Atherosclerosis Disease

BASICS

DESCRIPTION

The common form of arteriosclerosis in which deposits of yellowish plaques (atheromas) containing cholesterol, lipoid material, and lipophages are formed within the intima and inner media of large and medium sized arteries.

System(s) affected: Cardiovascular
Genetics: Probable genetic link; many risk factors for atherosclerosis (lipid metabolism, hypertension, and diabetes) are clearly inheritable
Incidence/Prevalence in USA:
- Common, but declining steadily. The effects upon the brain, heart, kidneys, extremities and other vital organs form the leading cause of morbidity and mortality in the USA and most Western countries.
- Complications of atherosclerosis account for 1/2 of all deaths, and 1/3 of deaths in persons between ages 35-65
Predominant age: 35 and older
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Characteristically silent until atheromas produce:
- Stenosis
- Thrombosis
- Aneurysm
- Embolus
For lists of possible symptoms see the following titles elsewhere in this book:
- Essential hypertension
- Coronary arteriosclerosis
- Congestive heart failure
- Cerebrovascular accident
- Atrial arrhythmias
- Ventricular arrhythmias
- Renal failure, chronic
- Dissecting aneurysm
- Thrombosis and embolism, arterial

CAUSES

Biochemical, physiologic, environmental factors that lead to thickening and occlusion of the lumen of arteries
Aging (some degree of atherosclerosis is universal)
One or more of the risk factors listed below

RISK FACTORS

Hypertension
Tobacco smoking
Diabetes mellitus
Obesity
Male gender
Physical inactivity
Increasing age
Family history of premature atherosclerosis
Decreased high-density lipoprotein (HDL) cholesterol
Increased low-density lipoprotein (LDL) cholesterol

DIAGNOSIS

LABORATORY

Associated with elevated serum cholesterol; elevated LDL and low HDL
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Early changes (simple) potentially reversible
- Accumulation of lipid-laden cells in the intimal layer of the artery (usually monocytes/macrophages from circulating blood)
- Lipid streaks in aortas and coronary arteries
Late changes (complicated) usually reversible
- Atheromatous plaques with necrosis, fibrosis, calcification
- Weakening of elastic lamellae
- Neovascularization
- Arterial obstruction
- Thrombosis

SPECIAL TESTS

N/A

IMAGING

Extensively calcified atherosclerotic plaques may be identified in major blood vessels on x-ray

DIAGNOSTIC PROCEDURES

X-ray (often incidental finding)
Associated with hypercholesterolemia; elevated LDL and low HDL
Arterial doppler studies (carotid, renal)
Angiography
Ankle-brachial index (ABI)

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient until complications occur; emphasis on prevention

GENERAL MEASURES

For details see the following titles:
- Essential hypertension
- Congestive heart failure
- Cerebrovascular accident
- Renal failure, chronic
- Dissecting aneurysm
- Thrombosis & embolism, arterial

SURGICAL MEASURES

N/A

ACTIVITY

Encourage physical fitness

DIET

Recommended daily intake

Initial diet; Step 1
- Total fat - < 30% of total calories; saturated fat < 10%
- Carbohydrates - 50-60% of total calories
- Protein - 10-20% of total calories
- Cholesterol - < 300 mg a day
- Total calories - amount required to achieve and maintain desirable weight
- Sodium - 1650-2400 mg
- Alcohol - < 30 g
Initial diet; Step 2
- Total fat - < 30% of total calories; saturated fat < 7%
- Carbohydrates - 50-60% of total calories
- Protein - 10-20% of total calories
- Cholesterol - < 200 mg a day
- Total calories - amount required to achieve and maintain desirable weight
- Sodium - 1650-2400 mg
- Alcohol - < 30 g

PATIENT EDUCATION

Crucial parts of preventing and treating atheroscleroses involve nutrition, fitness, and smoking cessation
Extensive educational materials available from many agencies (e.g., American Heart Association, U.S. Government Printing Office, National Cholesterol Education Program). Use these to help teach patients how to avoid or eliminate risk factors.

FOLLOW UP

PREVENTION/AVOIDANCE

Eliminate risk factors - all or as many as possible

POSSIBLE COMPLICATIONS

Coronary artery disease
Renal failure
Cerebrovascular accidents
Dissecting or ruptured aneurysms
Congestive heart failure
Arterial thrombosis
Gangrene
Cardiac arrhythmias
Sudden death

EXPECTED COURSE AND PROGNOSIS

Avoiding risk factors has greatly decreased mortality rates in the past decade

MISCELLANEOUS

ASSOCIATED CONDITIONS

Essential hypertension
Coronary arteriosclerosis
Congestive heart failure
Cerebrovascular accident
Atrial arrhythmias
Ventricular arrhythmias
Renal failure, chronic
Aortic dissection
Thrombosis and embolism, arterial

AGE-RELATED FACTORS

Pediatric: Fatty streaks and deposits in the intima of the aortas of all children begin as early as age 3 years
Geriatric: Atherosclerosis happens to all who live long enough. Its effects and complications can be minimized and/or delayed by avoiding all risk factors possible.
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.