How is an atherosclerotic plaque formed?
It all starts with damage to the inner lining of the artery - the endothelium. It is damaged by high blood pressure, components of tobacco smoke, high blood sugar, and an excess of atherogenic cholesterol particles. Low-density lipoproteins penetrate through the damaged wall, oxidize and attract cells of the immune system. They absorb fat, turn into foam cells and die, forming a lipid core. A connective tissue covering grows on top. As long as it is dense, the plaque is stable. If the tire is thin and the core is large, the plaque can tear - and then blood clotting begins to form a blood clot.
- Damage to the artery wall
- Penetration and oxidation of low-density lipoproteins
- Chronic inflammation in the vessel wall
- Formation of the lipid core and cap
- A stable plaque narrows the lumen gradually
- An unstable plaque ruptures and causes thrombosis
Causes and risk factors
Atherosclerosis is a disease with many causes, and most of them can be controlled. Low-density lipoprotein cholesterol levels, smoking, arterial hypertension and diabetes mellitus play a key role. Additional contributors include excess weight, inactivity, chronic stress and lack of sleep. Unchangeable factors are age, male gender and heredity: early heart attacks and strokes in close relatives significantly increase personal risk. Separately, familial hypercholesterolemia is distinguished - a hereditary condition in which cholesterol is high from childhood and vascular events occur early.
- Smoking, including e-cigarettes and hookah
- Elevated low-density lipoprotein cholesterol
- Arterial hypertension
- Diabetes mellitus and prediabetes
- Obesity, especially abdominal obesity
- Low physical activity
- Heredity and familial hypercholesterolemia
Symptoms depending on which arteries are affected
For a long time, the disease is asymptomatic: while the lumen is narrowed by less than half, there is enough blood flow. Complaints appear when an organ stops receiving enough blood under load. If the coronary arteries are damaged, angina occurs - pressing pain behind the sternum when walking or climbing stairs, which goes away with rest. When the arteries of the neck and brain are affected, there are transient episodes of weakness in the limbs and speech impairment. Atherosclerosis of the arteries of the legs gives intermittent claudication: pain in the calves when walking, forcing you to stop.
- Heart: pressing pain behind the sternum on exertion, shortness of breath
- Brain: dizziness, episodes of weakness and speech problems
- Legs: pain in calves when walking, chilliness, hair loss on legs
- Kidneys: difficult to treat hypertension
- Intestines: abdominal pain after eating, weight loss
- Sexual area: erectile dysfunction as an early sign
Diagnostics
The examination begins with a conversation, measuring blood pressure, waist circumference and calculating cardiovascular risk. The lipid spectrum is required: total cholesterol, low and high density lipoproteins, triglycerides. Check glucose and glycated hemoglobin, creatinine, and, if necessary, liver parameters. Visual information is provided by ultrasound examination of the carotid arteries with measurement of the thickness of the intima-media complex and arteries of the legs with measurement of the ankle-brachial index. If cardiac ischemia is suspected, an ECG, stress tests, echocardiography are performed, and for intervention planning, CT angiography or coronary angiography is performed.
- Fasting lipid spectrum
- Blood glucose and glycated hemoglobin
- Ultrasound of the carotid arteries with intima-media assessment
- Dopplerography of the arteries of the lower extremities
- ECG and stress tests
- CT angiography and coronary angiography according to indications
Treatment and prevention
The goal of treatment is not just to reduce test numbers, but to reduce the risk of heart attack and stroke. The basis is lifestyle: complete cessation of smoking, regular walking for at least 150 minutes a week, a diet with a predominance of vegetables, legumes, whole grains, fish and vegetable oils, limiting industrial baked goods, sausages and sweet drinks. Drugs that lower cholesterol, drugs to control blood pressure and sugar, and, if indicated, antiplatelet agents are used medicinally. The doctor selects target values and specific medications. If the artery is critically narrowed, stenting or bypass surgery is performed.
- Complete smoking cessation is the fastest effect
- Regular aerobic exercise
- Mediterranean type of nutrition
- Reducing weight and waist circumference
- Control blood pressure below 140/90 mm Hg. Art. and target values named by the doctor
- Lipid-lowering therapy as prescribed by a doctor
- Stenting or shunting for critical narrowing
