What causes vascular atherosclerosis? Atherosclerosis - what it is, types and causes of the disease, diagnosis, treatment. Medicines for atherosclerosis

Atherosclerotic damage to blood vessels is an unpleasant diagnosis that is faced mainly by older people. In official medicine, atherosclerosis of the arteries is called the main cause of the development of life-threatening conditions: ischemic stroke, myocardial infarction, and internal organ failure.

To date, no methods have been found for the treatment of vascular atherosclerosis that could permanently get rid of the disease. Patients have to take a number of special medications for the rest of their lives. But even this does not guarantee that there is no risk of deadly complications. For treatment of atherosclerosis to be effective, you have to change your lifestyle, follow a diet, and systematically undergo comprehensive diagnostics.

(function(w, d, n, s, t) ( w[n] = w[n] || ; w[n].push(function() ( Ya.Context.AdvManager.render(( blockId: "R-A -349558-2", renderTo: "yandex_rtb_R-A-349558-2", async: true )); )); t = d.getElementsByTagName("script"); s = d.createElement("script"); s .type = "text/javascript"; s.src = "//an.yandex.ru/system/context.js"; s.async = true; t.parentNode.insertBefore(s, t); ))(this , this.document, "yandexContextAsyncCallbacks");

What is atherosclerosis and can it be cured?

Official medicine classifies vascular atherosclerosis as a complex lesion of large and medium arteries by deposits consisting of cholesterol. Lipids form so-called plaques, which interfere with normal blood flow and, under certain conditions, flake off, clogging the lumen of smaller vascular branches. As the disease progresses, cholesterol deposits thicken and become more rigid due to the presence of connective tissue cells and calcifications in them. It becomes impossible to remove them using conservative methods.

In recent decades, pathology has acquired alarming proportions:

• the disease is diagnosed in every third man over 50 years of age, and in every fifth woman at the same age;
• half of the patients, even despite timely treatment of atherosclerosis, develop serious life-threatening complications;
• Mortality from atherosclerosis exceeded the rates of cancer, injuries and infections.

Such statistics are due to people’s ignorance of what atherosclerosis is, how it manifests itself and how you can protect yourself from this dangerous disease. Moreover, at least 15% of patients experiencing symptoms of the disease deny the need for diagnosis and treatment of atherosclerosis, do not follow doctor’s recommendations and refuse to take medications.

Contrary to the opinion of many patients who believe that atherosclerosis affects single vessels of individual organs (only the heart or only the brain), experts consider this disease to be systemic. The causes of atherosclerotic changes are multifaceted, so they cannot affect single vessels: the pathogenesis of atherosclerosis is based on a complex change in metabolism, metabolism and the functioning of internal organs, which is why pathological changes are observed in all large and medium-sized arteries.

Effective treatment of vascular atherosclerosis requires significant efforts. Doctors and the patient will have to work on nutrition and lifestyle, while simultaneously reducing the level of harmful lipids in the blood with medications. At the same time, there is no question of whether it is possible to cure atherosclerosis once and for all. Today, this disease is considered incurable, requiring lifelong therapy and constant monitoring of the state of the circulatory system and the functioning of the organs affected by the pathology.

Which doctor treats atherosclerosis?

If you suspect problems with blood vessels, you should not choose which specialist is best to contact. To begin with, it is recommended to consult a therapist. He will prescribe a comprehensive examination and, if atherosclerotic changes are detected, will refer you to a specialist. Which organs are affected by the disease will depend on which doctor treats atherosclerosis in an individual patient. This is usually done by several specialists: a cardiologist, a neurologist, a surgeon and other doctors of narrow specializations.

What is dangerous about atherosclerosis - the mechanism of development

The development of atherosclerotic changes occurs very slowly. On average, at least 20-30 years pass from the onset of pathological changes in blood vessels to the appearance of negative consequences of atherosclerosis. The slow progression causes symptoms to increase unnoticed. And this is the first reason why atherosclerotic changes in blood vessels are dangerous. An exacerbation of a disease or its manifestation is always sudden, which is why the patient may not receive timely help - in order to provide it, doctors must first diagnose high cholesterol and atherosclerosis.

For a long time, the patient does not notice the changes occurring in him and the initial signs of atherosclerosis, until the first vascular catastrophe occurs:

• ischemia of organs (brain, heart, kidneys and others);
• hemorrhagic or ischemic stroke;
• formation and rupture of aneurysm.

To prevent this from happening, it is important to know about the first signs of atherosclerosis and understand what exactly leads to the deposition of cholesterol in the arteries. This will allow you to assess risks and suspect problems with blood vessels before changes become irreversible or life-threatening.

The main factors in the development of atherosclerosis are conventionally divided into two groups:

1. Independent of a person, his environment, lifestyle. According to statistics, age is considered the main factor predisposing to the occurrence of cholesterol deposits. The older a person is, the higher the risk of getting sick. There are no known cases in medicine where atherosclerosis was detected in children, although theoretically and in practice there are cases of detection in large arteries in adolescents and children at the initial stage of pathology. It is they who have the second irreducible factor - hereditary predisposition. In such patients, the causes of atherosclerosis most often consist of metabolic disorders in which cholesterol is produced in the body in excessive quantities.
2. Depending on the person, his environment and lifestyle. First of all, this is an unhealthy diet that contains a lot of animal fats. Smoking, alcohol, and limited physical activity complicate the situation with cholesterol deposits. In the presence of these factors, atherosclerosis first affects the walls of blood vessels, and the body tries to restore them by forming a fatty film consisting of cholesterol.

Often, signs of atherosclerosis appear against the background of other diseases that are partially or completely controllable, but cannot be cured: diabetes, dyslipidemia (impaired lipid balance and metabolism in the body), hypertension, and general intoxication of the body. Such conditions lead to damage to arterial walls and prevent the breakdown and removal of harmful fats from the body.

Important! Atherosclerosis does not develop in the presence of one predisposing factor. For the progression of the disease to dangerous diagnosable stages, a combination of removable and non-removable, controllable and uncontrollable factors in various variations is necessary.

If the disease is not detected in a timely manner, or the patient for some reason does not receive treatment, he is at risk of such dangerous conditions as vascular insufficiency of internal organs, acute heart attack or stroke, or ruptured aneurysm.

Stages of atherosclerosis

Regarding the stages of development of atherosclerosis, the classification distinguishes 3 stages of disease progression. Each of them is characterized by varying degrees of arterial damage. The development of atherosclerosis by stages is described in more detail in the table below:

Disease stage	Localization of pathological foci	What happens to the vascular wall
Stage I - fatty spot	Large arteries at their branches.	In the initial stage of atherosclerosis, the body’s protective reaction to microdamage to the vascular walls takes place. At the site of such damage, local swelling and loosening occurs. Enzymes dissolve lipids for some time, protecting the integrity of the intima (inner surface of the vessel), and as the protective functions are depleted, increased deposition of lipids and proteins occurs. At an early stage of development, atherosclerosis does not manifest itself in any way. It can only be detected by examining the damaged area of ​​the artery under a microscope. Such changes can occur even in children. Further development of atherosclerosis will occur only in the presence of predisposing and traumatic factors.
Stage II - liposclerosis	Branches of large and smaller arteries.	Progressive atherosclerosis is accompanied by the formation of connective fibers in the fatty spot - an atherosclerotic plaque is formed. It is soft enough and does not interfere with blood flow, but under certain conditions it can come off and clog smaller vessels. The artery wall under the plaque, on the contrary, becomes less elastic, and with changes in blood pressure it can be destroyed, which leads to the formation of blood clots. At this stage of atherosclerosis, the first alarming symptoms are observed.
Stage III - atherocalcinosis	Any sections of large and medium-sized arteries.	With atherosclerosis of the 3rd degree, the cholesterol plaque thickens due to the accumulation of calcium salts to it. It becomes harder and continues to grow, causing the lumen of the arteries to noticeably narrow. The patient experiences severe symptoms associated with insufficient blood supply to organs, and sometimes to parts of the body (when peripheral atherosclerosis occurs). Ischemia of the brain, myocardium, kidneys and intestines occurs, and the risk of occlusion (blockage) increases significantly. Patients who have suffered this condition often experience post-infarction atherosclerosis, gangrene of the extremities, and necrosis of tissue of internal organs.

It is noteworthy that in the initial stages, early signs of atherosclerosis are ignored, although in the early stages the disease can be successfully controlled by taking a set of medications. At stages 2 and 3 of the disease, treatment of atherosclerosis is more complex. It requires not only stabilization of cholesterol levels, but also restoration of the functions of internal organs and systems.

Symptoms

There are no specific symptoms of atherosclerosis. Clinical manifestations of pathology are always complex and directly depend on which organs are affected by insufficient blood supply.

When the cerebral arteries are damaged, the following symptoms occur:

• deterioration of short-term memory - the patient remembers what happened in the distant past, but forgets events that took place a few minutes ago;
• sleep disorders - the patient has problems falling asleep, suffers from insomnia, wakes up several times at night;
• neurological disorders - mood swings, exacerbation of character traits, irritability are combined with regular headaches that are not relieved by conventional painkillers.

Symptoms develop gradually, which is why they are not always perceived as something threatening. At the final stage, they acquire particularly acute features: the patient suffers from a constant feeling of fatigue, cannot lead the same lifestyle and take care of himself due to persistent memory impairment. There is a loss of interest in life, apathy. Most people suffering from the disease become depressed.

Symptoms may resemble manifestations of heart and pulmonary diseases, as it causes:

• shortness of breath, shortness of breath;
• general weakness and rapid fatigue during physical activity;
• dull pain in the chest;
• heart rhythm disturbances such as angina pectoris.

Often, taking over-the-counter heart medications (Validol, Nitroglycerin, Corvalol) does not bring relief for such symptoms.

The symptoms resemble tumor processes in the abdominal and pelvic organs. In this case, patients complain of the following unpleasant sensations:

• paroxysmal abdominal pain of unclear localization that is not associated with food intake and stool;
• bloating that is not associated with eating fiber-rich foods;
• frequent tension of the anterior abdominal wall.

As in the case of damage to other vessels, standard medications (antispasmodics, analgesics, enterosorbents, defoamers and others) do not have the desired effect.

Atherosclerosis of the renal arteries is also accompanied by nonspecific symptoms. When this group of vessels is affected, patients suffer from a severe form of arterial hypertension. Against this background, dull pain in the lower back is observed, which persists during activity and at rest.

Patients complain of pain and heaviness in the legs, which at the initial stage of the disease subside at rest. Along with this, the quality of the skin changes: it becomes pale and dry in the area below the narrowing of the vessel. If atherosclerosis is not treated, trophic ulcers and areas of necrosis form on the limbs closer to the foot, which can then develop into gangrene. Similar symptoms are observed with damage to the arteries of the arms.

It is almost impossible to independently differentiate the disease due to the nonspecificity of symptoms. Moreover, specialists also cannot always immediately suspect this pathology, since in clinical practice it is extremely rare that only one group of arteries is affected: the combination of symptoms can be extremely atypical and unexpected, which will complicate diagnosis.

Treatment of vascular atherosclerosis

Treatment for vascular atherosclerosis is aimed at restoring and stimulating metabolism (primarily proteins and lipids), reducing cholesterol synthesis in the body and limiting its intake from food. Positive dynamics are observed only with therapy in the initial stages of the disease, while lipid deposits in the arteries do not contain connective tissue and calcifications. In advanced forms of the disease, complex therapy can only guarantee the absence of further progress.

Medicines

The main direction of therapy is taking several groups of medications. Statins play a major role in atherosclerosis. This group of drugs is designed to reduce cholesterol levels in the body by reducing the synthesis of lipids in the liver and reducing their absorption in the digestive tract. Bile acid sequestrants and fibrates, as well as nicotinic acid derivatives, have similar properties.

In addition to the listed drugs, patients with atherosclerotic changes are prescribed additional drugs:

• preparations containing Omega-3 - they improve lipid metabolism, reduce inflammation in the walls of arteries, and to a certain extent reduce blood viscosity;
• drugs that improve blood circulation in organs and tissues, including those based on medicinal herbs;
• drugs to stabilize blood pressure;
• sedatives and nootropics, including those based on herbal components.

Medicines are selected individually, taking into account the diagnostic results and the presence of concomitant diseases.

Diet

Drug therapy must be accompanied by compliance, since treating vascular atherosclerosis with drugs alone is not effective: without limiting the intake of lipids from food, they will not be able to have a pronounced effect on the body.

The following are excluded from the patient’s menu:

• animal products high in fat, including meat, lard, milk, sour cream and cream, butter;
• solid vegetable and animal fats;
• sweets, baked goods, chocolate and cream cakes, ice cream;
• alcoholic and low-alcohol drinks;
• strong coffee and tea.

The basis of the diet should be vegetables and fruits rich in fiber, cereals (oatmeal, buckwheat, rice), white meat (chicken and turkey breasts), seafood and sea fish, natural low-fat yogurt or kefir, egg whites or quail eggs, skim milk. Bread and pastries can be eaten if they are made from wholemeal flour.

In addition to the selection of certain products, the method of cooking plays a special role. The preferred cooking method is boiling, steaming, baking in parchment and stewing in its own juices. Meals should be fractional: the serving size should not exceed 200 ml, and the number of meals ranges from 5 to 7 times a day.

Surgical intervention

If there is a high risk of arterial blockage and the development of a heart attack or stroke, treatment of atherosclerosis continues using surgical methods. There are 4 effective methods of restoring blood flow:

• - open surgery on the arteries, during which the cholesterol plaque is removed along with part of the inner lining of the vessel;
• endovascular dilatation of arteries- expansion of the lumen using balloon catheters;
• endovascular stenting- expansion of the lumen of the arteries using a spiral or mesh cylinder (stent);
• coronary artery bypass surgery- creation of a new blood supply channel bypassing the damaged section of the artery.

A successful surgical intervention does not mean that the patient is completely free of the problem. After the operation, he will have to take medications and follow a diet.

How to identify atherosclerosis - diagnostic methods

For modern medicine, diagnosing atherosclerosis does not seem to be a difficult task, especially if the patient has clear clinical signs of the disease. Initial conclusions are drawn up based on an oral interview with the patient and a general examination. Evidence in favor of the disease is:

• swelling of soft tissues;
• trophic changes in the skin of the extremities;
• low weight;
• the presence of wen on the body;
• change in arterial pulsation;
• high or unstable blood pressure.

Since it is impossible to diagnose atherosclerosis only on the basis of complaints and history taking, a comprehensive examination is carried out, which includes:

• blood tests for low-density lipoproteins, triglycerides and cholesterol;
• vascular angiography;
• kidneys, carotid and coronary arteries, vessels of the lower extremities and aorta.

Also, the diagnosis of atherosclerosis may include examination using MRI and CT. Using these examination methods, organ damage due to tissue ischemia is diagnosed. Rheovasography of the lower extremities is also of no small importance, making it possible to detect a decrease in the speed of blood flow in them. This type of diagnosis is useful for incipient disease, since it can be difficult to detect atherosclerosis using previously mentioned methods at this stage of progression.

Complications of atherosclerosis

With the disease atherosclerosis and dyslipidemia, patients are threatened with many complications, because almost all organs and systems suffer from insufficient blood circulation. Conventionally, they can be divided into 3 groups:

Vascular insufficiency caused by insufficient nutrition and gas exchange in the tissues of internal organs: such complications of atherosclerosis can be represented by dystrophic and necrotic changes, which inevitably affect the functionality of organs and systems. the consequences of such processes can be progressive dementia, loss of vision, hearing, memory and profound disability. When the heart vessels are damaged, patients develop ischemic disease, which also leads to profound disability. Damage to the arteries supplying internal organs (kidneys, intestines, liver) results in multiple organ failure or organ necrosis. Atherosclerosis in the legs is complicated by gangrene.

Severance of cholesterol plaques or the formation of blood clots with subsequent blockage of blood vessels: Such complications of atherosclerosis arise rapidly and are catastrophic in nature (it is not for nothing that in medicine there are the terms “brain catastrophe” and “heart catastrophe”). As a result of such processes, myocardial infarction and acute ischemic stroke develop. The result is paralysis and loss of many usual functions. More than 70% die in the first year after plaque detachment occurs.

Thinning of the vessel wall with its subsequent protrusion outward - the development of an aneurysm: this complication can develop over a long period of time and go unnoticed. With stress, physical and emotional stress, which are often accompanied by surges in blood pressure, the artery wall can burst. Rupture of an aneurysm leads to heavy internal bleeding and is fatal in 80% of cases.

The only way to avoid such dangerous consequences of the disease is to consult a doctor if symptoms appear that may indicate vascular atherosclerosis. After diagnosis, it is important to strictly follow the doctor’s recommendations, lead a healthy lifestyle and take medications prescribed by a specialist. If these conditions are met, the patient can live to a ripe old age and maintain a high quality of life.

Video: atherosclerosis

Atherosclerosis is a common progressive disease that affects large and medium-sized arteries as a result of the accumulation of cholesterol in them, leading to poor circulation.
In economically developed countries, atherosclerosis is the most common cause of morbidity and overall mortality.

Causes of atherosclerosis

The following roles play a role in the occurrence and formation of atherosclerosis:
- lipid (fat) metabolism disorders;
- hereditary genetic factor;
- condition of the vascular wall.

Cholesterol is a lipid (fat) and performs many important functions in the human body. It is a building material for the walls of the body's cells, it is part of hormones and vitamins, without which normal human existence is impossible. Up to 70% of cholesterol in the body is synthesized in the liver, the rest comes from food. In the body, cholesterol is not in a free state, but is part of lipoproteins (complex compounds of protein and fats) that transport it through the bloodstream from the liver to the tissues, and if there is excess cholesterol, from the tissues back to the liver, where the excess cholesterol is utilized. If this process is disrupted, atherosclerosis develops.

The main role in the development of atherosclerosis belongs to low-density lipoproteins (LDL), which transport cholesterol from the liver into cells; there must be a strictly required amount; by exceeding its level, the risk of atherosclerosis is determined.

The reverse transport of cholesterol from tissues to the liver is ensured by high-density lipoproteins (HDL), an antiatherogenic class of lipoproteins. It cleanses the surface of cells from excess cholesterol. Increasing the level of LDL cholesterol and decreasing the level of HDL cholesterol increases the risk of the occurrence and development of atherosclerosis.

Initial changes in the wall of large and medium-sized arteries occur at a young age and evolve to fibroadenomatous plaques, which often develop after 40 years. Atherosclerotic vascular damage already occurs in persons under 20 years of age in 17% of cases, under 39 years of age in 60% of cases, and in persons 50 years of age and older in 85% of cases.

Cholesterol, fibrin and other substances penetrate into the middle of the arterial wall, which subsequently form an atherosclerotic plaque. Under the influence of excess cholesterol, the plaque increases, and obstacles arise to the normal flow of blood through the vessels at the site of narrowing. Blood flow decreases, an inflammatory process develops, blood clots form and can break off, with the danger of clogging vital vessels and stopping the delivery of blood to organs.

Factors that play a role in the development and progression of atherosclerosis are:
- modifiable (which can be eliminated or adjusted)
- non-modifiable (they cannot be changed).

Modifiable factors include:

1.Lifestyle:
- physical inactivity,
- abuse of fatty, cholesterol-rich foods,
- personality and behavior characteristics - stressful type of character,
- alcohol abuse,
- smoking.
2. Arterial hypertension, blood pressure 140/90 mm Hg. and higher.
3. Diabetes mellitus, fasting blood glucose level more than 6 mmol/l.
4. Hypercholesterolemia (increased blood cholesterol levels).
5. Abdominal obesity (waist circumference in men is more than 102 cm and more than 88 cm in women).

Non-modifiable factors include:

1. Age: men over 45 and women over 55 or with early menopause.
2. Male gender (men develop atherosclerosis 10 years earlier than women).
3. A family history of cases of early atherosclerosis. Familial hypercholesterolemia with a genetic basis. Myocardial infarction, stroke, sudden death in close relatives under the age of 55 years for a man and 65 years for a woman.

The adverse effects of risk factors lead to disruption of the integrity of the endothelium (the inner layer of blood vessels), which loses its barrier function, and against the background of lipid metabolism disorders lead to the development of atherosclerosis.

Symptoms of atherosclerosis.

The deposition of cholesterol in the arterial wall is accompanied by a compensatory bulging outward, due to which there are no obvious symptoms of atherosclerosis for a long time. But over time, the atherosclerotic plaque transforms from stable to unstable under the influence of systemic factors: physical activity, emotional stress, arterial hypertension, heart rhythm disturbances. They lead to cracks or rupture of the plaque. Blood clots form on the surface of an unstable atherosclerotic plaque - atherothrombosis is formed, leading to progressive vasoconstriction. There is a disturbance in blood circulation in organs and tissues, and clinical symptoms noticeable to the patient appear.

Depending on the location in the vascular system, atherosclerosis is the basis of the following diseases:

1. Coronary heart disease (angina pectoris, myocardial infarction, sudden cardiac death, arrhythmias, heart failure).
2. Cerebrovascular diseases (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 of the mesenteric arteries (intestinal infarction).

The atherosclerotic process leads to damage to several vascular beds. After a stroke, the likelihood of developing a myocardial infarction in such patients is 3 times higher, and damage to the peripheral arteries increases the risk of developing myocardial infarction by 4 times, and stroke by 3 times.

Atherosclerosis of the coronary arteries has many symptoms, depending on the severity of atherosclerosis, manifested by angina pectoris or acute coronary insufficiency, characterized by the development of myocardial infarction, heart failure. All forms of coronary heart disease occur against the background of atherosclerosis. Cardiac manifestations of atherosclerosis account for approximately half of all atherosclerotic lesions.

Atherosclerosis of the aorta often appears after 60 years of age. With atherosclerosis of the thoracic aorta, intense burning pain appears behind the sternum, radiating to the neck, back, and upper abdomen. With physical activity and stress, the pain intensifies. Unlike angina, the pain continues for days, periodically intensifying and weakening. Swallowing problems, hoarseness, dizziness, and fainting may occur. Atherosclerosis of the abdominal aorta is characterized by abdominal pain, bloating, and constipation. With atherosclerotic lesions of the aortic bifurcation (the place where the aorta divides into branches), Leriche syndrome develops with such manifestations as: intermittent claudication, coldness of the lower extremities, impotence, toe ulcers. A serious complication of aortic atherosclerosis is aneurysm (dissection) and rupture of the aorta.

Atherosclerosis of the mesenteric vessels is manifested by sharp, burning, cutting pain in the abdomen during meals, lasting 2-3 hours, bloating, and stool disturbances.

Atherosclerosis of the renal arteries is characterized by a persistent increase in blood pressure and changes in urine analysis.

Atherosclerosis of the peripheral arteries is manifested by weakness and increased fatigue of the leg muscles, a feeling of chilliness in the limbs, intermittent claudication (pain in the limbs appears while walking, forcing the patient to stop).

Examination for atherosclerosis.

The primary diagnosis of atherosclerosis is carried out by a general practitioner or family doctor during an annual medical examination. Measures blood pressure, determines body mass index, identifies risk factors (hypertension, diabetes, obesity).

1. Determination of lipid levels, after 30 years:
- total cholesterol (norm less than 5.0 mmol/l);
- LDL cholesterol (normal value is below 3.0 mmol/l);
- HDL cholesterol (the norm is above 1.0 mmol/l (in men) and above 1.2 mmol/l (in women);
- blood plasma triglycerides (the norm is below 1.2 mmol/l);
- ratio of total cholesterol/HDL cholesterol (atherogenicity index – a factor in the development of cardiovascular complications). Low risk - from 2.0 to 2.9, medium risk - from 3.0 to 4.9, high risk - more than 5.

2. Determination of the risk group in patients without clinical manifestations of atherosclerosis. The SCORE (systemic coronary risk assessment) scale allows you to determine the individual degree of risk for patients, with which you can estimate the probability of fatal cardiovascular events (myocardial infarction, stroke) within 10 years. Low risk -<4%, умеренный риск - 4–5%, высокий риск - 5–8% и очень высокий риск - >8%.

If atherosclerotic changes are suspected, consultation with specialists is indicated:
- cardiologist (for coronary heart disease);
- ophthalmologist (atherosclerosis of the fundus vessels);
- neurologist (cerebral atherosclerosis);
- nephrologist (atherosclerosis of the renal arteries);
- vascular surgeon (atherosclerosis of the vessels of the lower extremities, aorta).

To clarify the degree of atherosclerotic lesions, additional instrumental research methods may be prescribed:

1. Electrocardiography, with stress tests, ultrasound examination of the heart, aorta.
2. Angiography, coronary angiography, intravascular ultrasound. These are invasive research methods. Atherosclerotic plaques are identified and the total atherosclerotic lesion can be assessed. Used in patients with clinical manifestations of atherosclerosis (coronary heart disease).
3. Duplex and triplex scanning. Study of blood flow with ultrasound visualization of vessels: carotid arteries, abdominal aorta and its branches, arteries of the lower and upper extremities. Detects atherosclerotic plaques in the arteries and assesses the state of blood flow in the vessels.
4. Magnetic resonance imaging. Visualization of arterial walls and atherosclerotic plaques.

Treatment of atherosclerosis.

1. Without clinical manifestations of atherosclerosis, lifestyle modification is recommended for a patient with a moderate risk (up to 5% on the SCORE scale) and a total cholesterol level above 5 mmol/l. It includes: quitting smoking, drinking alcohol, anti-atherosclerotic diet, increasing physical activity. When the target cholesterol level is reached (total cholesterol up to 5 mmol/l, LDL cholesterol below 3 mmol/l), re-examination should be carried out at least once every 5 years.

Initiation of treatment for a high-risk patient (above 5% SCORE) with a total cholesterol level greater than 5 mmol/L should also begin with recommendations for lifestyle changes for 3 months and re-evaluation at the end of this period. When the patient reaches target levels of total cholesterol up to 5 mmol/L and LDL cholesterol below 3 mmol/L, lipid levels are subsequently monitored annually. If the risk remains high (above 5% on the SCORE scale), drug therapy is prescribed.

2. For patients with signs of atherosclerotic lesions of any location, lifestyle modification and drug therapy are recommended.

Diet recommendations are given to all patients, taking into account cholesterol levels and other risk factors: obesity, arterial hypertension, diabetes mellitus. The diet should be varied, in accordance with the cultural traditions of the patient. The caloric content of the daily diet should be sufficient to achieve and maintain normal weight.

Consumption of total fat should not exceed 30% of the calorie intake.
It is recommended to limit the consumption of animal fats (butter, cream, meat, lard), replacing them with vegetable fats. Daily consumption of fresh vegetables and fruits should be at least 400g per day.

It is recommended to consume lean meat and poultry without skin, fermented milk products, low-fat cottage cheese, grain bread, with bran, products enriched with ω3-unsaturated fatty acids (sea and ocean fish - salmon, mackerel, tuna, etc.). Limit the consumption of table salt to 6g per day, which corresponds to 1 teaspoon. Following a diet can reduce cholesterol levels by up to 10%.

Normalization of body weight indicators.

Excess body weight and obesity, especially abdominal obesity (waist circumference in men more than 102 cm and more than 88 cm in women), increase the risk of developing cardiovascular diseases. To lose weight, an individual diet is selected taking into account age and concomitant diseases.

Physical activity for atherosclerosis.

Increasing physical activity has a positive effect for patients with atherosclerosis.
Patients without clinical manifestations of atherosclerosis are advised to exercise for 40 minutes daily. The intensity of the exercise should be 60% of the maximum heart rate (calculated = 220 - age).

Patients with cardiovascular diseases require a constant regime of dynamic physical activity, taking into account the results of stress tests. Walking, swimming, dancing are useful - moderate intensity 60-90 minutes per week. Isometric (power) loads are unacceptable.

Stop smoking.

Smoking (active and passive), as a result of a sharp decrease in HDL (an anti-atherogenic class of lipoproteins), pathological effects on the vascular system, and disturbances in the rheological properties of blood, increases the risk of morbidity and mortality from cardiovascular complications by 20%. Smokers have a 2-fold higher risk of developing ischemic stroke than non-smokers.

Alcohol consumption.

Health-safe 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 practically healthy individuals, reduces mortality from cardiovascular complications. Drinking alcohol (12-24g per day of pure ethanol) reduces the risk of developing cardiovascular complications (heart attack and stroke) by 20%, and drinking 5 servings of alcohol (60g per day) increases the risk of cardiovascular complications by 65%.

Drugs.

The use of drugs, such as cocaine, amphetamine, heroin, causes sudden changes in blood pressure, inflammatory changes in the vascular system, and leads to disruption of the rheological properties of the blood. They increase the risk of stroke by 6.5 times in people under 35 years of age, and in people over 35 years of age by 11.2 times.

Drug treatment of atherosclerosis.

Drug therapy for atherosclerosis involves the use of 4 groups of hypolipidemic (lipid level-lowering) drugs: bile acid sequestrants, nicotinic acid, fibrates, statins. These agents have a stabilizing effect on the atherosclerotic plaque, improve the function of the endothelium (the inner lining of blood vessels), and inhibit the development of atherosclerosis, while differing in the severity of their effect on various indicators of lipid metabolism.

Only the attending physician will recommend the necessary drug and its dosage. The most commonly used drugs are statins. Treatment with statins significantly reduces mortality and prevents cardiovascular complications. The required dose of statins is selected individually for each patient. The drug is taken once a day - in the evening before bedtime.

Preparations based on fish oil and essential phospholipids are of auxiliary importance. They are used only in combination with statins.

If there is a threat of developing complications of atherosclerosis, surgical treatment is indicated that restores the patency of the arteries (revascularization). In case of coronary heart disease, coronary artery stenting or bypass surgery is performed to prevent the development of a heart attack. In case of cerebral atherosclerosis, stenting of the carotid arteries is performed to prevent the development of stroke. To prevent the development of gangrene of the lower extremities, prosthetics of the main arteries is performed. The need and extent of surgical intervention is determined by the surgeon (cardiac surgeon, vascular surgeon).

Surgical treatment of atherosclerosis does not provide a complete cure. The complication is eliminated, not the cause that caused it (atherosclerosis). Therefore, after surgery, changes in lifestyle, nutrition and conservative treatment are mandatory.

Prevention of atherosclerosis.

Primary prevention of atherosclerosis involves:

1. Control and achievement of target cholesterol levels (total cholesterol up to 5 mmol/l, LDL cholesterol below 3 mmol/l).
2. Stop smoking, drinking alcohol, and taking drugs.
3. Adequate level of physical activity.
4. Normalization of body weight.
5. Limiting emotional overload.
6. Normal blood glucose levels.
7. Blood pressure below 140/90 mmHg.
8. Compliance with the principles of the anti-atherosclerotic diet.

Secondary prevention measures aimed at preventing complications of an already developed disease, in addition to primary prevention measures, also include taking cholesterol-lowering drugs (statins), antiplatelet agents (acetylsalicylic acid).

Consultation with a doctor on the topic of atherosclerosis:

Question: Is it advisable for elderly and senile people (70-80 years old) to take statins?
Answer: Treatment of atherosclerosis with statins in older adults not only reduces the risk of stroke and heart attack, but also reduces overall mortality.

Question: How long should I take statins?
Answer: To significantly improve life prognosis and reduce the risk of cardiovascular complications, it is necessary to use statins daily for at least 3-5 years without unreasonable dose reduction and unauthorized premature cessation of treatment.

General practitioner Vostrenkova I.N.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is atherosclerosis?

Atherosclerosis is a disease based on impaired lipid (fat) metabolism in the body. With this pathology, fat is deposited on the inner wall of medium- and large-caliber arteries. Atherosclerosis underlies many cardiovascular diseases and is also a risk factor for stroke and heart attack.
It occupies a leading position in the list of the most common diseases in the world. Also, this vascular disease occupies one of the first places in the list of diseases leading to death. According to statistics, every 10th death on the planet occurs from the consequences of atherosclerosis, which most often include myocardial infarction and cerebral hemorrhage.

The areas where this disease is most common are countries in Europe and North America with a high level of economic development. According to the United States Population Bureau, 30 percent of deaths are caused by atherosclerosis. In the second half of the twentieth century, this metabolic disorder began to be increasingly diagnosed in Japan and China. Experts note that this is facilitated by the development of technology, which entails a sedentary lifestyle. In the Russian Federation, atherosclerosis is also a common pathology. Every year, atherosclerotic changes in blood vessels cause death among men in more than 60 percent of cases. Traditional causes of atherosclerosis are considered to be poor diet, smoking and a sedentary lifestyle. According to these factors, atherosclerosis is a modern disease, since in ancient times there was no fast food or tobacco products, and at the same time, our ancestors led an active life. However, data from some studies refute this assumption. Employees of a medical center in California analyzed mummified bodies. During the experiment, the remains of 76 people who lived on the territory of 5 continents many centuries ago were examined. The study found that 35 percent of the bodies had symptoms of atherosclerosis. The head of the study emphasized that scientists were unable to discover at least one ancient civilization whose representatives did not exhibit signs of this disease. This led researchers to believe that a large percentage of the risk of developing atherosclerosis in modern humans is due to a genetic factor.

The absence of a direct connection between atherosclerosis and diet is also confirmed by studies conducted among residents of African countries. Some African tribes feed primarily on camel and goat milk, which is several times fattier than cow's milk. Despite this, increased blood cholesterol levels and atherosclerosis are much less common in these people than in other peoples.
A large-scale study on the topic of atherosclerosis was conducted in India. The analysis provided evidence that mortality from the consequences of atherosclerosis among residents of the southern part of the country is 7 times higher than among those living in the northwestern region. It is noteworthy that residents of northwestern India consume significantly more tobacco products and fatty animal products.

Causes and risk factors of atherosclerosis

Atherosclerosis is a polyetiological (multifactorial) disease, in the development of which more than a dozen factors are simultaneously involved.

The causes and risk factors of atherosclerosis are:

• dyslipidemia – a disorder of lipid metabolism;
• arterial hypertension - high blood pressure, which provokes stratification of the epithelium of the vascular wall and the rapid penetration of lipids into it;

• smoking – the integrity of the vascular wall is also compromised;
• obesity – accompanied by impaired metabolism and excessive concentration of lipids in the blood serum;
• metabolic disorders - diabetes mellitus;
• complicated heredity - plays a major role in familial dyslipidemia;
• male gender – atherosclerosis occurs more often in men than in women;
• age over 55 years – metabolism slows down with age;
• sedentary lifestyle;
• unhealthy diet – excess fat consumption;
• hormonal imbalance - androgens have an atherogenic effect.

All of the above risk factors must be considered not individually, but together. They play a role not so much in the occurrence of atherosclerosis, but in its further progression. The most significant factors, the maximum risk of which was recognized by the World Health Organization (WHO), are the first five - dyslipidemia, arterial hypertension, smoking, obesity and diabetes mellitus. These factors are assessed by the family doctor first, since their presence is correlated (interrelated) with complications of atherosclerosis such as, for example, coronary heart disease. In fact, they are also the causes of atherosclerosis.

Dyslipidemia

Dyslipidemia is a disorder of lipid metabolism. Lipids, also known as fats, play an important role in the body. They are the building material for cell membranes, for nervous tissue and for the synthesis of hormones. However, their increased content is accompanied by the development of atherosclerosis. There are several lipid fractions, each of which plays its own role.
In order to assess lipid metabolism disorders, it is necessary to know what normal blood lipid composition looks like.

The ratio of major lipids is normal

Lipid name	Characteristic	Normal concentration
Total cholesterol	It is a precursor of sex hormones, bile acids, vitamin D.	3.5 – 5.2 millimoles per liter
LDL (Low density lipoproteins)	They transport cholesterol from one cell to another. They are also called “bad lipids” because they increase the risk of developing atherosclerosis.	up to 3.5 millimoles per liter
HDL (High density lipoproteins)	Functional examination When examining a patient by a cardiologist, some objective signs may be revealed that will indicate dilatation of the aorta. Objective signs of aortic atherosclerosis are: pulsation in the supraclavicular fossa; difference in blood pressure on the right and left arms; Auscultation of the heart reveals a systolic murmur. Atherosclerosis of the abdominal aorta This variant of atherosclerosis is accompanied by impaired circulation in the internal organs (visceral circulation). In this case, atherosclerotic plaques are deposited on the inner wall of the visceral arteries (arteries that supply internal organs). The narrowing of these arteries leads to the development of ischemia and disorders of the internal organs. For a long time, chronic oxygen starvation of internal organs can occur hidden. This explains the fact that atherosclerosis of the abdominal aorta is diagnosed extremely rarely. Symptoms of atherosclerosis of the abdominal aorta are: cramping abdominal pain; violation of intestinal motor function; weight loss. Stomach ache Pain syndrome most often appears after eating fatty foods in large quantities. Initially, there is a feeling of heaviness and fullness in the stomach, which occurs 10 - 15 minutes after eating. Further, these sensations are replaced by pronounced, aching pains of a dull nature. As a rule, the pain is localized around the navel and lasts about an hour or more. The pain does not respond to painkillers, such as no-spa. They go away on their own and appear again half an hour after a heavy meal. Upon examination and palpation (medical palpation), abdominal pain is revealed in its various parts, depending on the location of atherosclerosis. Impaired intestinal motor function One of the most important functions of the intestines is the movement of food. This function is realized thanks to the peristaltic waves of the intestine, that is, thanks to its motility. With atherosclerosis, it is disrupted, which provokes a number of symptoms. First of all, this is increased gas formation and bloating. Due to the lack of peristalsis, gases are not removed from the intestines and accumulate in it. Other symptoms include loose stools with a tendency to constipation and decreased appetite. Weight loss Progressive weight loss is a consequence of impaired intestinal secretory function. Nutrients are no longer absorbed by the body due to oxygen starvation of the intestines. Since atherosclerotic plaque slows blood circulation in the intestinal loops, structural changes begin to develop in them. The mucous membrane stops absorbing essential vitamins and nutrients. Leriche syndrome A severe complication of atherosclerosis is Leriche syndrome. This is a complex of symptoms that develops when the aorta is completely blocked at the site of its bifurcation. It can be either congenital (due to congenital narrowing) or acquired. More often, Leriche syndrome is of atherosclerotic nature. With this syndrome, occlusion (blockage) by an atherosclerotic plaque occurs at the site of the bifurcation of the aorta into the iliac arteries. This means that both limbs stop receiving blood supply at once. Also, the pelvic organs (genitourinary organs, sigmoid and rectum) and muscles do not receive enough blood supply. The main manifestation of this syndrome is pain. The pain syndrome affects the calf muscles and initially occurs only during walking. When the patient stops, the pain stops. This is due to a decrease in the load on the muscles and a decrease in their need for oxygen. However, as the aorta narrows, pain appears more often and with much less stress. With significant narrowing of the abdominal aorta, the pain rises higher - to the thigh and gluteal muscles. An objective examination by a doctor reveals some specific symptoms. Objective symptoms of Leriche syndrome are: weakening of the pulse until it completely disappears in the arteries of the feet, as well as in the popliteal and femoral arteries; the appearance of trophic ulcers and necrosis (tissue death) on the toes and heels; decrease in skin temperature of the extremities - the legs feel very cold, almost icy; change in color of the lower extremities - first sharply pale, then blue; hair loss on the legs, changes in nails. Diabetes mellitus and atherosclerosis When atherosclerosis and diabetes mellitus are combined, the risk of developing cardiovascular complications increases several times. Firstly, this is explained by the fact that diabetes itself is a risk factor for the development of atherosclerosis. And secondly, diabetes mellitus is combined with a number of other pathologies (for example, arterial hypertension), which also increase the risk of developing atherosclerosis. Thus, diabetes mellitus is not only a risk factor for atherosclerosis, but also contributes to its progression. The combination of these two pathologies is a major risk factor for coronary heart disease and myocardial infarction. Also, these pathologies occur with vascular damage, which increases the risk of complications such as gangrene and trophic ulcers tenfold. Manifestations of diabetes mellitus and atherosclerosis The main manifestation of diabetes mellitus is an increased level of glucose (popularly known as sugar) in the blood. This provokes a number of symptoms that characterize diabetes in the initial stages. The main symptoms of diabetes are: constant thirst; itching of the mucous membranes, which manifests itself as vaginal itching; Diabetes mellitus mainly affects small blood vessels. The target organs for diabetes are the retina, brain, and kidneys. As diabetes progresses, various structural abnormalities develop in them. Complications of diabetes Much less commonly, diabetes mellitus affects the coronary vessels of the heart. But, despite this, the pathological process develops much faster than in other vessels. Excessive concentration of sugar leads to the fact that the walls of the coronary vessels begin to be damaged. The endothelium loses its functions, and in addition its structure is disrupted. Hyperglycemia also activates thrombus formation processes. Thus, diabetes mellitus combines the same mechanisms of vascular damage as atherosclerosis. That is why the combination of these pathologies increases the risk of cardiovascular diseases tenfold. The danger of diabetes mellitus also lies in the fact that insulin deficiency leads to a decrease in the activity of enzymes that break down fats. This, in turn, leads to increased concentration. Also, in diabetes mellitus, endothelial function is impaired and vascular permeability changes. As a result, lipids penetrate and saturate the vascular wall much more easily. Thus, when diabetes mellitus and atherosclerosis are combined, a vicious circle is observed. An increased concentration of glucose creates the ground for lipids to penetrate into the vascular wall. And atherosclerosis itself reduces tissue sensitivity to insulin and provokes the development of insulin resistance. Pathology of the cardiovascular system and atherosclerosis Numerous studies have proven that atherosclerosis is combined with an increased risk of developing cardiovascular diseases. First of all, this is a risk for the development of coronary heart disease. Coronary heart disease is a chronic damage to the heart muscle, which is caused by a decrease in blood supply. As a result of decreased blood circulation, the myocardium (heart muscle) ceases to receive the required amount of blood and oxygen. The main cause of coronary heart disease today is atherosclerosis of the coronary arteries. Coronary atherosclerosis and coronary heart disease Coronary atherosclerosis is atherosclerosis of the coronary arteries of the heart. It is known that the heart is fed by two coronary arteries - the right and left. Each of them gives rise to numerous small branches that nourish the myocardium. Atherosclerotic lesion of any of these arteries leads to insufficient coronary circulation. Narrowing of the artery lumen by more than 70 percent leads to a detailed clinical picture of coronary heart disease. Complete obstruction of a blood vessel can lead to myocardial infarction. Lack of blood circulation provokes oxygen starvation of the heart muscle. The heart begins to lack oxygen and nutrients supplied by the blood. With a lack of oxygen in the muscle, anaerobic (oxygen-free) processes begin to activate. These processes are accompanied by the production of lactic acid, which is a strong irritant. It irritates the nerve endings, which provokes pain - the main symptom of coronary artery disease. Characteristics of pain in coronary heart disease are: the pain is localized behind the sternum; the pain has the character of a burning sensation, rarely pressure; an attack of pain lasts from 5 to 15 (maximum 20) minutes; pain often radiates to the arm or shoulder; ischemic pain responds well to nitroglycerin. Atherosclerosis also underlies such cardiovascular pathologies as cardiosclerosis, myocardial infarction, aortic aneurysm and others. Myocardial infarction A serious complication of atherosclerosis of the heart vessels is myocardial infarction. A heart attack is the death (necrosis) of a certain area of ​​the heart muscle due to complete occlusion of one of the coronary arteries. Any tissue in the body needs oxygen to carry out its functions. Thus, the vital activity of tissues and organs of the body is maintained. The lack of oxygen leads to cell death and tissue destruction. The organs most susceptible to lack of oxygen are the brain and heart. Complete cessation of blood supply to the heart due to blockage of the coronary arteries leads to acute hypoxia of the organ and tissue necrosis. The lack of oxygen activates the anaerobic processes of the heart, in which the end product is lactic acid. Being a strong irritant, it irritates the nerve endings and provokes severe, burning pain. Manifestations of myocardial infarction are: sharp, burning or pressing pain in the heart area; pain duration is more than 30 minutes; pain does not respond to taking vasodilators (glycerin); cold clammy sweat; shortness of breath, heart rhythm disturbances (in 40 percent of cases). It must be remembered that myocardial infarction can occur without pain. This atypical variant occurs when the patient has a decompensated form of diabetes mellitus. Cardiosclerosis Cardiosclerosis is characterized by the replacement of cardiac muscle tissue with connective tissue fibers. As a rule, cardiosclerosis is a consequence of long-term ischemic heart disease. The main reason for it is hypoxia (oxygen starvation). Hypoxia is the main stimulator of connective tissue proliferation. Therefore, when the heart lacks oxygen for a long time, its tissue is replaced by connective tissue fibers. In cardiosclerosis of atherosclerotic origin, the proliferation of connective tissue occurs diffusely. The structure and architecture of the myocardium is lost. Connective tissue, unlike muscle tissue, does not have such contractility. Therefore, as the connective tissue grows, heart failure develops. It is expressed in the fact that the heart begins to contract with much less force. Accordingly, it can no longer provide normal blood supply to the body. The patient develops shortness of breath, rapid heartbeats, and swelling in the legs progresses. There are contraindications. Before use, you should consult a specialist.

According to statistics, diseases associated with atherosclerosis rank first among the most likely causes of death. The disease can develop unnoticed over a long period of time, but against its background there are frequent cases of sudden death or acute myocardial infarction. Therefore, it is very important to know why vascular atherosclerosis develops and what treatment methods exist.

Atherosclerosis is a condition in which fatty deposits accumulate on the walls of the arteries, which can limit blood flow to a greater or lesser extent. At the early stage of development of the disease, there are practically no symptoms, but later a whole “bouquet of diseases” may arise.

If earlier this disease was preferably identified in older people, today it is diagnosed at a relatively young age (men under 55 years of age or women under 65 years of age).

Despite advances in the diagnosis and treatment of atherosclerosis, the condition continues to affect many people. Determining this disease at a relatively young age is especially difficult. Further, serious complications can affect health and significantly worsen the patient’s quality of life.

Video: Cholesterol and atherosclerosis. Vascular atherosclerosis symptoms and treatment

Description of vascular atherosclerosis

Atherosclerotic cardiovascular disease (ASCVD) is caused by the accumulation of cholesterol plaques in the arteries and often causes:

• acute coronary syndrome;
• peripheral arterial disease;
• myocardial infarction;
• stroke.

Atherosclerosis is a leading cause of morbidity and mortality in the United States. Dyslipidemia, diabetes mellitus (DM), obesity, inactive lifestyle, hypertension, smoking and family history are the major risk factors for atherosclerosis. Determination of the 10-year risk in patients associated with the occurrence of

ASCVD is fundamental to determining the need to lower cholesterol levels.

Testing of lipids, including total cholesterol, low-density lipoprotein cholesterol (LDL-C or LDL), high-density lipoprotein cholesterol (HDL-C or HDL) and triglycerides, has traditionally been part of ASCVD risk assessment. Testing is also used for screening and monitoring. Non-traditional new markers such as apolipoproteins, lipoprotein particles and high-sensitivity C-reactive protein (hsCRP) are also gaining acceptance in the assessment of high-risk patients.

Mechanism of development of atherosclerosis

In ASCVD, the arteries (blood vessels that carry oxygenated blood from the heart to other parts of the body) become narrowed because fat (represented by cholesterol) deposits on the inner walls of the vessels and then grows fibrous tissue and calcifies. In this way, an atherosclerotic plaque is formed.

An increase in the size of the plaque leads to a narrowing of the lumen of the artery. This causes a decrease in the amount of oxygen supplied and disruption of blood supply to the affected organ (for example, the heart, eyes, kidneys, lower extremities, intestines, or brain structures). The plaque can eventually completely block the artery, causing ischemia and tissue death. According to this principle, a heart attack or stroke most often develops.

• When the arteries of the heart (coronary arteries) are affected by atherosclerosis, a person may develop angina, heart attack, congestive heart failure, or abnormal heart rhythms (arrhythmias).
• When cerebral arteries are damaged by atherosclerosis, a person has an increased risk of having a stroke, called a transient ischemic attack. In extreme cases, death of brain tissue occurs, that is, a stroke.

Vascular atherosclerosis is a progressive condition that can begin in childhood. Fatty deposits often accumulate in the aorta (the largest blood vessel that supplies blood to both the upper and lower parts of the body) shortly after birth. If you have a hereditary predisposition to high blood cholesterol, the condition may begin to worsen after age 20 and gradually become more pronounced in your 40s and 50s.

Lipid deposits like cholesterol are deposited inside the vessels, which obstruct blood flow. They are dangerous due to complete blockage of the vessel.

Reasons for the development of atherosclerosis

The exact cause of vascular atherosclerosis is not fully understood, but risk factors for the development and progression of ASCVD have been identified. Risk factors can be divided into modifiable factors, which can be changed, and those that cannot be corrected (non-modifiable).

Risk factors that can be modified:

1. High blood pressure.
2. High levels of cholesterol in the blood, especially low-density lipoprotein (LDL).
3. Smoking cigarettes
4. Diabetes.
5. Obesity.
6. Lack of physical activity.

A diet with excess consumption of fatty meats, dairy products, eggs and fast foods (McDonald's syndrome) and a low intake of fruits, vegetables and fish is important.

Risk factors that cannot be changed:

1. Elderly age.
2. Male gender (women are at lower risk of developing ASCVD, but only before menopause).
3. Having a close relative who had heart disease or stroke at a relatively young age (genetic predisposition, especially if there is familial hypercholesterolemia, that is, high cholesterol).

Additionally, it is noted that Africans are at increased risk of excessive and early increases in blood pressure, which leads to premature stroke, heart attack, congestive heart failure and death.

Video: Atherosclerosis - how and why blockage of blood vessels occurs

Symptoms of vascular atherosclerosis

Arteriosclerosis often does not cause symptoms until the lumen of the affected artery is narrowed to a critical extent or completely blocked.

Symptoms of atherosclerosis vary greatly and can range from minor signs (in the early stages of the disease) to symptoms of a heart attack or stroke (when the lumen of the artery is partially or completely blocked). Sudden cardiac death may also be the first symptom of coronary artery disease.

Symptoms depend on the location of the arteries affected by atherosclerosis.

If affected coronary arteries, nourishing the heart, then a person may develop:

• chest pain;
• dyspnea;
• sweating;
• anxiety.

Chest pain (as with angina) due to insufficient blood flow to the heart muscle is usually felt with exertion and disappears with rest. In its classic form, angina is a heavy, squeezing and depressing sensation in the middle of the chest. Rarely, angina may occur at rest. More often than not, this indicates a more unstable atherosclerotic plaque and possibly a risk of heart attack.

Many types of chest pain are not due to the development of angina, including pain in the muscles and ligaments in the chest, damaged lungs surrounding the heart, and a painful esophagus, which runs through the chest behind the heart.

If affected carotid or vertebral arteries, supplying the brain, a person can be determined by:

• numbness;
• weakness;
• loss of speech;
• difficulty swallowing;
• blindness;
• paralysis of a part of the body (usually the right or left side).

Defeat arteries supplying the lower limbs , causes peripheral vascular disease. In particular, the patient may have severe pain in the legs, which usually occurs when walking and goes away when stopping (intermittent claudication). When the disease is severe, pain may be felt even at rest and/or at night. With this variant of the course of the disease, the skin on the legs becomes dystrophic, a wound appears, which often heals poorly, which, if left untreated, leads to amputation.

Involvement of the renal arteries in the atherosclerotic process causes symptoms of high blood pressure. In severe cases, kidney failure occurs.

When should you see a doctor?

You should see your doctor if you have risk factors for atherosclerosis, especially if you experience any unexplained symptoms that indicate a blocked artery.

If a person has been diagnosed with coronary atherosclerosis, a physician should be consulted before starting any exercise-related treatment program.

Diagnostics

After collecting complaints, the doctor may prescribe the following studies:

1. Physical examination , which involves measuring height and weight and blood pressure in both arms, followed by body mass index (BMI) and waist circumference.
2. Auscultation - unusual sounds or turbulence are heard over blocked arteries in the neck, abdomen and legs, which can sometimes be heard with a stethoscope. Blocked arteries in the heart are not detected by this method.
3. Lipid profile - used to check the level of total cholesterol in the blood, low-density lipoprotein (LDL) or high-density lipoprotein (HDL). Triglycerides are also measured, especially in people with diabetes.
4. Level measurement blood glucose to screen for diabetes, especially if the patient is obese, has high blood pressure, high lipid levels, and/or a family history of diabetes.
5. Standard ECG - record the speed and regularity of the heart rhythm. The test may indicate a previous heart attack. A patient with several severely blocked arteries may have a completely normal ECG.
6. Stress ECG - do an exercise on a treadmill or a stationary bicycle, while the ECG, blood pressure and respiration are constantly recorded. In people suffering from atherosclerosis, this test may indicate a decrease in blood supply to the heart caused by a lack of oxygen. If the patient cannot exercise, then a chemical stimulant is used.
7. Nuclear stress test - involves injecting a radioactive substance into the bloodstream followed by imaging of the heart muscle at rest and immediately after exercise. The images provide insight into myocardial perfusion. If you have coronary artery disease, the blood supply to the affected area is reduced during exercise. The test is more sensitive than a stress ECG and is guaranteed to determine the location of the blocked artery. This diagnostic method is also much more expensive than an ECG.
8. Echocardiography - This study is based on the evaluation of a moving image of the heart, which is visualized on a screen using ultrasound equipment. If the area of ​​the heart is weakened due to a heart attack, the location of the damage can be located and the extent of the damage determined. Echocardiography also detects problems with the heart valves, any fluid in the pericardium, and congenital changes in the heart. The pressure inside the heart cavities is also assessed.
9. Echocardiography using exercise is an alternative to nuclear stress testing. Echocardiography only analyzes the movement of the left ventricle. In the absence of blood flow, the ischemic area stops working. Then, with rest and resolution of ischemia, the muscle begins to move again.
10. Angiography of the affected artery is performed in cases where there are no symptoms and/or the above studies cannot be performed for some reason. This is an invasive procedure performed by a cardiologist in the catheterization department. A special radiopaque dye is injected into the arteries through a thin tube or catheter, which is inserted into the body under local anesthesia, usually in the groin area. Serial x-rays are then taken to visualize the arteries. As a result, the presence of any narrowing is determined as reliably as possible.

Angiography is the most specific test for evaluating coronary artery disease.

Treatment of vascular atherosclerosis

There are various tactics of drug therapy. For example, if there are no significant signs of discomfort due to atherosclerosis, then treatment may be limited to lifestyle changes and proper nutrition. In more complex cases, depending on the indications and contraindications, the following is performed:

• taking medications,
• angioplasty and other surgical interventions.

N the most affordable home remedies for the treatment of atherosclerosis

Lifestyle changes play an important role in slowing the progression of the atherosclerotic process, so the following recommendations should be followed:

1. Eat low cholesterol foods.
2. Increase your consumption of vegetables and fruits.
3. Eat fish at least twice a week.
4. Quit smoking.
5. Lose weight if you are overweight.
6. Perform physical exercises agreed with your doctor.
7. It is important to maintain blood glucose and glycosylated hemoglobin (HbA1c) levels at acceptable levels, which may require taking appropriate medications.

When you stop smoking cigarettes, the risk of developing atherosclerosis quickly and significantly decreases. It is important to know that the likelihood of developing coronary heart disease in people who recently quit smoking is similar to the likelihood of developing coronary heart disease within two years.

Smoking cigarettes lowers the level of good cholesterol (high-density lipoprotein or HDL cholesterol) and increases the amount of bad cholesterol. However, smoking is even more dangerous for people who are at risk of heart disease.

Tobacco consumption increases the amount of carbon monoxide in the blood, which in turn contributes to damage to the intima of the arterial wall. This also facilitates the formation of plaques. In addition, smoking narrows the arteries, which further reduces the amount of blood flowing to the cells.

Drug treatment of vascular atherosclerosis

The goal of treatment is to improve blood flow to the affected parts of the body. To achieve this, risk factor reduction tactics can be used, which can be modified through the following steps:

• Accept drugs to normalize blood pressure if hypertension is noted.
• Involved lmedications to normalize blood glucose levels , which primarily concerns patients with diabetes.
• Use lipid lowering agents , especially if there is an increase in their concentration. These drugs help lower LDL cholesterol and triglycerides and increase HDL cholesterol. Statins are the most commonly used drugs that reduce levels of “bad” lipids, as confirmed by clinical trial results over the past 11 years.

Additionally aspirin should be regularly used by persons with established atherosclerosis of any arteries, as well as in the presence of a high risk (according to analyzes of predisposing factors) of developing this disease. Acetylsalicylic acid inhibits platelet aggregation.

Medicines for the treatment of atherosclerosis

Medicines used to lower blood cholesterol levels are broadly divided into five categories:

1. Statins . Commonly used drugs include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), simvastatin (Zocor) and rosuvastatin (Crestor). Statins inhibit an enzyme that controls the rate of cholesterol production in the body. The tablets are usually taken once a day and are started after tried diets and exercise have not produced the expected results.
2. Bile acid sequestrants . In particular, cholestyramine (Questran, Questran Light, Prevalite, LoCholest), colestipol (Colestid) and colesevelam (Welchol) are used. These drugs help bind cholesterol bile acids in the intestines, which are then excreted from the body in feces. Thus, medications reduce the absorption of consumed cholesterol from the intestines. However, they can cause diarrhea, so many patients cannot tolerate them.
3. Cholesterol absorption inhibitors . The most commonly used drug is ezetimibe (Zetia), which selectively reduces the absorption of cholesterol. This drug is often combined with statins.
4. Nicotinic acid or niacin is a water-soluble vitamin PP that significantly increases the concentration of HDL cholesterol (“good” cholesterol) and reduces the level of LDL cholesterol (“bad” cholesterol). Intense stomach cleansing is the most common side effect.
5. Fibrates : Gemfibrozil (Lopid) and fenofibrate (Tricor) are commonly used in this pharmacological group. They are primarily effective in reducing triglycerides and “bad” cholesterol and, to a lesser extent, helping to increase “good” cholesterol.

Surgical treatment of atherosclerosis

Balloon angioplasty- During this procedure, a catheter with a balloon on the end is used to open blocked or narrowed arteries. A catheter (thin tube) is inserted into the body through a blood vessel in the groin area and moved up to the blocked artery. When the narrowed part of the vessel is reached, the balloon is inflated, thereby pressing the plaque against the arterial wall. As a result, the lumen of the affected artery increased in diameter and blood flow through the previously blocked area improved. A side effect of the procedure may be damage to the vessel wall by the opening balloon, which provokes proliferative changes in the endothelium with repeated stenosis of the vessel and the development of connective tissue.

Stenting- During this minor surgery, a metal tube called a stent is placed in the artery. With its help, the lumen of the vessel, open after successful dilatation, can be maintained as such for a long time. The stent supports the arterial walls and prevents them from closing, which prevents the collapse or hardening of damaged areas of the endothelium. Some stents are coated with special drugs that help prevent endothelial proliferation and re-blocking of the affected artery. After stenting, the patient is asked to take medications to prevent platelets from accumulating on the metal surface.

If lifestyle changes and medications do not help relieve the symptoms of atherosclerosis, and/or angioplasty with stenting cannot be performed for technical reasons, then a method of creating a bypass for blood flow is used.

Bypass surgery- This operation uses arteries or veins from other parts of the body to create a path for blood flow to bypass the blocked artery. This improves blood circulation in the descending parts of the circulatory system.

The operation performed on the coronary arteries is called coronary artery bypass grafting. Lower extremity arterial bypass surgery primarily uses specially designed tubes (grafts) made of tissue, Dacron, or plastic to create the bypass.

Prevention and prognosis for atherosclerosis

It is possible to prevent the development of atherosclerosis by reducing/eliminating modifiable (modifiable) risk factors, determined in each specific case separately (may be high blood pressure, high blood glucose, high blood cholesterol, cigarette smoking, obesity, lack of physical activity ).

You should eat a healthy diet that is low in saturated fat and rich in fruits, greens and vegetables.

If you experience frequent emotional stress, then you need to find ways to reduce or control it. For this, both traditional methods of influence and medications can be used after prior consultation with a doctor.

Fortunately, taking steps to address some risk factors can help change other predisposing conditions. For example, exercise helps an obese person lose weight, which in turn helps lower cholesterol and blood pressure.

Prognosis for vascular atherosclerosis

The prognostic conclusion for atherosclerosis is variable. In some cases, many people with critically restricted blood flow to vital organs such as the heart and brain survive and continue to live for many years. On the other hand, sudden cardiac death may be the first clinical manifestation of atherosclerosis.

Thus, the individual characteristics of a person must be taken into account, monitoring his general condition and identifying his own risk factors. The prognosis is also influenced by the quality of measures used to prevent vascular atherosclerosis.

Video: The whole truth about the treatment of atherosclerosis

Atherosclerosis is a pathological disorder accompanied by the formation of cholesterol deposits on the inner surface of the walls of arterial vessels of the circulatory system. As it progresses, connective tissue grows and atherosclerotic plaques form.

As a result of the pathological process, the lumen of the vessels is blocked, which leads to disturbances in the blood supply to tissues and organs. The result of this disorder is the appearance of cell starvation, both oxygen and starvation due to lack of nutrients.

This disease, according to available medical statistics, is one of the most common diseases. In terms of mortality and disability, this disease is a leader among other ailments.

In the modern world, the disease has ceased to be an ailment affecting the body of older people; the disease has begun to affect even the bodies of people of the young and middle generation.

Classification of atherosclerosis by etiology

There are different types of atherosclerosis, the disease is classified depending on the etiology and area of ​​localization of the pathological process.

The division into types of atherosclerosis depending on its origin was proposed by WHO and supported by domestic specialists in the field of cardiology, vascular surgeons and phlebologists.

In addition, the disease is classified into several types depending on the causes of occurrence, course and stages of development.

Depending on the etiology, pathology is divided into several types: hemodynamic, metabolic, mixed.

The hemodynamic form develops due to increased blood pressure. The maximum risk of cholesterol deposits occurs with this form of disorder at the branching sites of arterial vessels. In places of branching, damage to the protective surface layer of the endothelium occurs under the influence of increased hemodynamic pressure.

Under the influence of destructive factors, the lining of blood vessels acquires increased permeability to low and very low density lipoproteins.

An increase in intimal permeability leads to the fact that cholesterol subsequently begins to be deposited in this area and the formation of a plaque.

In addition, the reasons for the development of this form of atherosclerosis are:

1. development of thrombosis;
2. varicose veins;
3. thrombophlebitis.

An additional factor that provokes the development of the disease is the frequent occurrence of spasms of vascular smooth muscle.

The metabolic form of pathology is called nutritional. This variety occurs as a result of disruptions in carbohydrate and fat metabolism. This pathology develops with an unbalanced diet or with a lack of mineral components in the food consumed. This form of the disease includes atherosclerosis provoked by the occurrence of autoimmune disorders, such as increased activity of thyroid cells, diabetes mellitus or decreased production of sex hormones.

A mixed form of the disease appears when the body is exposed to hemodynamic and metabolic factors.

The formation of blood clots in the lumens of blood vessels leads to disruptions in blood circulation, which in turn cause disruptions in metabolic processes. Hyperlipidemia develops in the patient's body.

Disorders of carbohydrate and fat metabolism lead to increased blood clotting, which provokes the formation of blood clots in the vessels.

As the pathology progresses, fat deposits in the form of stripes and spots form on the walls of blood vessels.

At this stage of progression, the disease is easily treatable if it is detected early and adequate treatment is prescribed.

Classification of atherosclerosis depending on location

Sugar level

Depending on the location of the pathological process, researchers distinguish several types of the disease.

Each form of the disease has its own specific symptoms due to the development of accompanying complications.

The degree of development of associated complications depends on the area of ​​localization.

Any of the atherosclerotic manifestations is a complication of the pathology; for this reason, the disorder is difficult to diagnose at the earliest stages of its development.

Depending on the area of ​​localization of the pathological process, the following types of atherosclerosis are distinguished:

• coronary - damage is detected on the walls of the vascular system that supplies the heart muscle;
• cerebral - damage occurs to the intima of the walls of cerebral vessels;
• obliterating – damage is localized in the arterial vessels that supply the tissues of the lower extremities;
• atherosclerosis of the renal arteries;
• atherosclerosis of the brachiocephalic arteries;
• multifocal form of the disease.

Each type of disease has its own specific symptoms, prognosis and course.

The development of one form or another of the disease occurs under the influence of certain causes - risk factors. Depending on the predominance of one or another factor, a certain form of the disease develops.

Features of the most common atherosclerotic changes

The development of atherosclerotic changes in the vessels of the heart is characterized by a long latent period. It can take more than one year from the appearance of the first fatty spots on the surface of the intima of blood vessels to the formation of full-fledged cholesterol plaques.

Most often, characteristic symptoms appear at the moment when the forming cholesterol deposits significantly disrupt the blood supply to the myocardium. During this period, the development of such complications as cardiac ischemia is observed.

This type of disease is accompanied by the appearance of attacks of angina pectoris and arrhythmia, in addition to this, swelling of the lower extremities occurs.

Further progression of the disease leads to insufficiency of left ventricular function, and an increase in body weight is observed. The most dangerous complication of this form of the disease is myocardial infarction.

The cerebral form of the disease is characterized by the presence of three stages in its development:

1. The first is initial, characterized by the appearance of disorders of a functional nature.
2. The second is characterized by the fact that morphological disorders are added to the functional ones, and the manifestations of the pathological process become more persistent.
3. The third - the last one is manifested by the presence of frequent ischemic attacks, which lead to necrosis of parts of the brain and the loss of certain functions by a person.

The main signs are emotional instability, decreased memory functions and decreased intellectual abilities. With further progression, paresis and paralysis develop.

It is characterized by the formation of cholesterol deposits on the inner surface of the arteries supplying blood to the tissues of the lower extremities.

The main provoking factor is diabetes mellitus and varicose veins. In this type of disease, deposits of LDL and VLDL occur in the hip artery.

The progression of the disease provokes the appearance of symptoms such as numbness and chills in the extremities, and later intermittent claudication occurs.

Obliterating atherosclerosis leads to a change in the natural color of the feet and cessation of hair growth on the affected limb. The last stage is characterized by the appearance of tissue necrosis. Which leads to gangrene.

When cholesterol deposits form in the aorta, an aneurysm may appear, which, if it ruptures, leads to death.

Multifocal atherosclerosis is a generalized lesion of arterial vessels. This disease is different in that it affects almost all the vessels transporting arterial blood in the body.

This variety has no obvious symptoms, which makes it one of the most dangerous and difficult to diagnose.

Over time, in the later stages, signs of damage to the coronary, cerebral arteries and vascular systems of the legs appear.

Classification depending on the degree of plaque development

Soviet specialist in the field of cardiology A. L. Myasnikov proposed a classification of pathology depending on the processes that occur in the vessels.

The classification of atherosclerotic plaques underlies the division of the disease into types and stages proposed by Myasnikov.

There are several types of atherosclerotic plaques that form on the walls of the vascular system of the human body.

There are three stages in the formation of plaques.

In the first stage, cholesterol seals form in the arteries. This stage is characterized by slow progression. There are no characteristic symptoms at this stage of the disease, and identifying the disease is very difficult.

In the second stage, there is a slow increase in the area and volume of the fatty compaction. The growing compaction leads to partial blocking of the lumen, which provokes the appearance of characteristic signs. This stage of the formation of cholesterol deposits is diagnosed using hardware diagnostics.

At the third stage of formation, cholesterol deposits acquire voluminous dimensions and retain a soft structure. At this stage, the risk of plaque detachment from the endothelium or vessel blockage increases. What provokes the development of a heart attack. Stroke and other disorders of the cardiovascular system.

The last stage of plaque formation is characterized by the appearance of the entire spectrum of symptoms characteristic of the disease.

Based on their structure and density, there are 3 types of plaques.

Low stability. The cholesterol accumulation forms a homogeneous structure, no different from the blood flow. This form of plaque is the most unfavorable. She is characterized by rapid growth, and her growth is accompanied by signs of coronary insufficiency. Most often, such plaques are detected only in the later stages of the disease.

Plaques of average stability. These formations have a loose structure and are covered with a fibrous membrane, which has a high tendency to rupture. As this formation grows, a blood clot forms, which has a high probability of breaking off and being transported through the circulatory system. Plaques of this type are easily diagnosed and treatable.

Highly stable plaques consist of collagen fibers and are highly elastic. This formation is characterized by slow growth with simultaneous calcification. This structure makes it difficult to assess luminal stenosis during the diagnostic process.

In addition, deposits are divided into homogeneous and heterogeneous. Depending on the type of plaque, the choice of therapy method depends.

Brief information about atherosclerosis is provided in the video in this article.