What is severe atherosclerosis. Vascular atherosclerosis: first manifestations, symptoms and treatment. Manifestations of atherosclerosis of the vessels of the legs

The basis of the vascular wall is muscle fibers, it is covered on the outside by a connective tissue adventitia membrane, from the inside - by the endothelium, which, together with the underlying thin layer of connective tissue, forms the inner shell of the vessel - the intima.

The endothelium has a barrier function and repels cellular elements Therefore, intravascular thrombosis does not normally occur. If the structure of the intima is disturbed, leukocytes migrate to the site of damage, and lipoproteins precipitate from the bloodstream - the process of formation of an atherosclerotic plaque begins.

Causes and signs of atherosclerosis

There is no unified theory of the development of atherosclerotic lesions, however, most scientists and clinicians consider damage to the vascular endothelium and a decrease in its barrier function to be the starting point for plaque formation. The damaged area of ​​the inner lining of the artery becomes a target for atherogenic factors.

Elevated blood levels of atherogenic low-density lipoproteins also contributes to the progression of atherosclerotic lesions. At the initial stage, the damaged intima is impregnated with lipoproteins - an atheromatous spot is formed - the initial stage of plaque formation.

Nonlinear blood flow is normally observed in the places where the arteries branch, and when they spasm and increase blood pressure, it can occur anywhere. In this case, favorable conditions are created both for damage to the endothelium and for the deposition of lipoproteins.

Risk factors for atherosclerosis

Atherosclerosis is a polyetiological process. This means that for the occurrence of a lesion, a combination of several unfavorable factors is necessary, and not just one trigger.

In this case, they often talk not about the causes, but about the risk factors for the disease. These include:

• Smoking- nicotine provokes vasospasm and adversely affects the barrier properties of the endothelium. In addition, chronic nicotine intoxication leads to a change in the ratio of atherogenic and non-atherogenic lipoproteins in the peripheral blood, which is an additional cause of plaque formation.
• Irrational nutrition, alcohol abuse and a sedentary lifestyle can lead to causes of lipid metabolism disorders and obesity, and also provoke an increase in blood pressure. The combination of increased low-density lipoprotein content and increased pressure gives impetus to the onset of atherogenesis.
• Emotional overload in combination with reduced physical activity: stress response (preparation of the body for intense physical activity). If this mechanism is not implemented, the action of stress hormones is too long and causes damage to the endothelium.
• Gender and age: female sex hormones prevent damage to the vascular wall, so atherosclerotic vascular lesions in women often occur after menopause. In general, the likelihood of developing the disease increases with age.
• Heredity: some structural features of the endothelium and fat metabolism, inherited, create favorable conditions for the formation of atherosclerotic plaques.

Classification

Depending on which factor is primary, the hemodynamic and metabolic forms of atherosclerosis are distinguished. In the first case, vascular disorders are primary (structural abnormalities, inferiority of the endothelium,), in the second - metabolic disorders (increased levels of low-density lipoproteins, hyperglycemia).

Depending on the period of the flow, there are three phases:

• The initial phase (preclinical) proceeds without symptoms. Changes in the lining of the vessels are already taking place, but they are not sufficient to disrupt the function of an organ or tissue. At this stage, atherosclerosis can be detected by laboratory parameters, so a biochemical blood test for lipoprotein content is included in the list of studies that are mandatory when undergoing a preventive medical examination.
• Deployed phase clinical manifestations, which, in turn, is subdivided into:
  • ischemic- the formed plaque partially blocks the lumen of the vessel, while the blood supply to the tissues suffers; with increased load, ischemic damage becomes apparent; in relation to coronary vessels - this;
  • thrombonecrotic- an overgrown atheromatous plaque is easily injured, provoking vessel thrombosis, while the blood supply to the tissue is completely stopped, and it can become necrotic; an example of clinical manifestations at this stage is either, dry gangrene or mesenteric thrombosis.
• The sclerotic stage is characterized by a persistent narrowing of blood vessels and a gradual connective tissue degeneration of the tissue, for example, cerebro- or cardiosclerosis.

Depending on the activity of the course of the atherosclerotic process, there are:

• progressive atherosclerosis - the formation of new or growth of formed atheromatous plaques continues, clinical manifestations gradually worsen, the risk of complications is high;
• stabilized atherosclerosis - the development and formation of new plaques stops, clinical manifestations remain unchanged or regress, the risk of complications is low;
• regressive atherosclerosis - clinical symptoms are declining, the general condition and laboratory blood counts are improving.

What are the main symptoms of atherosclerosis?

On the initial stages the formation of an atherosclerotic plaque is asymptomatic, vascular obstruction is not so strong as to cause clinical manifestations.

Circulatory disorders in tissues begin at the stage of fibrosis and plaque calcification, and signs of atherosclerosis are determined by the location of the lesion:

• atherosclerosis of the arteries of the brain is manifested by chronic headache, memory impairment, decreased mental performance and concentration of attention; the progression of the process can lead to personality changes and mental disorders; a typical complication that occurs when the lumen of the vessel is completely closed -;
• atherosclerosis of the coronary arteries leads to the development of coronary heart disease; clinically, it manifests itself in the form of attacks of severe pain behind the sternum in the region of the heart after physical or emotional stress, as well as a decrease in physical performance; a plaque can completely block the lumen of the coronary artery or provoke its thrombosis - in this case it will develop;
• atherosclerosis of the arteries abdominal cavity leads to partial or complete ischemia of the mesentery and intestines; in the first case, pain after eating, bloating and stool disturbances are disturbing, in the second case, acute thrombosis of the mesenteric vessels occurs - a condition requiring emergency surgical care;
• atherosclerosis of the aorta is manifested by chronic arterial hypertension; with a long course, an aortic aneurysm may occur.

Diagnostics

Based on the patient's complaints and changes identified during the clinical examination, the doctor may suspect the presence of atherosclerosis. To clarify and confirm the diagnosis, laboratory and instrumental studies are prescribed:

• Blood chemistry for cholesterol content. Using this method, both total cholesterol and the ratio of the level of high and low density lipoproteins are determined. The latter have a high atherogenic potential, therefore, an increase in their level, especially in combination with a decrease in the level of high density lipoproteins, indicates an active course of the atherosclerotic process.
• X-ray methods of research. A chest x-ray is performed if aortic atherosclerosis is suspected, it can be used to judge the degree of its deformation and the presence of calcifications. To study smaller vessels, angiography (coronary angiography, cerebral angiography) is used - obtaining a series of radiographs after intravascular injection of a radiopaque substance. With this study, you can see the localization and size of plaques, as well as assess the degree of narrowing of the lumen of the vessel.
• ultrasound more often used to study the vessels of the extremities, it can also be used to detect the presence of plaques and assess the degree of narrowing of the vessel.

Treatment of atherosclerosis

Treatment of atherosclerosis without fail includes lifestyle correction and control of the course of concomitant diseases (diabetes mellitus). If this is not enough, medication is prescribed.

With damage to the vessels of the extremities, the heart or the vessels of the mesentery, it is possible to restore their patency surgically.

Non-drug treatment of atherosclerosis

• Diet low in cholesterol. The best option is the Mediterranean diet. Recommended use olive oil, fish and seafood, greens, fresh vegetables and fruits. Fatty meats are excluded, chicken fillet and lean beef are recommended from meat dishes.
• Rational physical activity contributes to the normalization of vascular tone, is the best prevention obesity and arterial hypertension.
• Quitting smoking and drinking alcohol, minimizing stressful situations. It is very important to learn how to cope with stress without the use of drugs and psychoactive substances.
• Lifestyle correction is the basis of atherosclerosis therapy, without which no drugs and surgical methods will not be effective. For treatment, medications are used that prevent the absorption of cholesterol in the digestive tract or accelerate its breakdown. The selection of the drug and dose should be carried out by a doctor.

Surgery

• Removal of the affected vessel if the blood supply can be restored due to the compensatory development of collaterals. Most often, these are the arteries of the extremities of medium caliber. The affected vessel is removed at a high risk of thrombosis, thrombus separation and related complications.
• Balloon angioplasty or coronary stenting is used in case of damage to the vessels of the heart in order to restore the blood supply to the heart muscle in case of a critical narrowing of the lumen of the supplying artery.

Prevention

The only reliable way to prevent atherosclerotic vascular disease is healthy lifestyle life. Studies have shown that the first cholesterol spots can appear on the walls of blood vessels already in childhood, so prevention should begin from childhood.

You can prevent complications with already developed atherosclerosis if you take prescribed drugs and follow the recommendations of your doctor. If there are concomitant diseases, their treatment is also a mandatory measure in the prevention of complications.

Prognosis for atherosclerosis

Subject to lifestyle correction, smoking cessation and timely treatment favorable prognosis: stabilization and even regression of the atherosclerotic process is quite possible. Regression of atherosclerosis is possible only at the initial, preclinical stage. If any major symptoms of atherosclerosis have already appeared, supportive treatment will be lifelong.

When treatment is refused and risk factors persist, the likelihood of complications becomes extremely high. In this case, the prognosis, both for the health and for the life of the patient, is unfavorable.

Found an error? Select it and press Ctrl + Enter

Atherosclerosis in medicine is a disease in which there is a systemic lesion of blood vessels (arteries) of large and medium diameter as a result of the deposition of lipids on their inner surface. According to statistics provided by the Institute of Therapy, it is this pathology that causes death in 3% of all cases recorded in the world. At the same time, in young people such a diagnosis is posthumously recorded in 2%, in the elderly - in 25%, in people of advanced age up to 39% of cases.

According to the same statistics, vascular atherosclerosis is the cause of myocardial infarction, stroke, coronary disease, and other fatal diseases. dangerous pathologies human cardiovascular system. Over the past decade, this pathology has been diagnosed 1.5 times more often, which indicates a rapid deterioration in the health of the world's population. Age statistics is also deteriorating - the disease is more often recorded in young people.

Atherosclerosis mainly affects the large arteries human body: carotid and cerebral arteries, renal, cardiac and abdominal aorta. The disease is based on a change in metabolic processes, in which there is an excessive accumulation of heavy cholesterol and β-lipoprotein in the blood against the background of a decrease in the amount of phospholipids and proteins. The result of this imbalance is a systematic change in the vascular walls, passing through several stages. As they occur, the following changes occur:

1. The stage of a lipid (fatty) spot, in which edema and loosening of the epithelium appear on the surface of the vascular wall. At this stage, vascular damage is not deadly; moreover, it is practically impossible to diagnose, since lipid deposits on the lesions are located on the inner lining of the arteries in the so-called intima. Localization of lipid spots - mainly in the branches of the arteries.
2. The stage of liposclerosis or the growth of a lipomatous plaque due to the active formation of connective tissue in the affected area. At this stage, it is quite easy to eliminate such neoplasms, since drugs for the treatment of atherosclerosis easily dissolve still soft plaques. On the other hand, it is at this stage of the development of the disease that there is a high probability of fragment detachment with subsequent blockage of the arterial lumen. This stage of atherosclerosis is characterized by a change in the physical characteristics of the vascular wall - it becomes less elastic and is easily traumatized.
3. The stage of atherocalcinosis or thickening of an atherosclerotic plaque due to its saturation with calcium salts. At this stage, pathological changes reach their peak - deposits grow and limit blood flow due to deformation of the vascular walls. At this stage, atherosclerosis of the arteries is expressed by the formation of foci of necrosis or gangrene on the limbs and organs that feed the damaged vessel.

In addition to the described changes, the main cause of atherosclerosis may be infection with the herpes virus, cytomegalovirus, chlamydia, mutation of epithelial cells circulatory system, hereditary pathologies causing changes in lipid metabolism. Despite the initial causes of atherosclerosis, the disease in any case goes through all the stages described above.

Factors and risk groups

Experts identify several population groups for which atherosclerosis risk factors are most relevant:

1. By age - people over 40-50 years old.
2. By gender, men are more susceptible to the disease than women.
3. Heredity - the risk of atherosclerosis is higher in those whose relatives have such a diagnosis.

These factors are insurmountable and cannot be changed by man. In medicine, they are given the definition of "indestructible."

The second group of factors that provoke the occurrence of atherosclerosis is called potentially removable. These include systemic pathologies that lead to changes in the functions of the cardiovascular system. Their negative impact can be avoided if the patient takes the drugs recommended by the doctor.

Conditionally eliminated factors include:

1. Arterial hypertension.
2. Dyslipidemia, or elevated blood cholesterol levels.
3. Intoxication with infectious agents.
4. Diabetes.
5. Obesity.

Removable factors of atherosclerosis include predominantly unhealthy lifestyle and bad habits: smoking, alcoholism, physical inactivity and unbalanced diet. They provoke the occurrence of diseases that, in the absence of therapy, are complicated by atherosclerosis. Such factors significantly accelerate the progress of the disease and increase the risk of death from atherosclerosis.

Symptoms of the disease

Clinical signs of atherosclerosis appear only with the active progression of the disease, when the lumen of the blood vessel narrows by 50 percent or more. In general, the symptoms depend on which vessels have undergone pathological changes.

Manifestations of atherosclerosis of the aorta

If pathological process occurs in the aortic arch and its branches, patients develop symptomatic hypertension. This type of atherosclerosis is accompanied by a syndrome of circulatory failure of the brain and upper shoulder girdle. The disease is accompanied by the following symptoms and clinical manifestations:

• an increase in systole indicators against the background of normal or reduced dystole indicators;
• headaches and dizziness;
• fainting states;
• paresthesia and feeling of weakness in the arms

If vascular the process began in the abdominal aorta, the main symptoms of atherosclerosis are the weakening of blood pulsation in the femoral and popliteal arteries, disruption of some internal organs(more detailed symptoms will be discussed later).

Since treating atherosclerosis with such phenomena does not begin immediately, the disease can be complicated by an aneurysm of various parts of the aorta. This causes the following symptoms:

• with damage to the ascending aorta - prolonged aching or squeezing pain in the chest, arising and fading gradually;
• with damage to the aortic arch - hoarseness, difficulty breathing, displacement of the larynx;
• with damage to the descending aorta - pain in the chest and back, a feeling of squeezing the esophagus.

Aortic dissection is accompanied by intense pain in the chest, in the epigastric region. The patient at the same time suffers from lack of air and severe weakness due to a critical decrease in blood pressure.

Aortic dissection is considered fatal dangerous phenomenon. The survival rate with it is less than 50%, and only if medical care is provided in a timely manner.

Manifestations of atherosclerosis of the mesenteric vessels

With damage to the mesenteric vessels, it is important to recognize the typical signs of pathology in time, since this type of atherosclerosis manifests itself clinically similar to an exacerbation peptic ulcer. Objectively, the patient can observe:

• bloating;
• absence or significant weakening of peristalsis;
• pain when trying to palpate upper part abdomen
• slight stress abdominal wall.

The main symptoms of atherosclerosis of the vessels of the abdominal cavity are pain that occurs after eating. Pathology can be differentiated by the lack of effect from taking medications intended to normalize digestion. At the same time, taking nitroglycerin quickly stops the attack.

With untimely therapy, atherosclerosis of this variety ends with a sudden onset of thrombosis, which is accompanied by wandering or localized abdominal pain, stool retention, vomiting mixed with bile and blood. Misdiagnosis and delayed treatment can lead to intestinal gangrene.

Manifestations of atherosclerosis of the renal arteries

With damage to the renal artery, the disease is accompanied by a steady increase in blood pressure. Clinical course atherosclerosis is smooth, without sharp exacerbations. If thrombosis of the renal vein occurs, the patient may be disturbed by pain in the lower back and abdomen, signs of dyspepsia.

Manifestations of atherosclerosis of the vessels of the legs

Atherosclerotic changes lower extremities are manifested by the syndrome of intermittent claudication, paresthesia and a feeling of cold in the limb. An external examination of the legs can reveal the following signs of the disease:

• weakening of the pulsation;
• trophic ulcers on the fingers, shins or heels;
• blanching of the skin;
• thinning and dry skin.

Vein thrombosis, which occurs against the background of atherosclerotic changes, leads to increased pain and the appearance of greatly enlarged veins in the legs.

Manifestations of atherosclerosis of cerebral vessels

In a disease such as atherosclerosis, the classification includes damage to the cerebral vessels. This type of disease is expressed by a significant deterioration in the functioning of the central nervous system, which is expressed:

• decrease in working capacity;
• deterioration of attention and memory;
• decrease in intelligence;
• sleep disturbance;
• dizziness.

The patient may also suffer from headaches. There are also significant changes mental state. This subspecies of atherosclerosis is dangerous with such a complication as a stroke.

Manifestations of atherosclerosis of the coronary arteries

With the defeat of the coronary arteries, the patient complains of pain behind the sternum, a feeling of weakness and fatigue. During an exacerbation of the disease, there is a feeling of numbness in the left hand, shortness of breath. Attacks are accompanied by fear of death, clouding or complete loss of consciousness. The danger of this type of pathology is the high risk of death due to myocardial infarction.

Diagnosis of vascular atherosclerosis

When contacting the clinic, the attending physician collects an anamnesis and finds out the patient's complaints, on the basis of which it is already possible to draw up an initial picture of the disease. To clarify the diagnosis are used the following types diagnostics:

• auscultation of coronary vessels;
• measurement of blood pressure;
• laboratory blood tests;
• aortography and coronary angiography;
• angiography;
• Ultrasound and ultrasound.

Additionally, consultation with a cardiologist, neurologist or psychiatrist may be required.

Treatment methods for the disease

The main treatment for atherosclerosis of the vessels is to take medications and change the lifestyle of the patient. First of all, the patient is prescribed a complex of drugs, the action of which is aimed at lowering blood cholesterol and reducing tissue hypoxia (especially with damage to the coronary and cerebral vessels). In this case, apply:

• drugs nicotinic acid in the form of tablets and injections;
• bile acid sequestrants;
• statins;
• fibrates.

The listed groups of drugs for atherosclerosis are prescribed in accordance with the presence of indications and contraindications, and the dosage is calculated on an individual basis.

A strict diet, which implies a decrease in the amount of animal fats, can also improve the patient's condition. Nutrition should comply with the principles of the treatment table No. 10c. With an uncomplicated course of the disease, diet No. 5 is used.

With a high probability of occlusion of the affected vessels, patients are shown surgical treatment:

• endarterectomy - open surgery;
• endovascular therapy - minimally invasive operations on the arteries.

During these procedures, stents are placed in the artery or the artery is dilated using balloon catheters. Coronary artery bypass grafting is performed in case of damage to the coronary vessels.

Atherosclerosis is a fairly common chronic disease characterized by its own progression. Atherosclerosis, the symptoms of which appear against the background of lesions of medium and large arteries due to the accumulation of cholesterol in them (which determines the cause of this disease), causes circulatory disorders and a number of serious risks provoked by this disorder.

general description

With atherosclerosis, atherosclerotic plaques form on the walls of blood vessels (they are based on fatty deposits in combination with growing connective tissue). Because of these plaques, narrowing of the vessels and their subsequent deformation occur. These changes, in turn, lead to impaired blood circulation, as well as damage to internal organs. Basically, large arteries are affected.

Let us dwell in more detail on the picture of this disease. First of all, we note that the occurrence and subsequent formation of atherosclerosis depends on the following factors:

• the state in which the vascular walls are located;
• the relevance of the genetic hereditary factor;
• disorders in fat (lipid) metabolism.

Initially noted cholesterol refers to fats, with its help a number of different functions are provided in our body. In other words, it can be considered as a building material used in cell walls. In addition, cholesterol is a component of vitamins and hormones, due to which adequate vital activity of the body is ensured. Cholesterol is synthesized by about 70% of its total amount in the liver, while the remaining part of it enters the body through food.

Note that cholesterol in the body is not in a free state, it is included in the composition of specific complex compounds of fats and protein - lipoproteins. Lipoproteins, in turn, provide the possibility of its transfer from the liver to the tissues through the bloodstream. If the cholesterol in the body is in an excessive state, then from the tissues it goes to the liver, and it is here that the excess amount is utilized. Violation of the functioning of this mechanism leads to the development of the disease we are considering, that is, atherosclerosis.

In the development of atherosclerosis, the main role is assigned to low-density lipoproteins, in an abbreviated form, this is LDL. At their expense, cholesterol is transported from the liver to the cells, while a strictly defined amount of it is subject to such transportation, otherwise an excess of the level determines a serious risk for the possible development of atherosclerosis against this background.

As for the return transport of cholesterol from tissues to the liver, it is already provided by high-density lipoproteins, which in an abbreviated version defines them as HDL, a separate class of anti-atherogenic lipoproteins. They provide cleansing of the surface layer of cells from excess cholesterol. The risk of developing atherosclerosis occurs with a low level of HDL cholesterol and with an increased level of LDL.

Let us dwell on the age-related features of atherosclerosis. So, it can be noted that the initial type of changes within the walls of the arteries (their medium and large caliber) are already noted at a young age. Subsequently, their evolution occurs, in which they are transformed into fibroadenomatous plaques, which, in turn, often develop after the age of 40 years. The specified atherosclerotic vascular lesion is actual in about 17% of cases in patients under the age of 20 years, in 60% - under the age of 40 years, in 85% - in the age of 50 years and older.

In the future, the picture of the disease is as follows. The arterial wall undergoes penetration into its base of fibrin, cholesterol and a number of substances, due to the influence of which an atherosclerotic plaque is formed. Being in excess, cholesterol, when exerting an appropriate effect, causes an increase in the plaque in size, due to which there is an obstacle to adequate blood flow through the vessels in the area of ​​the formed narrowing. Against this background, blood flow decreases, inflammation develops. Blood clots are also formed, they can subsequently come off, thereby determining a significant danger to the vessels that are vital in our body. This is due to the possibility of their blockage, because of which, in turn, the organs will be deprived of the blood supply they require.

Causes of atherosclerosis

The causes of atherosclerosis can be very different, they are also equated with risk factors for the development of atherosclerosis, which indicates that the compliance of conditions with these factors increases the risk of possible development of atherosclerosis in patients. In general, such risk factors can be divided into two main groups, depending on the nature of the impact on them by the patient himself. Thus, the causes of atherosclerosis can be changeable and unchangeable (modifiable and non-modifiable).

Immutable (non-modifiable) reasons, as can be determined already from their name, it is impossible to change by certain measures of influence (including medical ones). These factors include the following:

• Floor. This factor is considered as an independent risk factor in considering the development of atherosclerosis. Atherosclerosis in men develops about 10 years earlier, which is known on the basis of certain statistical data on this subject when compared with female morbidity. In addition, before the age of 50, the risk of developing this disease in men is four times higher than, respectively, in women. When the threshold of 50 years of age is reached, the incidence in both sexes is equalized. This feature is explained by the fact that female body from this period, specific hormonal changes begin, and the protective function provided by estrogens disappears (here, as you can understand, we are talking about menopause and a gradual decrease in the intensity of the release of these estrogen hormones).
• Age. As the reader may have already noticed, with age, the risk of developing the disease we are considering increases. Accordingly, the older the person, the greater this risk. And, of course, it is also impossible to influence this factor, because it is considered in this group of them. It should be noted that in general, atherosclerosis as a disease is often compared with the aging of the body, that is, as one of the manifestations of this process. This is explained by the fact that atherosclerotic changes after the transition beyond a specific age period are determined in absolutely all patients. And, as already noted, from the age of 45-50, the risk of such changes especially increases.
• genetic predisposition. This risk factor is also unchanged when considering atherosclerosis. Thus, those patients whose closest relatives are diagnosed with one or another of its forms are especially susceptible to this disease. It is generally accepted that genetic predisposition (it is also heredity) also acts as such a factor, due to which the relative acceleration of the development of atherosclerosis is determined (up to the age of 50). Meanwhile, in people whose age exceeds the mark of 50 years, the factor of heredity in practice determines a slight influence on the development of atherosclerosis, therefore, it is impossible to give a clear statement regarding the early development of this disease if relatives have it.

Changeable (modifiable) reasons, in turn, are characterized by the fact that they can be influenced by the patient. This may include lifestyle adjustments, treatment, etc. Let us single out the options that are relevant for the disease under consideration:

• arterial hypertension. This cause (factor) is independent in considering the development of atherosclerosis. The peculiarity of the impact of hypertension is that against its background there is an increase in the intensity of impregnation of arterial walls with fats, which, in turn, is considered as the initial stage in the development of the main manifestation of atherosclerosis, an atherosclerotic plaque. At the same time, atherosclerosis, due to which the elasticity of the arteries is subject to change, is a factor that increases the risk of developing hypertension in a patient.
• Smoking. This factor is a serious help for the development of many diseases, and atherosclerosis is no exception. With prolonged smoking, the risk of developing the hypertension discussed above, as a predisposing factor in the development of atherosclerosis, increases, which already allows us to trace the chain of changes that are relevant in this case. In addition, smoking also contributes to the development of CHD (coronary heart disease) and hyperlipidemia, which also accelerates the development of atherosclerosis in smokers. The basis of the influence is based on the negative impact that the components of tobacco smoke have directly on the vessels.
• Obesity. Another, no less significant factor in the influence, contributing to the development of atherosclerosis. Again, obesity predisposes not only to the development of atherosclerosis itself, but also to one of the factors already listed by us, arterial hypertension, which in any case, as can be understood, links this factor with the disease we are considering. In addition, we note that obesity is also one of the main factors in the development of diabetes mellitus, which also plays an important role in considering the modifiable factors of interest to us.
• Diabetes. The relevance of this factor for patients significantly increases the risk of developing atherosclerosis (approximately 5-7 times). This is explained high risk the relevance of metabolic disorders (in particular, this applies to fats), which provokes the development of atherosclerotic changes in the vessels.
• Hyperlipidemia (dyslipidemia). This factor implies a violation in the metabolism of fats, which determines its no less significant role in terms of considering factors provoking atherosclerosis. It should be noted that all of the above factors are directly related to dyslipidemia, that is, with each of them, the problem of impaired fat metabolism is relevant. The main role in the development of atherosclerosis (as well as other types of diseases associated with the cardiovascular system) is given to the following forms of fat metabolism disorders: elevated cholesterol, elevated triglycerides and elevated levels of lipoproteins in the blood.
• Features of nutrition. The development of atherosclerosis in particular is affected by the presence of a significant amount of animal fats in the diet.
• Hypodynamia (sedentary lifestyle). This factor also plays an important role in the development of atherosclerosis, including the development of the previously listed conditions (diabetes mellitus, arterial hypertension, obesity). Due to the reduced motor activity, as you might guess, the processes of metabolism of carbohydrates and fats are disrupted, due to which, accordingly, the risk of developing the listed disorders and atherosclerosis in particular increases.
• Infections. The infectious nature of the development of atherosclerosis has been considered relatively recently. On the basis of ongoing research, it was found that cytomegalovirus and chlamydial infections can be considered as two options representing this item in its connection with atherosclerosis.

Atherosclerosis: stages

As we have already identified, the pathological process that is relevant for atherosclerosis is concentrated within the walls of the arteries. This, in turn, leads to the gradual destruction of the affected wall. In accordance with the degree of damage and its features, 3 stages of atherosclerosis are determined sequential in their manifestation, we will consider them below.

• I stage. As part of its manifestation lipid spots form. This implies the impregnation of the walls of the arteries with fat molecules, the localization of the impregnation is noted in this case only within the limited sections of the walls. These areas appear as yellowish stripes concentrated along the entire length of the affected artery. The features of this stage are characterized by the fact that the symptoms of atherosclerosis as such do not manifest themselves, and in general there are no specific disorders due to which it would be possible to determine the relevance of a violation of circulation in the blood arteries. The acceleration of the formation of lipid spots can occur due to the influence of the modifiable factors discussed above in the form of obesity, arterial hypertension and diabetes mellitus.
• II stage. This stage is also defined as the stage of liposclerosis, characterized by the development of atherosclerosis to a stage in which inflammation of lipid spots occurs, which leads to the accumulation of cells in their cavities. immune system. In particular, they attempt to cleanse the arterial wall from fats that have had time to deposit on it (in some cases, these may be microbes). Against the background of a prolonged inflammatory process, the fats deposited on the arterial wall begin to decompose, and at the same time, the germination of connective tissues in it occurs. This leads to fibrous plaque formation which determines this stage. The surface of such a plaque is in a somewhat elevated position relative to the inner surface of the affected vessel, due to which, thus, its lumen is narrowed, and blood circulation is also disturbed.
• III stage. This stage is the final stage in the development of atherosclerosis, it is characterized by the development of a number of complications, directly related to the development of fibrous plaque. In addition, it is from this stage of the disease that its symptoms begin to appear. This stage is defined as the stage of atherocalcinosis. The progression of the plaque deformation at this stage is determined by the compaction relevant to it, as well as the deposition of calcium salts in it. The nature of the manifestation of an atherosclerotic plaque can determine both its stability and gradual growth, due to which it will continue to deform the arterial lumen and narrow it. Against the background of this last variant, the development of a progressive form will, in turn, be provoked. chronic disorder in the blood supply of the organ that is fed by the artery that has undergone such a lesion. This also causes a significant risk of occlusion formation ( acute form blockage), in which the lumen of the vessel is blocked either by a thrombus or by an element of plaque decay, as a result of which the blood-supplying organ or limb undergoes a different type of lesion against this background - in the form of the formation of a site of necrosis (infarction) or gangrene.

Atherosclerosis: symptoms

Predominantly affected by atherosclerosis is the aorta (abdominal and thoracic), mesenteric, coronary and renal arteries, as well as the arteries of the brain and lower extremities.

As part of the development of the disease, its asymptomatic (or preclinical) period and the clinical period are distinguished. The asymptomatic period is accompanied by an increased content of beta-lipoproteins in the blood or an increased content of cholesterol in it, while there are no symptoms, as can be understood from the definition of this period.

As for the period of clinical manifestations, they are relevant when the arterial lumen is narrowed by 50% or more. This, in turn, determines the relevance of the three main stages of the period: ischemic stage, thrombonecrotic stage and fibrous stage.

Ischemic stage It is characterized by the fact that with it the blood supply to a certain organ is disturbed. As an example, we can highlight the picture of the course of this stage, in which myocardial ischemia against the background of atherosclerosis of the coronary vessels manifests itself in the form of angina pectoris. Stage thrombonecrotic characterized by the addition of thrombosis of arteries that have undergone changes. Atherosclerosis of the coronary arteries in this case can in its own course reach complications in the form of myocardial infarction. And finally fibrous stage, which is characterized by the proliferation of connective tissue that occurs in inefficiently supplied organs. Again, when considering atherosclerosis of the coronary arteries at this stage, one can distinguish the transition to the development of such a pathology as atherosclerotic cardiosclerosis.

As for the specific manifestations of atherosclerosis, its symptoms are determined based on which type of artery has been affected. Below we consider the main variants of the course of this disease.

Atherosclerosis of the aorta: symptoms

Atherosclerosis of the aorta is the most common variant of the manifestation of atherosclerosis, respectively, in most patients it is revealed. Atherosclerosis can affect its various parts, on the basis of which, in turn, the symptoms of the disease and the prognosis for it are determined.

As you probably know, the aorta is the largest blood vessel in our body. It starts from the heart (left ventricle), then branches, thus forming many small vessels that spread to the tissues and organs of our body. The aorta consists of two main sections, which are located in anatomically different areas. The abdominal and thoracic aorta act as such departments.

The thoracic aorta in the aorta is the initial site, due to which the blood supply to the upper part of our body is provided, respectively, these are the organs of the chest itself, neck, head and upper limbs. Concerning abdominal aorta, then it is the final site, blood supply due to it is provided for the abdominal organs. In turn, its final section is divided into two main branches, which are the left and right iliac arteries, through which blood flows to the lower extremities and to the pelvic organs.

In atherosclerosis of the aorta, the lesion, which is relevant for this disease, covers either the entire aorta along its length, or its individual areas. The symptomatology in this case is also determined depending on where exactly the pathological process is localized and how pronounced the changes that have arisen in the walls of the aorta under its influence have become.

as the most dangerous complication, provoked by atherosclerosis of the aorta, an aortic aneurysm appears. With an aortic aneurysm, a certain section of the artery expands, which is accompanied by thinning of the vessel wall and an increased risk of rupture of the artery, which, in turn, can lead to life-threatening bleeding.

Atherosclerosis of the thoracic aorta: symptoms

For a long time, there are no symptoms. Often, atherosclerosis of this department develops along with such forms of the disease as atherosclerosis of the coronary arteries of the heart (i.e. coronary arteries), as well as atherosclerosis of cerebral vessels.

The manifestation of symptoms is observed mainly at the age of 60-70 years, which is explained by the significant damage to the walls of the aorta by this time. Patients complain of burning pain in the chest area, increased systolic arterial pressure, swallowing becomes difficult, dizziness is relevant.

As less specific manifestations of symptoms, early aging can be noted, which is combined with the early appearance of gray hair. At the same time, there is an abundance of hair growth in the area of ​​​​the auricles, a characteristic light strip appears along the outer edge of the iris, and wen appear on the skin of the face.

Atherosclerosis of the abdominal aorta: symptoms

This form of the disease is diagnosed in almost half of the cases of all possible variants of its manifestation. Similar to the previous form, long time he may not show up at all.

Atherosclerosis of the area under consideration acts as a reason for the development in patients of such a pathology as abdominal ischemic disease. It, similar to coronary artery disease (IHD), is characterized by the fact that it leads to impaired blood supply against the background of atherosclerosis of vessels, which is particularly relevant for those organs that these vessels feed.

Symptoms associated with a lesion of the abdominal aorta can manifest themselves in the following:

• Stomach ache. Such pains occur after eating, the nature of the manifestation is paroxysmal, aching. As a rule, they are not too intense, they do not have a clear localization. Such pains disappear in a few hours on their own.
• Digestive disorders. In particular, complaints of bloating, the appearance of constipation and diarrhea (alternation of conditions) and a decrease in appetite are relevant.
• Weight loss. This symptom is progressive, caused by a stable form of indigestion.
• Arterial hypertension (high blood pressure), renal failure. Increased blood pressure is due to the fact that the blood supply to the kidneys is subject to violation. As for renal failure, it develops due to the fact that gradually their normal tissues begin to be replaced by connective tissues. This, in turn, determines their gradual necrosis against the background of insufficient blood supply.
• Thrombosis of the visceral arteries. This complication is deadly in atherosclerosis of the considered part of the aorta, moreover, it requires urgent specialized medical care. With the necrosis of the vessels, due to which the blood supply to the intestine is ensured, its loops become dead, which leads to massive inflammation of the organs concentrated in the abdominal cavity and in the peritoneum (which determines peritonitis). The symptoms of this condition include severe pain that does not disappear when taking antispasmodics and painkillers. In addition, a sudden deterioration in general well-being soon joins the pain.

Atherosclerosis of cerebral vessels: symptoms

This form of atherosclerosis is no less common; in this case, the intracranial and extracranial vessels that feed the brain are subject to damage. The severity of symptoms is determined based on the degree of damage to these vessels. Due to atherosclerosis of the cerebral vessels, the activity of the nervous system is gradually inhibited, mental disorders or a stroke.

The first manifestations of the symptoms of this form of atherosclerosis are diagnosed at the age of 60-65 years of patients, while their interpretation is reduced in most cases only to manifestations of signs of aging. However, this belief is only partly correct. Aging itself is an irreversible physiological process, while atherosclerosis acts as a specific type of disease, the course of which, until it reaches certain limits, determines the possibility of a cure, as well as the implementation of certain preventive measures against it.

Now let's move on to symptoms. The initial manifestations of atherosclerosis of this form are episodic attacks of an "ischemic attack", within which relatively stable neurological symptoms appear. This includes, in particular, violations of sensitivity, which can manifest itself either in its decrease on one side of the body, or in complete loss. There are also movement disorders in the form of paresis (partial loss of muscle strength) and paralysis. In addition, there may be hearing, vision and speech impairments. The listed symptomatology, meanwhile, manifests itself within a short time period, after which it disappears.

With a pronounced form of manifestation of atherosclerosis of the cerebral vessels, a stroke often develops, in which there is a necrosis of a certain area of ​​brain tissue. This condition is characterized by a persistent manifestation of the symptoms that we have already considered (loss of sensitivity, paralysis, loss of speech), it can be treated to a small extent.

As other manifestations of the symptoms of atherosclerosis of this form, one can note a disorder of higher nervous activity in one form or another (in particular, this applies to intellectual abilities and memory), changes in character (pickiness, capriciousness, etc.), sleep disturbances, development of depressive states.

Lack of adequate treatment can lead to dementia (senile dementia). It, in turn, is a severe and, unfortunately, an irreversible manifestation of a decrease in the higher functions inherent in the brain.

Stroke is the greatest danger this disease. This condition is essentially a condition similar to myocardial infarction, a condition in which tissue necrosis occurs. This condition is accompanied by increased mortality, as well as frequent disability of patients.

It should be noted that in some cases, symptoms indicating atherosclerosis of the arteries of the brain can be quite difficult to differentiate, for example, from symptoms that manifest themselves in hypertensive encephalopathy or from actual disorders of cerebral blood supply due to the development of spinal diseases of a degenerative scale (for example, osteochondrosis). In reality, it often happens that in patients of the senile age group, many of the diseases that could be confused with atherosclerosis are relevant, because the diagnosis of this disease determines the need for an integrated approach to this process.

Atherosclerosis of the vessels of the lower extremities: symptoms

Similar to the forms we considered earlier, atherosclerosis of the lower extremities (atherosclerosis obliterans) does not manifest itself for a long time, and this lasts until the blood circulation through the vessels is seriously disturbed against the background of the disease we are considering.

As a classic, one might say, symptom, in this case, pains that occur when walking in the muscles of the lower extremities are considered. This symptom has a definition corresponding to its manifestation - “intermittent claudication” (which is explained by periodic stops while walking due to arising pain to reduce their intensity). Pain occurs in this case due to the fact that there is a lack of oxygen in the functioning muscles, which, in turn, occurs due to the specifics of atherosclerosis itself.

It is noteworthy that arterial insufficiency that occurs with this form of atherosclerosis negatively affects not only the functions characteristic of the legs, but it also acts as a cause of the development of trophic disorders, in which the nutrition of the lower extremities is subject to violation in particular. Trophic disorders can manifest themselves in hair loss and skin changes (thinning, pallor). Nails are prone to deformation, become brittle. In severe cases, atherosclerosis of the legs is accompanied not only by muscle atrophy, but also by the formation of trophic ulcers in combination with gangrene.

Arterial insufficiency of the legs manifests itself in accordance with the disorders that determine its main four stages.

• I stage . In this case, pain in the legs appears only in combination with significant physical exertion (for example, it can be walking for long distances (from one kilometer or more)).
• II stage . In this case, the limiting distance for the occurrence of pain is reduced, amounting to no more than 200 meters, after overcoming which, accordingly, the pain appears.
• III stage . Here, pain already occurs when walking within a distance of no more than 25 meters, or even at rest.
• IV stage . At this stage, trophic ulcers form in patients, gangrene of the lower extremities develops.

As another sign corresponding to the manifestations of atherosclerosis, the disappearance of the pulse, noted in the region of the arteries of the lower extremities (this may be the region on the back of the inner ankle, the region of the popliteal fossa, or the region of the thigh), is considered.

Thrombosis of the iliac arteries and the terminal part of the abdominal aorta provokes the development of Leriche's syndrome.

Leriche's syndrome is accompanied by a violation of blood circulation, relevant for the arteries of the lower extremities, as well as for organs concentrated in the pelvic area. Quite often, this syndrome develops against the background of atherosclerosis of the aorta. The manifestations of this pathology are similar to those that occur with atherosclerosis of the vessels of the legs.

In addition, impotence may develop, which, as you know, is relevant for men. Obliterating atherosclerosis of the vessels of the lower extremities can act as a serious kind of trophic disorders that directly affect the limbs (legs), which can also lead to the development of gangrene, and, ultimately, to the loss of one of them. Accordingly, any warning sign can serve as a reason for contacting a specialist.

Atherosclerosis of the coronary arteries of the heart: symptoms

This form of the disease acts as the main cause of the development of coronary heart disease in patients, which, in turn, develops against the background of impaired blood supply to the heart muscle. Myocardial infarction and angina pectoris are pathologies that directly depend on the degree of development of atherosclerosis that affects the arteries of the heart. Thus, with partial blockage, coronary disease develops (of varying degrees of severity of its own manifestation), and with complete blockage, myocardial infarction develops.

Focusing on the features of the pathology of interest to us, which is atherosclerosis of the coronary arteries of the heart, we highlight the features of the blood supply to the heart. It is provided in particular by two coronary arteries that follow from the aorta. With any violation that occurs during the circulation of blood through the coronary (coronary) arteries, the work of the heart muscle is disrupted, respectively. This, in turn, can lead to a heart attack.

Most often, blood circulation is disturbed against the background of atherosclerosis of the coronary arteries. In this case, this pathology is accompanied by the process of formation of dense plaques, due to which the deformation and destruction of the artery wall gradually occurs while its lumen narrows (a typical picture of the course of atherosclerosis). Symptoms of atherosclerosis of the coronary arteries correspond to those symptoms that appear in coronary artery disease, but the main cause in any case is precisely atherosclerosis.

The main manifestations of symptoms, respectively, in this case are the development of angina pectoris and coronary artery disease, cardiosclerosis and myocardial infarction act as complications of atherosclerosis of the heart vessels. An attack of angina, manifested in the form of atherosclerosis under consideration, is characterized by the following manifestations of symptoms:

• the appearance of burning, pressing pain in the chest; the spread of such pain to the left shoulder and to the back; occurrence - in the event of stressful situations or when physical activity;
• shortness of breath (there is a feeling of lack of air, it is usually accompanied by the pain attack indicated above; in some cases, it becomes necessary to take a sitting position, because the patient simply begins to choke when lying down);
• as a possible option to supplement the picture of an attack, the appearance of symptoms such as headache, nausea, vomiting and dizziness.

Treatment of an angina attack is provided by taking nitroglycerin to patients, moreover, this particular drug is the main one in considering emergency relief of an attack.

With a complication in the form myocardial infarction patients develop intense pain, reminiscent of those that occur with angina pectoris. The difference is that the use of nitroglycerin does not determine the corresponding effect. As complementary manifestations of symptoms, severe shortness of breath is noted, the patient may lose consciousness. The manifestation of heart failure is characterized by its own sharpness.

If a complication such as cardiosclerosis, then heart failure with it manifests itself in a gradual manner, which is accompanied by a decrease in physical activity in combination with shortness of breath and the occurrence of swelling.

The determination of specific signs corresponding to atherosclerosis of the coronary arteries can only be made using special diagnostic techniques.

Atherosclerosis of mesenteric vessels: symptoms

This form of atherosclerosis manifests itself predominantly from the side of the upper abdomen. The time of manifestation of symptoms, which, first of all, is the appearance of pain, mainly occurs in the late hours, in particular after dinner. The duration of the manifestation of pain can be from several minutes to up to an hour. As concomitant manifestations of symptoms, bloating and belching may also be noted, and constipation may occur. Pain in atherosclerosis, when compared with pain syndrome associated with peptic ulcer, is not so long in manifestation.

The main symptoms associated with atherosclerosis in this form include the following manifestations:

• bloating;
• moderate manifestation of pain, determined by probing the abdomen;
• slight muscle tension in the anterior abdominal wall;
• weakening of peristalsis or its complete absence.

The listed manifestations are defined as such a condition as "angina pectoris". It develops due to a discrepancy between the volume of blood required to provide blood supply to the organs of the digestive system and the actual volume, which, as can be understood, is insufficient for this.

As one of the complications of this form of atherosclerosis, thrombosis that develops in the mesenteric vessels can be noted. As a rule, it appears suddenly, accompanied by the following concomitant symptoms:

• constant pain of a wandering or diffuse nature that occurs in the abdomen;
• pain in the area of ​​​​the navel;
• nausea, repeated vomiting (with an admixture of bile; blood may also be present, which is noted in this case in the feces);
• constipation, flatulence (gas).

Often, thrombosis of the mesenteric vessels ends with the development of intestinal gangrene, which, in turn, is accompanied by severe symptoms of peritonitis.

Atherosclerosis of the renal arteries: symptoms

This form of atherosclerosis causes the development of a persistent form of ischemia, which, in turn, acts as a factor provoking the development of a consistently high form of arterial hypertension.

Some cases of the course of atherosclerosis of the renal arteries are accompanied by the absence of symptoms. Meanwhile, more often the picture of the disease manifests itself in the form of the development of atherosclerotic plaques with simultaneous narrowing of the lumen of the renal artery, against which a secondary form of arterial hypertension develops.

If only one of the renal arteries is affected, we can talk about the slow progression of this disease; in this case, high blood pressure becomes the foremost manifestation of symptoms. If the spread of the process affects both arteries at once, then this, in turn, causes the development of the disease according to the type in which arterial hypertension is malignant, characterized by rapid progression and a serious deterioration in the general condition of the patient.

Associated symptoms may include abdominal pain and pain in the lumbar region. The duration of pain sensations manifests itself in different ways, in some cases being about several hours, in others - about several days. Nausea and vomiting may also occur.

Diagnosis

The primary diagnosis of atherosclerosis is carried out by a therapist as part of a standard annual examination of the patient in this area. To do this, pressure is measured, risk factors that contribute to the development of atherosclerosis are identified, and body mass index is measured.

As a clarifying measure, the following research methods can be applied:

• ECG (echocardiography) in combination with ultrasound of the aorta and heart, as well as with special stress tests;
• Invasive research methods (coronary angiography, angiography, ultrasound intravascular examination);
• Duplex scanning, triplex scanning (blood flow is subject to examination by means of ultrasound imaging of blood vessels);
• MRI (magnetic resonance imaging), through which visualization of atherosclerotic plaques and arterial walls is performed.

Treatment

Treatment of atherosclerosis is based on a number of the following principles:

• impact on infectious agents;
• implementation of measures replacement therapy(relevant for women during menopause);
• increased excretion of cholesterol and its metabolites from the body;
• limiting the intake of cholesterol in the body, reducing the synthesis of cholesterol by cells.

Against this background, the lifestyle is subject to adjustments, a diet is additionally prescribed, in which, as you can understand, products containing cholesterol are subject to the maximum exclusion.

Concerning drug treatment, then it is based on taking the following types of drugs:

• nicotinic acid in combination with its derivatives (providing the possibility of lowering cholesterol and triglycerides in the blood, as well as increasing the content of lipoproteins with increased density due to them);
• fibrates (drugs of this group provide a decrease in the synthesis of their own fats by the body);
• statins (provide the ability to reduce cholesterol in the most effective way by influencing the processes of their production by the body itself);
• sequestrants (provide binding and excretion of bile acids from the intestines while reducing cholesterol and fats in cells).

Atherosclerosis may require in some cases and surgical treatment, which is relevant in case of a serious threat or with the development of an acute form of blockage by a thrombus or plaque of an artery. To do this, endarterectomy (open surgery on the artery) or endovascular surgery (dilatation of the artery, installation in the area of ​​​​stent narrowing, due to which an obstacle to subsequent blockage is provided) can be performed. A pronounced form of atherosclerosis with damage to the vessels of the heart, against which a myocardial infarction may develop, requires coronary artery bypass grafting.

Yandex.Zen

Inflammation of the lungs (officially pneumonia) is inflammatory process in one or both respiratory organs, which usually has infectious nature and is caused by various viruses, bacteria and fungi. In ancient times, this disease was considered one of the most dangerous, and although modern facilities treatment allows you to quickly and without consequences get rid of the infection, the disease has not lost its relevance. According to official figures, in our country every year about a million people suffer from pneumonia in one form or another.

According to statistics, diseases associated with atherosclerosis occupy the first places among the most probable causes of death. The disease can develop imperceptibly for a long time, but against its background, there are frequent cases of sudden death or acute infarction myocardium. Therefore, it is very important to know what causes atherosclerosis of the vessels and what methods of treatment exist.

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

If earlier this disease was preferentially determined in the elderly, 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. The definition of this disease at a relatively young age is especially difficult. Further, serious complications can affect health and significantly worsen the quality of life of the patient.

Video: Cholesterol and atherosclerosis. Vascular atherosclerosis symptoms and treatment

Description of atherosclerosis

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

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

Lipid testing, including total cholesterol, low-density lipoprotein (LDL-C or LDL) cholesterol, high-density lipoprotein (HDL-C or HDL) cholesterol, and triglycerides, has traditionally been part of ASCVD risk assessment. Testing is also used for screening and monitoring. Unconventional new markers such as apolipoproteins, lipoprotein particles and highly sensitive C-reactive protein (hsCRP) are also gaining acceptance in terms of evaluating high-risk patients.

The 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 constricted because fat (represented by cholesterol) is deposited on the inner walls of the vessels and then grows into fibrous tissue, calcifying. Thus, 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 incoming oxygen and a violation of the 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, a heart attack, congestive heart failure, or abnormal heart rhythms (arrhythmias).
• With the defeat of atherosclerosis of the cerebral arteries, a person has an increased risk of a stroke, called transient ischemic attack. In extreme cases, the death of brain tissue occurs, that is, a stroke.

Vascular atherosclerosis is a progressive condition that can begin in childhood. Fat 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. With a hereditary predisposition to high blood cholesterol, the condition may begin to worsen after the age of 20 and gradually become more pronounced by the 40s and 50s.

Inside the vessels, lipid deposits like cholesterol are deposited, which impede blood flow. They are dangerous by complete blockage of the vessel.

Reasons for the development of atherosclerosis

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

Risk factors that can be changed:

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 high in fatty meats, dairy products, eggs, and fast foods (McDonald's syndrome) and low in 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 until menopause).
3. Having a close relative who had heart disease or stroke at a relatively young age (gene predisposition, especially if familial hypercholesterolemia is present, i.e. advanced level cholesterol).

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

Video: Atherosclerosis - how and why vascular blockage occurs

Symptoms of vascular atherosclerosis

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

Symptoms of atherosclerosis vary greatly and can be presented as minor signs (on early stage diseases), and the clinic of a heart attack or stroke (when the lumen of an artery is partially or completely blocked). Sudden cardiac death can also be the first symptom of coronary heart disease.

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

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

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

Chest pain (as in angina) due to insufficient blood flow to the heart muscle is usually felt with exertion and disappears at rest. In the classic version, angina pectoris is a heavy, squeezing and depressing sensation in the middle of the chest. Rarely, angina may occur at rest. Most often, this indicates a more unstable atherosclerotic plaque and, possibly, the threat of a heart attack.

Many types of chest pain are not due to angina, including muscle and ligament pain in the chest, damaged lungs surrounding the heart, and a painful esophagus that runs through the chest behind the heart.

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

• 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 strong pain in the legs, which usually occurs when walking and disappears during a stop (intermittent claudication). When the illness 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 occurs, often poorly healing, which, if left untreated, leads to amputation.

Involvement in the atherosclerotic process of the renal arteries 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 have any unexplained symptoms that indicate a blocked artery.

If a person has been diagnosed with atherosclerosis of the coronary vessels, a doctor's consultation should be sought before starting any exercise-related treatment program.

Diagnostics

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

1. Physical examination , which includes measurement of height and weight, as well as blood pressure in both arms, followed by determination of body mass index (BMI) and measurement of waist circumference.
2. Auscultation - Uncharacteristic sounds or turbulence is 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 determined 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 detected, especially in people with diabetes.
4. Level measurement blood glucose for screening for diabetes, especially if the patient is obese, has high blood pressure, high lipid levels, and/or family history diabetes.
5. Standard ECG - register the speed and regularity of the heart rhythm. The study may indicate a previous heart attack. A patient with several severely blocked arteries may have a completely normal ECG.
6. Stress ECG - doing exercise on a treadmill or stationary bike, while ECG, blood pressure and respiration are constantly recorded. In individuals suffering from atherosclerosis, this test may indicate a decrease in the 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 - consists in the introduction of a radioactive substance into the bloodstream, followed by obtaining an image of the heart muscle at rest and immediately after exercise. The images give an idea of ​​myocardial perfusion. If there is coronary artery disease, the blood supply to the background of the exercise decreases in the affected area. The test is more sensitive than a stress ECG and is guaranteed to locate a 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 the screen using ultrasound equipment. If an area of ​​the heart has weakened due to a heart attack, the site of the injury can be located and the extent of the lesion can be determined. Echocardiography also reveals problems with the heart valves, any fluid in the pericardium, congenital heart changes. The pressure inside the heart cavities is also assessed.
9. echocardiography with exercise is an alternative to the nuclear stress test. EchoCG only analyzes the movement of the left ventricle. In the absence of blood flow, the ischemic region 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 for some reason cannot be performed. This invasive procedure conducted by a cardiologist in the catheterization department. A special radiopaque dye is injected into the arteries through a thin tube or catheter that 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 assessing coronary artery disease.

Treatment of vascular atherosclerosis

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

• taking medication,
• angioplasty and other surgical intervention.

H most affordable home remedies for atherosclerosis

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

1. eat food with low level cholesterol.
2. Increase 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 the attending physician.
7. It is important to keep your blood glucose and glycosylated hemoglobin (HbA1c) levels at acceptable levels, which may require appropriate medications.

Stopping cigarette smoking quickly and significantly reduces the risk of developing atherosclerosis. It is important to know that the likelihood of developing coronary heart disease in people who have recently quit smoking is similar to the likelihood of developing the disease in non-smokers within two years.

Cigarette smoking reduces good cholesterol (high-density lipoprotein or HDL cholesterol) and increases bad cholesterol. However, smoking is even more dangerous for people who are at risk for heart disease.

Against the background of tobacco consumption, the amount of carbon monoxide in the blood increases, which in turn contributes to damage to the intima of the arterial wall. It also facilitates the process of plaque formation. 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. For this, risk factor reduction tactics can be used, which can be modified with the following steps:

• accept drugs to normalize blood pressure if hypertension is present.
• Engage lmedicines to normalize blood glucose levels that primarily concerns patients with diabetes mellitus.
• 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 "bad" lipid-lowering drugs, as evidenced by the results of clinical trials 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 high risk(according to analyzes of predisposing factors) the development of 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 . Drugs commonly used 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. Tablets are usually taken once a day and are started after tried diets and exercise did not give the expected results.
2. Bile acid sequestrants . In particular, cholestyramine (Questran, Questran Light, Prevalite, LoCholest), colestipol (Colestid), and colesevelam (Welchol) are used. These drugs promote the binding of cholesterol bile acids in the intestines, which are then excreted from the body with feces. Thus, drugs reduce the absorption of consumed cholesterol from the intestines. However, they can cause diarrhea, so many patients do not tolerate them.
3. Cholesterol absorption inhibitors . The most commonly used 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 lowers the level of LDL (“bad” cholesterol). Intensive emptying of the stomach is the most common side effect.
5. Fibrates : usually from this pharmacological group Gemfibrozil (Lopid) and fenofibrate (Tricor) are used. They are primarily effective in lowering triglycerides and "bad" cholesterol levels and, to a lesser extent, increase the level of "good" cholesterol.

Surgical treatment of atherosclerosis

Balloon angioplasty- During this procedure, a balloon-tipped catheter 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 advanced up to the blocked artery. When the narrowed part of the vessel is reached, the balloon is inflated, due to which the plaque is pressed against the arterial wall. As a result, the lumen of the affected artery increased in diameter and improved blood flow through the previously blocked area. Side effect The procedure may involve damage to the vessel wall with an opening balloon, which provokes proliferative changes in the endothelium with repeated stenosis of the vessel and the development of connective tissue.

Stenting- during this small surgical intervention a metal tube called a stent is placed in the artery. With its help, the lumen of the vessel, opened 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 thickening 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 medication to prevent platelet accumulation on the metal surface.

If lifestyle changes and medications fail to alleviate the symptoms of atherosclerosis, and/or angioplasty with stenting cannot be performed for technical reasons, then a method of creating bypasses for blood flow is used.

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

The operation carried out on coronary arteries called coronary artery bypass grafting. In bypass surgery of the arteries of the lower extremities, specially designed tubes (grafts) made of tissue, dacron or plastic are used, which are used to perform bypasses.

Prevention and prognosis in atherosclerosis

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

Eat healthy foods that are low in saturated fat and rich in fruits, herbs, and vegetables.

If there is frequent emotional stress, then you need to find ways to reduce or control it. For this it can be used as folk ways impact, and medical preparations after prior consultation with a doctor.

Fortunately, taking steps to address some of the risk factors helps to 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 outcome for atherosclerosis is variable. In some cases, many people with critical blood flow restriction in their vital important 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 should be taken into account with the control of his general condition and the identification of his own risk factors. The quality of the measures used to prevent vascular atherosclerosis also affects the prognosis.

Video: The whole truth about the treatment of atherosclerosis

Atherosclerosis - (from the Greek athera - gruel and sclerosis) - a chronic disease of the arteries, expressed in the thickening and compaction of their walls in the form of separate plaques or more extensive changes.
At the core atherosclerosis there is a metabolic disorder, in which, due to an increase in the blood of fat-like substances - lipoids, mainly cholesterol, the latter are deposited in the inner lining of the artery with the subsequent development of focal connective tissue thickenings around these deposits (atherosclerotic plaques).

In addition to the main cause (lipoid metabolism disorders), other factors are also important in the development of atherosclerosis; violation of carbohydrate metabolism, imbalance of the coagulation and anticoagulation systems, in the first place is the influence of the nervous system on the arteries. Because of this influence, the wall of the arteries exhibits a tendency to spasms, which are especially common in hypertension. Therefore, the combination of atherosclerosis with hypertension very common.

This common disease organism, in which only muscular-elastic arteries , the most loaded arteries are affected. Atherosclerotic plaques on the inner lining of the arteries cause thickening of their walls and narrowing of the lumen of the arteries; at the same time, the elasticity of the arteries is lost, they do not expand enough and do not collapse well with pulsation. There is a difficulty in the general blood flow in the vessels, as a result of which the work of the heart is also difficult and the supply of tissues with blood decreases.
Violation of tissue nutrition entails changes in the structure of the organs themselves: in areas with particularly poor blood supply, cells specific to the organ die, instead of them, connective tissue; the so-called sclerosis of the organs is formed, in which their functional ability decreases more or less sharply.

With strong development atherosclerosis, especially in small and medium-sized arteries, their lumen is completely closed, and the blood flow to the corresponding area completely stops. If there are no additional other arteries in this place, tissue necrosis may occur - necrosis, gangrene(such as, for example, gangrene of the legs). In larger arteries, on the contrary, it may not thicken, but disintegrate the tissues of the arterial wall, which at the same time becomes thinner, under pressure from the inside in this thinned place, a saccular expansion of the artery is formed - the so-called aneurysm.
Atherosclerosis occurs with periods remissions and exacerbations, with long chronic course. During remission, there may be a reverse development of the process. The longer the remission, the greater the possibility of complete restoration of the organ (collaterals develop).

Etiology.

• hereditary predisposition,
• Age,
• Unfavorable living conditions, intense mental work associated with sedentary way of life,
• Chronic infectious diseases, diseases of the endocrine glands, metabolism (obesity),
• Too much food
• Bad habits: alcohol abuse, nicotine,
• Constant stress.

Theory of the pathogenesis of atherosclerosis.
The lipid-infiltrative theory. The following factors are important: metabolic disorders, the ratio of lipoproteins and, as a result, pathological changes in the vascular wall.

Lipids and lipoproteins involved in fat metabolism.
Lipids (fats) in pure form do not dissolve in the blood.
More than 95% of dietary lipids are triglycerides, the rest is Phospholipids, Free fatty acids (SJK), Cholesterol.

Triglycerides or neutral fats - are the most important source of energy for cells, especially cells of the nervous system. But despite this, if the level of triglycerides in the blood is higher than normal, then this is harmful to the body, since they, like LDL, are deposited in the arteries, which also leads to vasoconstriction, atherosclerosis. Often, an increase in the level of triglycerides in the blood is accompanied by an increase in the level of LDL (the so-called bad cholesterol) and a decrease in the level of HDL (the so-called good cholesterol).

Lecithin - phospholipid -- good emulsifier, cholesterol antagonist. The composition of lecithin includes the vitamin-like substance choline. It is an integral part of cell membranes, participates in lipid metabolism, in the construction nervous tissue. Reduce the level of cholesterol in the blood. This fat causes a stable emulsion of fat in the blood, i.e. it does not dissolve.

Cholesterol - natural lipid (fat). About 80% of cholesterol is produced by the body itself, the remaining 20% ​​comes from food. Cholesterol ensures the vital activity of cell membranes. It is necessary for the production of Vitamin D, for the activity of the brain, the immune system, etc. But an increase in the level of cholesterol in the blood above the norm leads to metabolic disorders and, ultimately, to atherosclerosis.
Cholesterol it is insoluble in water (and therefore in the blood) and in its pure form cannot be delivered to the tissues of the body with blood.
Therefore, for the transport of lipids (fats) with blood in the body, complexes of fats with proteins - L hypoproteins.
Squirrels - apoproteins, and fat molecules - phospholipids and cholesterol.

The following types are synthesized in the body Lipoprotein :

Chylomicrons (HM),

• Very low density lipoproteins (VLDL),
• Intermediate density lipoproteins LPPP ,
• low density lipoproteins LDL (so-called bad cholesterol) And
• high density lipoproteins HDL (the so-called good cholesterol), that prevent the development of atherosclerosis.

Chylomicrons
Chylomicrons are almost entirely (80-95%) composed of triglycerides and are the main transport form of exogenous (food) triglycerides, transferring them from enterocytes small intestine into the bloodstream. Chylomicrons are the largest of lipoproteins, reach sizes from 75-1.2 nm, the large size of the CM does not allow them to penetrate through the walls of the capillaries, therefore, from the intestinal cells, they first enter lymphatic system and then through the main thoracic duct they are poured into the blood along with the lymph, they are less dangerous. Remains of chylomicrons containing cholesterol are captured by hepatocytes and quickly removed from the bloodstream.

Low density lipoproteins (LDL) - small particles that are the main transport form of cholesterol. They contain about 6% triglycerides, 50% cholesterol and 22% protein.
High density lipoproteins (HDL) - the smallest and densest particles of lipoproteins, have anti-atherogenic properties.

Critical for the emergence and progression atherosclerosis has a ratio of lipoproteins of various classes: high content Triglycerides, cholesterol(total, LDL and VLDL) and low HDL.

Clinical symptoms of atherosclerosis.

Clinical manifestations depend mainly on the period and stage in which the disease is located, and on the vessels of which organ are most affected by atherosclerosis. During the course of the disease, two periods can be distinguished.
1. Preclinical manifestations.
In the initial period, there are only symptoms indicating neurovascular disorders - a tendency to spasms, an increase in the level of cholesterol in the blood.

2. Clinical manifestations.
The second period of atherosclerosis is the period of clinical manifestations. It, in turn, can be subdivided at 3 stages.
In the 1st stage the organ, the vessels of which are most affected by atherosclerosis, suffers from insufficient blood supply (the so-called ischemia), leading to a moderate malnutrition of the organ.

In the 2nd stage the insufficiency of blood supply becomes more pronounced, a blood clot can form in one or another area inside the artery, blocking it. In the organ, the artery of which has undergone blockage, there are areas of necrosis (necrosis).

In the 3rd stage in the organ, the artery of which has undergone blockage, there are areas of necrosis (necrosis). These changes are usually irreversible and lead to the growth of scar connective tissue. This stage is already showing up characteristic symptoms depending on the location of the disease.

Uniform damage to all the arteries of the body is relatively rare in atherosclerosis. Usually available atherosclerotic lesions predominantly in one area.
Most often, the vessels of the heart, brain, and extremities are affected.
Initially affected aorta, then are amazed coronary and cerebral vessels, renal vessels, vessels of the extremities (often lower), mesenteric vessels, pulmonary arteries. If more than 4 systems are affected, it is considered "common atherosclerosis". In the organs there are either organic lesions or diffuse organ damage. At a young age, atherosclerosis is more common in men, and more often in women after menopause. But it can also be congenital hypercholesterolemia.

Atherosclerosis of the coronary arteries of the heart.
It manifests itself mainly in angina attacks - pain behind the sternum or in the region of the heart, which can later lead to myocardial infarction. Atherosclerosis of the coronary vessels of the heart leads to a reduced blood supply to the heart muscle, the tissue of which undergoes a series of structural changes ending with the death of heart muscle cells and their replacement with connective tissue (Cardiosclerosis).

Atherosclerosis of cerebral vessels.
Weakening and change of mentality of the patient are characteristic, amplify characteristics person. Decreased memory, talkativeness, stubbornness, suspicion, or, conversely, carelessness, gullibility, etc., are characteristic. Dizziness (mainly with a change in body position, with sudden movements) and a sensation of noise in the head are typical.
With damage to the vessels of the brain, there is a violation of the function of automatism, respiratory failure: snoring, whistling, snoring, heavy snoring. With atherosclerosis, everything new, new information is poorly absorbed, and gradual memory loss may occur.
If on the basis of atherosclerosis of cerebral vessels a blockage (thrombosis) of one or another cerebral artery develops, then this can lead to rupture of the affected artery and hemorrhage in the brain - Most often this happens when cerebral atherosclerosis is combined with hypertension.

Atherosclerosis of the renal vessels.
With the development of sclerosis of the renal arteries, the normal functioning of the organ is disrupted. At the same time, it is characteristic nocturia(night urination) which is common in the elderly.
Monotonous specific gravity, within 1018-1020, does not change. A shriveled kidney may develop. If the kidney shrinks as a result of atherosclerosis, it is a primary wrinkled kidney, and as a result, it is a secondary wrinkled kidney.

Atherosclerosis of the peripheral arteries supplying the skin, subcutaneous tissue and muscles manifested by thinning, dryness and wrinkling of the skin, emaciation, so typical of old age, severe chilliness, constantly cold extremities. The pain in the back, lower back, and limbs observed in the elderly, especially when standing up, is also due to atherosclerosis of the peripheral arteries.

Circulatory disorders of the extremities.
The performance of the lower extremities decreases, causing rapid fatigue, pain in the legs, cold extremities, hot soles. Intermittent claudication appears, which is often a harbinger of a more severe atherosclerotic lesion of the arteries of the extremities - endarteritis obliterans.

Violation of the abdominal organs can lead to may lead to an increase in other digestive dysfunctions, etc. For example, in the pancreas, due to pathological changes, insulin production may be disrupted.

Classification of lipid metabolism disorders according to Friderikson, adopted by WHO:

1 type Dyslipidemia.
Lipid increase: Total cholesterol is elevated, LDL-C is lowered or normal, TG triglycerides are elevated,
Increase in lipoproteins --- an excess of chylomicrons.
Risk of developing atherosclerosis--- not upgraded. This type often occurs in obese people.
Treatment: dietary adjustments are indicated.

2 type ADyslipidemia.
Lipid increase: Total cholesterol is elevated or normal, LDL-C is elevated, TG triglycerides are normal,
Increase in lipoproteins --- boost LPPNP.
elevated, primarily in the coronary arteries.
Treatment: Statins, Nicotinic acid preparations, Bile acid sequestrants, Fibrates, Bile acid sequestrants + Fibrates, Nicotinic acid.

Type 2 B Dyslipidemia.
Lipid increase: Total cholesterol - increased, LDL-C - increased, TG triglycerides - increased,
Increase in lipoproteins --- increase in LDL and VLDL.
Risk of developing atherosclerosis--- Significantly increased, especially for coronary.
Treatment: Fibrates, Bile acid sequestrants + Fibrates, Bile acid sequestrants + Statins, Nicotinic acid.

3 type Dyslipidemia.
Lipid increase: Total cholesterol is elevated, LDL-C is lowered or normal, TG triglycerides are elevated,
Increase in lipoproteins-increased LPP and chylomicrons.
Risk of developing atherosclerosis --- significantly increased, especially for the coronary and peripheral arteries.
Treatment: fibrates, statins.

4 type Dyslipidemia.
Lipid increase: Total cholesterol is elevated or normal, LDL-C is normal, TG triglycerides are elevated,
Increase in lipoprotein c - increase in VLDL.
Risk of developing atherosclerosis- Elevated for coronary atherosclerosis.
Treatment: Nicotinic acid preparations, Fibrates, Statins, Fibrates + Statins.

Type 5 Hyperlipidemia.
Lipid increase: Total cholesterol is elevated, LDL-C is normal, TG triglycerides are elevated,
Increase in lipoproteins- Increased chylomicrons and VLDL.
Risk of developing atherosclerosis- not clear.
Treatment: Fibrates + Statins, Statins + Preparations of Omega-3 polyunsaturated fatty acids (lovase, omacor).

TREATMENT OF ATHEROSCLEROSIS.

Treatment should be long. Prevention primary and secondary.

Primary prevention is carried out among healthy people with risk factors, with obesity, in men over 40 years old, hypertensive patients, patients with impaired internal secretion, with chronic diseases digestive system.
Secondary prevention in patients with atherosclerosis. The goal is to prolong remission.

primary prevention.
This is primarily a strengthening of 3 links. This is the help of the state, the healthcare system, the patient himself.
Regular working hours required available medicines, alternation of mental and physical labor.
It is necessary to ensure systematic rest, regular breaks in work, normal working conditions, elimination of excessive noise in enterprises, sufficient sleep,at least 7 hours a day, proper nutrition, regular stool and etc.

Research has shown that interesting good job together with other favorable conditionslife is a good prevention of atherosclerosis.Those who retire early show signs of atherosclerosis earlier, from lack of employment. Although this is not the basis for evidence-based medicine.
For prevention, systematic physical labor and sports that calm the nervous system are also important. Time to give up bad habits- smoking, alcohol abuse.

Diet.
With obesity, it is necessary to reduce body weight to normal. Excessive weight loss is also harmful to the activity of the cardiovascular system. Nutrition should preferably be 4 times.

Squirrels. The content of proteins in the diet should be within the normal range or increased, while 50% of proteins are of animal origin (low-fat dairy products, fish, lean poultry), 50% vegetable proteins.

Fats are necessary, but it is necessary to sharply limit the amount of foods containing saturated fatty acids (fatty meats, meat products, milk and dairy products, hydrogenated fats). Especially harmful are fats that have undergone heat treatment, overcooked (lipid peroxides). Butter is needed per day up to 15-20 g, but no more. You can take fat-rich marine fish (herring, mackerel, salmon, tuna, perch, etc.) To normalize lipid metabolism, nuts are useful as a source of polyunsaturated fatty acids and dietary fiber, but it is necessary to limit their amount in obesity.
Saturated fats also negatively affect blood clotting factors in coronary artery disease.

Carbohydrates. Carbohydrate intake at normal body weight should be slightly higher than the dietary norm, with a decrease in their fat content to ensure energy value food. But with diabetes and coronary artery disease, obesity, the amount of carbohydrates in the diet is reduced.

Vitamins and minerals they do not play a significant role in the prevention of atherosclerosis, but their necessary content in the diet is necessary for the normal functioning of the whole organism.

Salt necessary, but in moderation. Sugar is also necessary, but also moderately. Fruits, vegetables, honey are desirable, dietary fibers are very useful in atherosclerosis. Food must be chewed thoroughly.

Alcohol. Held in different countries studies confirm that moderate regular alcohol intake increases HDL (good cholesterol), but in large quantities, regular alcohol intake, on the contrary, is harmful.
You can take alcohol no more than 20 - 30 g of ethanol per day (50 - 60 ml of vodka or cognac, or 200 - 250 ml of dry wine, or 500 - 600 ml of beer), for women - up to 10 - 15 g of ethanol, i.e. half as much.

secondary prevention.
Primary prevention and drug treatment.
Drug treatment: continuous-intermittent treatment, 2-3 times a year, when the weather changes. Treatment for a minimum of 4-6 weeks in a row.

Medical treatment.

A nicotinic acid (Niacin, vitamin PP, B3).
Takes an active part in carbohydrate, protein and porphyrin metabolism. It has a pronounced effect on the central nervous system, causes the expansion of peripheral blood vessels.
Nicotinic acid has lipoproteinemic (lowering the level of lipoproteins in the blood) activity. In large doses (3-4 g per day) lowers the content of triglycerides and beta-lipoproteins in the blood.

Can be assigned on an incremental basis. If itching occurs, stop. Start with 50 mg, 1 tab. per day, we bring the daily dose to 1000 mg per day, if the man is younger than 50 years old, and give women up to 600 mg per day. And we leave this dose for 10 days, with normal laboratory data, then gradually reduce. Use with caution in women of childbearing age.

Derivatives of nicotinic acid (nicofuranose, acipimox, enduracin). They reduce the production of LDL and very low density lipoproteins (VLDL).

Preparations based on omega-3 polyunsaturated fatty acids (w-3-PUFA) (lovaza, omakor).

Statins – Simvastatin, Atorvastatins, Lovastatin, Fluvastatin, Pravastatin,Rosuvastatin, Pitavastein .
These are drugs that suppress the synthesis of cholesterol, promote the excretion of bile acids, antioxidants, anti-inflammatory, immunomodulators, and normalize lipid metabolism.

Bile acid sequestrants - Cholesteramine, Cholestipol.
Drugs that interfere with the absorption of lipids in the intestine. Displays bile acids. If there is stagnation of bile, itching, then it is prescribed.

Fibrates - - Gemfibrozil, Fenofibrate, Clofibrate and etc. These drugs increase the catabolism of triglycerides.

Lipostabil .
Combined preparation, contains essential phospholipids. Reduces the concentration of lipoproteins in the blood, normalizes lipid metabolism, improves the functional state of the liver, prevents the progression of atherosclerosis, improves microcirculation.
It is indicated for hyperlipoproteinemia, atherosclerosis of the vessels of the heart, brain, limbs, angina pectoris, after myocardial infarction and cerebral stroke, angiopathy, especially in diabetes mellitus; prevention of thromboembolism before surgery, endarteritis, nephrotic syndrome, prevention and treatment of fat embolism.

Antiplatelet agents - substances that prevent blood clotting, with atherosclerosis, are prescribed for life, if there are no contraindications.
Aspirin(acetylsalicylic acid) causes hemolysis of red blood cells, can cause hemolytic jaundice. It is impossible for children under 15 years old, pregnant, lactating, with ulcers, erosion, during menstruation. Daily dose- 75 mg, 300, 350 mg. Excreted in alkaline urine. Aspirin in small doses provokes an exacerbation of gout.
Curantyl- you can take 25, 50, mg 3-4 times a day. Elderly 25 mg once a day for life with atherosclerosis. Do not give in acute heart attacks.

VITAMINS.
Although evidence-based medicine has not identified positive impact additional intake of vitamins for the treatment of atherosclerosis, but a deficiency in the body of certain vitamins impairs metabolism, which can contribute to the development of atherosclerosis and coronary artery disease
It is advisable to supplement diets with multivitamin preparations, but not in therapeutic, but in physiological doses.

Vitamin C (ascorbic acid) is not produced in the body. It must be taken regularly for prevention.
Ascorbic acid plays an important role in the life of the body, regulates redox processes, participates in carbohydrate, phosphorus metabolism, normalizes the permeability of skin capillaries. Participates in the metabolism of phenylalanine, tyrosine, folic acid, the synthesis of lipids, proteins, stimulates the immune system. Has antiplatelet and pronounced antioxidant properties
Most vitamin C is found in raw vegetables, fruits and berries; when cooked, they lose about 50% of it.
There is also a lot of vitamin C in syrups and concentrates from rose hips, blackcurrant berries, green onions, corned beef, red pepper, salted fish, green peppers.
From January to the end of May, when fresh fruits and vegetables are scarce, you can take vitamin C in the form of tablets and dragees up to 500 mg per day, if there are no contraindications.

B vitamins .
Vitamin B1 is a coenzyme of cocarboxylase, necessary for the activation of redox processes in the body. It plays an important role in carbohydrate metabolism, affects the functions of the cardiovascular, digestive, endocrine and nervous systems.
Found in milk, nuts, liver, yeast, rye bread, brown rice, brewer's yeast, wheat, rye, black bread, legumes, liver, nuts, carrots, animal products.
Vitamin B6.
Vitamin B6 takes an active part in the metabolism of amino acids, protein and fat metabolism, improves lipid metabolism in atherosclerosis, liver function, regulates the activity of the nervous system, improves memory. Vitamin B6 strengthens the immune system, supports the activity of the cardiovascular system, prevents the formation of blood clots, reduces the likelihood of developing a heart attack, stroke, atherosclerosis, and is able to regulate blood pressure.
B1, B6 - it is necessary to appoint every other day, one day B1, another B6, preferably in the form of injections.
Best given in autumn and spring, 4 weeks in a row, 2 times a year.

Vitamin B12 . Possesses high biological activity. Participates in the formation of choline, methionine, nucleic acids. It has a beneficial effect on the metabolism of carbohydrates and lipids. Activates the blood coagulation system. Reduces the concentration of cholesterol in the blood, improves the function of the liver and nervous system, increases the ability of tissues to regenerate.
But since it contains radioactive cobalt, in very small doses, it can be taken only once every 2 years, more often it is impossible.

Vitamin A + E.
Vitamin A found in animal fats fish fat, liver, butter, cream, milk, egg yolk), in products plant origin(carrots, apricots, tomatoes, green peas). Is an antioxidant.
Vitamin A plays an important role in the trophic processes of the skin, and is also involved in the redox reactions of the body.
It is advisable to prescribe vitamin A together with vitamin E for better absorption by the body.
Vitamin E is an antioxidant and protects vitamin A from oxidation both in the intestines and in tissues.