Atherosclerosis

Description:

Atherosclerosis (from Greek , "chaff, gruel" and , "firm, dense") — the chronic disease of arteries of elastic and muscular and elastic type arising owing to disturbance of lipidic exchange and which is followed by adjournment of cholesterol and some fractions of lipoproteids in an intima of vessels. Deposits form in the form of atheromatous  plaques. The subsequent growth in them connecting fabric (sclerosis), and calcification of a vascular wall is led to deformation and narrowing of a gleam up to an obliteration (obstruction). It is important to distinguish atherosclerosis from Menkeberg's arteriosclerosis, other form of sclerous damages of arteries of which adjournment of salts of calcium in an average cover of arteries, diffusion of defeat (lack of plaques), development of aneurisms (but not obstruction) vessels is characteristic.

Atherosclerosis symptoms:

Clinical manifestations often do not correspond to morphology. At pathoanatomical opening the extensive and expressed atherosclerotic defeat of vessels can be a find. To the contrary, the clinic of ischemia of body can appear at a moderate obliteration of a gleam of a vessel. Preferential defeat of certain arterial pools is characteristic. The clinical picture of a disease also depends on it. Defeat of coronary arteries gradually results in coronary insufficiency, the shown coronary heart disease. Interest of cerebral  arteries causes either passing ischemia of a brain or strokes. Damage of arteries of extremities — the reason of the alternating lameness and dry gangrene. Atherosclerosis of mesenteric arteries leads to ischemia and a heart attack of intestines (mezenterialny thrombosis). Damage of renal arteries with formation of a kidney of Goldblatt is also possible. Even within certain arterial pools focal defeats — with involvement of typical sites and safety next are characteristic. So, in heart vessels occlusion most often arises in proximal department of a front interventricular branch of the left coronary artery. Other typical localization — proximal department of a renal artery and bifurcation of a carotid artery. Some arteries, for example internal chest, are surprised seldom, despite proximity to coronary arteries both on an arrangement, and on a structure. Ateroskleretichesky plaques often arise in bifurcation of arteries — where the blood stream is uneven; in other words, in an arrangement of plaques the local hemodynamics plays a role.

Atherosclerosis reasons:

At the moment there is no uniform theory of developing of this disease. The following options, and also their combinations move forward:

    * the theory of lipoproteidny infiltration — initially accumulation of lipoproteids in a vascular wall,
    * the theory of dysfunction of an endothelium — initially disturbance of protective properties of an endothelium and its mediators,
    * autoimmune — initially dysfunction of macrophages and leukocytes, infiltration of a vascular wall by them,
    * monoclonal — initially emergence of a pathological clone of smooth muscle cells,
    * virus — initially virus damage of an endothelium (herpes, a cytomegalovirus, etc.),
    * peroxide — initially disturbance of antioxidant system,
    * genetic — hereditary defect of a vascular wall is primary,
    * hlamidiozny — primary defeat of a vascular wall chlamydias, generally Chlamydia pneumoniae.
    * hormonal — age increase in level of gonadotropic and adrenocorticotropic hormones leads to the increased synthesis of construction material for hormones-cholesterol.

Risk factors:
    * smoking (most dangerous factor)
    * giperlipoproteinemiya (general cholesterol> of 5 mmol/l, LPNP> 3 mmol/l, LP(a)> 50 mg/dl)
    * arterial hypertension (systolic ABP> 140 mm hg diastolic ABP> 90 mm hg)
    * diabetes mellitus
    * obesity
    * slow-moving way of life
    * emotional overstrain
    * the use of large amounts of alcohol (the moderate use, on the contrary, reduces risk of a disease)
    * improper feeding
    * genetic predisposition
    * postmenopause
    * fibrinosis
    * gomotsisteinuriya

Treatment of Atherosclerosis:

In the scheme of treatment of atherosclerosis both medicamentous, and non-drug methods are considered.
Non-drug methods of correction of a lipidemia:

For achievement of adequate effect duration of such treatment has to be not less than 6 months. In the scheme of therapy the next moments are key:

    * refusal of smoking
    * an anti-atherosclerotic diet — for example, "Mediterranean": oil only rape or olive, for sandwiches the margarine enriched with polyunsaturated fatty acids (in shops in assortment), from alcohol only table wine to 150 ml a day, is less than bread from high-grade flour, day without fruit and vegetables, it is more than orange fruits, it is more than greens, it is more than fish, it is less than meat (the poultry is better).
    * active lifestyle — the regular dosed exercise stresses.
    * maintenance of psychological and physical comfort
    * decrease in body weight

Medicamentous therapy:
Includes correction of arterial hypertension (especially systolic ABP), a diabetes mellitus, a metabolic syndrome. However the most significant is normalization of a lipidic range. The drugs used for this purpose are divided into four main groups:

    * I \interfering cholesterol absorption
    * II \the reducing synthesis of cholesterol and triglycerides in a liver and reducing their concentration in a blood plasma
    * III \the raising catabolism and removal of atherogenous lipids and lipoproteids
    * IV \additional

Artery operations can be open (endarterectomy) when removal of a plaque or straightening of crimpiness is made by means of open operation, or endovascular — artery dilatation by means of balloon catheters with placement on site of an arteriostenosis of the stents interfering a vessel reokklyuziya (transluminal balloon angioplasty and stenting of an artery). The choice of a method depends on the place and prevalence of narrowing or closing of a gleam of an artery.