many industrialised countries have fallen over the past 20–30 years (e.g. by 50–60% in Australia, Canada, Japan and the USA), there have been striking increases in the rates in eastern/central Europe (e.g. 25–35% rises in Romania and Poland) and in developing countries. [8]

Prevention

Medical priorities [9]; In the context of a comprehensive population strategy— to reduce tobacco use, encourage healthy food choices and increase physical activity for the whole population — the medical priority is to focus on those who have developed symptoms of coronary heart disease or other major atherosclerotic disease, and those who are at high risk of developing such diseases in the future.

The priorities for preventive cardiology are:

1. Patients with established coronary heart disease or other atherosclerotic disease.
2. Healthy individuals who are at high risk of developing coronary heart disease or other atherosclerotic disease, because of a combination of risk factors—including smoking, raised blood pressure, lipids (raised total cholesterol and low density lipoprotein (LDL)-cholesterol, low high density lipoprotein (HDL)-cholesterol and raised triglycerides) raised blood glucose, family history of premature coronary disease—or who have severe hypercholesterolaemia or other forms of dyslipidaemia, hypertension or diabetes.
3. Close relatives of patients with early onset coronary heart disease or other atherosclerotic disease, and of healthy individuals at particularly high risk.
4. Other individuals met in connection with ordinary clinical practice.

Secondary prevention [9]; Patients with coronary heart disease or other atherosclerotic disease :
Lifestyle; Lifestyle changes depend on the readiness of coronary and other high risk patients to modify their behaviour. When patients develop symptoms of coronary heart disease, or are found to be at high risk, this is an ideal opportunity to review lifestyle. Many will consider making appropriate changes and, with professional and family support, can do so for life.

Stop smoking tobacco; Patients should be professionally encouraged and supported to stop smoking all forms of tobacco for life.

Make healthy food choices; For a patient with atherosclerotic disease the dietetic goals are:

1. To reduce total fat intake to 30% or less of total energy intake, the intake of saturated fat to no more than one third of total fat intake, and the intake of cholesterol to less than 300 mg per day.
2. To achieve the reduction in saturated fats by replacing them in part with monounsaturated and polyunsaturated fats from both vegetable and marine sources, as well as with complex carbohydrates.
3. To increase the intake of fresh fruits, cereals and vegetables.
4. To reduce total calorie intake when weight reduction is needed.
5. To reduce salt and alcohol use when blood pressure is elevated.

Increase physical activity; All patients should be professionally encouraged and supported to increase their physical activity safely to a level associated with the lowest risk of vascular disease.

Treatment of Atherosclerosis and CHD

The main treatment for atherosclerosis and CHD is lifestyle changes. You also may need medicines and medical procedures. These, along with ongoing medical care, can help you live a healthier life. You must consult to your pharmacist and doctor for drugs (medicines) treatment. Your pharmacist and doctor can help decide which type of drug is best for you.

Andi Surya Amal
Email : suryaamal88@gmail.com

Reference :

1. Sokolow M, Mcllroy (1979), Clinical Cardiology, Lange Medical Publications-California,124125
2. Healthscout’s site; Description of Atherosclerosis
3. Malcoma T.G., McMahanb C.A., et al, (2009) Associations of Arterial Tissue Lipids with Coronary Heart Disease Risk Factors in Young People, Atherosclerosis Journal, Vol. 203-2; 515-521.
4. Gupta S and Camm A.J.(1999), Developments in Cardiovascular Medicine; Chronic Infection, Chlamydia And Coronary Heart Disease, Springer Netherlands Publisher. Vol. 218, 1
5. Wood D, Backer G.D. et.al. (1998), Prevention of coronary heart disease in clinical practice, Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention, European Heart Journal 19, 1434–1503
6. Mangion D.M and Roy S.S,(1993), Serum lipids and coronary heart disease in British elderly, Postgrad Med J 69, 609 – 614
7. Wierzbicki A.S, Mikhailidis D.P, (2002), The Relationship Between HDL-C, Atherosclerosis and Coronary Heart Disease, Librapharm Limited, Curr Med Res Opin;18(1)
8. Ingelsson E, Schaefer E. J.(2007) Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and Women, JAMA;298:776-785
9. Moshides, J. (1987), High Density Lipoprotein Free Cholesterol and Other Lipids in Coronary Heart Disease, Journal of The American Heart Association; Arterioscler Thromb Vasc Biol ;7;262-266