Atherosclerosis is a disease characterized by the accumulation of cholesterol, fatty substances, and other materials, such as calcium and platelets, within the walls of the arteries.
This buildup can lead to the thickening and hardening of the arterial walls, reducing the lumen (internal diameter) of the blood vessels. Over time, this process may result in partial or complete blockage of the arteries, impairing blood flow to vital organs and tissues.
The terms atherosclerosis and arteriosclerosis are sometimes confused. While arteriosclerosis refers to the general thickening and stiffening of the arterial walls, atherosclerosis is a specific type of arteriosclerosis caused by the accumulation of fats (such as cholesterol and triglycerides), along with other substances like calcium and platelets. This leads to the formation of atherosclerotic plaques that can narrow the arteries and hinder blood flow.
The increase in circulating cholesterol and triglycerides, especially LDL cholesterol (or “bad” cholesterol), leads to the accumulation of these substances as plaques inside the artery walls (atherosclerotic plaques or atheromas).
In addition to LDL cholesterol, high levels of apolipoprotein B100, or Apo B100, are now considered a key factor promoting the formation of cholesterol plaques in the arteries.
These plaques tend to calcify, obstructing blood flow, and can sometimes break off and travel through the bloodstream (embolization), a common cause of myocardial infarction (heart attack) and cerebrovascular accidents (strokes).
In some cases, this narrowing caused by plaques can lead to the formation of clots, which may travel until they encounter a narrower blood vessel, blocking it and potentially causing a stroke, heart attack, or pulmonary embolism.
Generally, atheromatous plaque formation is believed to result from a combination of arterial damage, elevated blood fats, and inflammation triggered by factors such as smoking.
The main risk factors for developing atherosclerosis are:
Atherosclerosis can be a contributing factor in the following conditions:
Generally, a cardiovascular risk assessment is recommended for every healthy person over 40 during any medical consultation. This test helps estimate the likelihood of an atherosclerosis-related event, such as a heart attack, that could be fatal within the next ten years.
Additionally, this cardiovascular risk test is recommended for individuals of any age who have at least one risk factor for atherosclerosis.
In Europe, the SCORE index (Systematic Coronary Risk Estimation) is used, which takes into account factors like total cholesterol levels, age, sex, smoking habits, and systolic blood pressure. In the United States, similar calculations include the AHA/ACC risk estimator and the Framingham Risk Score (FRS), which also consider factors like diabetes and race.
Signs of ischemia in various organs should be monitored, including chest tightness with exertion, leg pain when walking (intermittent claudication), sudden loss of strength in the hands, facial paralysis, and sudden vision or hearing loss.
A general examination may reveal abnormal heart murmurs due to artery narrowing near the heart, reduced pulses in the limbs, skin changes, and other findings depending on the location of atherosclerosis.
In lab tests, cholesterol levels, especially LDL, triglycerides, and apolipoprotein B100, will often be elevated.
From here, various exploratory techniques can be performed depending on the affected organs:
Treatment goals are determined based on calculated cardiovascular risk.
The initial approach involves a diet aimed at weight loss, lowering cholesterol and triglyceride levels, along with regular exercise.
Medications are used to lower lipids and cholesterol, but there are limited options for removing already established atheroma plaques.
Anticoagulants are often prescribed, especially for individuals who have experienced blood clots (thrombosis or embolism).
The most commonly used medications include:
In cases where specific arteries are significantly narrowed, surgical procedures such as endarterectomy may be performed to remove plaques. If the issue is in the coronary arteries, stents may be placed to widen the affected arteries.
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