Atherosclerosis PDF

Atherosclerosis Atherosclerosis is a condition characterized by the buildup of fatty deposits, cholesterol, and other substances (called plaques) on the inner walls of arteries. Over time, this buildup can cause arteries to become narrow, stiff, and less flexible, impairing blood flow to vital o...

Atherosclerosis Atherosclerosis is a condition characterized by the buildup of fatty deposits, cholesterol, and other substances (called plaques) on the inner walls of arteries. Over time, this buildup can cause arteries to become narrow, stiff, and less flexible, impairing blood flow to vital organs and tissues. It is a leading cause of cardiovascular diseases (CVD)  Definition Atherosclerosis is a term given to the condition of the accumulation of fatty substances (TG-LDL-VLDL-TC) along the walls of the body’s arteries, causing: 1- Narrowing of the arteries, which leads to poor blood flow through this artery to the organ fed by the artery, which leads to poor vitality and function of this organ. 2- If there is a complete blockage of this artery, this leads to the death of the organ, such as the death of part of the heart muscle as a result of the blockage of the coronary artery ‫ الشريان التاجي‬that feeds this muscle. 3- There is weakness in the artery wall and thus its rupture and the occurrence of bleeding, such as bleeding that occurs in the brain, causing stroke in the elderly. 4- In other cases, the accumulation of fat on the walls of the arteries leads to the separation of small parts of these plaques and transmission through the blood, causing a blockage to other small arteries and thus the occurrence of a clot in a place far from the source of this clot. 40% of Egyptians suffer from atherosclerosis  1 2 4 3  2 1 3  How Atherosclerosis Develops 1.Endothelial Damage: 1. The process begins with damage to the endothelium, the thin inner lining of the arteries. 2. Causes of damage include high blood pressure, smoking, high cholesterol levels, diabetes, or inflammation. 2.Formation of Fatty Streaks: 1. Low-density lipoprotein (LDL, "bad" cholesterol) penetrates the damaged endothelium. 2. LDL cholesterol becomes oxidized, causing an immune response. 3.Inflammation and Immune Response: 1. White blood cells (macrophages) are attracted to the site and engulf the oxidized LDL, forming foam cells. 2. This leads to fatty streaks in the artery walls. 4.Plaque Formation: 1. Over time, fatty streaks grow, and smooth muscle cells from the arterial wall migrate to form a fibrous cap ‫ غطاء ليفي‬over the fatty core ‫ فوق اللب الدهني‬. 2. Plaque continues to enlarge, narrowing the artery and restricting blood flow. 5.Plaque Rupture: 1. In advanced stages, the fibrous cap may rupture, causing a blood clot (thrombus) to form. 2. This can completely block the artery, leading to acute events like a heart attack or stroke.  1- Unhealthy diet (rich in saturated fats, trans fats, and sugar). Causes 2- smoking - obesity – diabetes/insulin resistance - hypertension 3- Increased body fat and cholesterol (LDL-TG-TC) and decreased HDL 4- Excessive intake of fatty animal foods and foods rich in cholesterol, and low intake of vegetables and fish 5- Lack of exercise (laziness, inactivity) 6- Age and gender (males over 45 years old and females over 55 years old, as estrogen production protects against atherosclerosis) 7- Genetic  7- Other factors: ❑ Hyperuricemia (+ oxidative stress + vascular inflammation) Causes ❑ Nutritional deficiency in the fetus (it can lead to functional changes in the fetus, which increases human exposure in the future to a number of chronic diseases such as high blood pressure, diabetes, and coronary heart disease ❑ Exposure to Continuous pollution ❑ Fibrinogen in the blood ❑ Higher Hemocysteine in the blood (an amino acid that originates from methionine and damage the blood vessels + promote blood clot), and in the presence of B6, B12, Folic, the excess Hemocysteine turns into cysteine or methionine)  Symptoms 1- Chest pain that spreads to the arms (especially the left arm) (angina pectoris ‫ ) الذبحة الصدرية‬as a result of a decrease in blood reaching the heart muscle, especially if the person tries to make an effort because the heart muscle’s need for blood during movement is greater than it is during rest and relaxation. Angina pectoris is either stable: it causes a narrowing of no more than 70% of the diameter of the lumen of the affected part of the artery unstable: he complains of chest pain when he does less effort‫ مع اقل مجهود‬, or the chest pain becomes repeatedly in a day, or the pain occurs during rest. Heart infarction: ‫احتشاء القلب‬ A heart attack occurs when one of the coronary arteries becomes blocked and does not allow blood to pass through it completely, thus damaging the part of the heart that feeds this artery. This pain usually spreads to the left arm and may spread to the jaw ‫ الفك‬or back ‫الظهر‬ and may be accompanied by nausea, shortness of breath or coma, and the patient often appears pale and sweating. It is more severe and lasts much longer than the pain of angina. 2- Leg pain if the arteries of the legs are affected by atherosclerosis, a condition in which we see an elderly person walking for a while and then stopping as a result of the occurrence of pain and then walking again, which is the sign called intermittent walking ‫ المشي المتقطع‬as a result of hardening of the arteries of the legs. In the latter cases, the legs pain occurs even at rest Symptoms depend on the affected artery: Coronary Arteries: Chest pain (angina), shortness of breath, or heart attack. Carotid Arteries ‫شرايين تنقل الدم من القلب الي الدماغ‬: Stroke symptoms like sudden weakness, numbness, or difficulty speaking. Peripheral Arteries: Pain or cramping in the legs while walking (claudication ‫)يعرج‬. Renal Arteries: High blood pressure or kidney failure.  Diagnosis 1- Measuring the % of fat and cholesterol in the body / Ideal level LDL-c less than 100, TC less than 200 mg/dL TG less than 150 mg/dl, HDL greater than 60 2- Ensuring the effectiveness and function of the kidneys and liver - making sure that there is no diabetes 3-Using a tomography diagnostic device (CT) ‫ اشعة مقطعية‬for the body - the use of colored rays ‫ اشعة بالصبغة‬of the arteries  4- Heart enzymes, are substances that are released into the blood when the heart muscle is damaged or stressed including heart attack (myocardial infarction) ‫احتشاء القلب‬, myocarditis ‫التهاب عضلة‬ ‫القلب‬, or heart failure ‫قصور في القلب‬. Troponins: proteins found in heart muscle cells that help regulate muscle contraction. Elevated levels often indicate a heart attack. Creatine Kinase-MB: An enzyme found in the heart and other muscles, Elevated levels suggest heart muscle damage, but it is less specific than troponin. Myoglobin: t rises quickly after heart injury but is not specific to the heart, as it is also found in skeletal muscle. Lactate Dehydrogenase (LDH): An enzyme involved in energy production, present in many tissues, including the heart. Elevated levels may indicate tissue damage, but it is not specific to the heart. B-Type Natriuretic Peptide (BNP) : Hormones released by the heart in response to stress or stretching of heart muscle walls. High levels are associated with heart failure rather than acute damage.  Treatment 1- Stop smoking, weight control 2- Reducing the intake of foods high in fat and cholesterol 3- Maintaining exercise (light for 20-30 s) & reducing excess weight 4- Early diagnosis and treatment of diabetes , high blood pressure , hyperlipidemia and cholesterol 5- Use of some drugs that delay the occurrence of Clots, increase blood fluidity, or reduce the level of fat and cholesterol in the body Omega 3 works on the fluidity of the blood Heart-healthy diet (low in saturated fats and cholesterol, rich in fruits, vegetables, and whole grains).  Foods that reduce arteriosclerosis 1- Pomegranate: contains a high percentage of antioxidants polyphenols + vitamin C + salts and vitamins 2- Olive oil: polyunsaturated fatty acids + rich in antioxidants 3- Herbs: marjoram ‫البردقوش‬- curry - ginger - onions - fennel ‫شمر‬- thyme - ground flaxseeds - garlic - coriander - caraway – parsley 5- Aspirin: prevents platelet aggregation 6- Water: reduces blood viscosity by reducing fibrinogen 7- Legumes (fenugreek sprouts - lupine) - artichokes - soy proteins 8- Vitamin C, E, Vitamin A, Selenium 9- Fruits: Berries - red grapes - cherries - plum‫ البرقوق‬- hibiscus ‫كركديه‬- watermelon - strawberries - tomatoes - red peppers - peaches – green/white tea - licorice ‫العرق سوس‬- broccoli Protein: 10 – 15% Fats : 25- 30 % (vegetable oils ) Saturated fat not exceed 10%, monounsaturated fatty acids 10-15%, poly unsaturated fatty acids less than 10%. Carb.: 55% Cholesterol : 200 mg/day  Desirable foods No desirable foods Red meat - veal - fat free Brain - Kidneys - Liver Chicken without skin - turkey Ducks - pigeons -- chicken without skin skin Lean fish (tilapia, whiting High-fat fish - shrimp - shells) sardines - tuna - crab egg white egg yolk Skimmed milk - skimmed All full fat dairy - ice cream - yogurt - cottage cheese full fat cheese Vegetable oils Butter , hydrogenated oils  Dietary Strategies for Atherosclerosis: 1-Reduce Saturated and Trans Fats: which contributes to plaque buildup: * Butter, lard, and full-fat dairy products., * Red meats and processed meats (e.g., sausages, hot dogs). * Fried foods and baked goods made with hydrogenated oils. 2- Increase Unsaturated Fats: * Olive oil, avocado, and nuts (e.g., almonds, walnuts). * Fatty fish rich in omega-3 fatty acids (e.g., salmon, mackerel, sardines). * Seeds like flaxseeds and chia seeds. 3-High-Fiber Diet: Soluble fiber binds to cholesterol in the digestive tract, reducing LDL levels. * Whole grains (e.g., oats, quinoa, barley). * Legumes (e.g., lentils, chickpeas, beans). * Fruits (e.g., apples, oranges, berries). Vegetables (e.g., carrots, broccoli, artichokes).  Dietary Strategies for Atherosclerosis: 4- Limit Refined Carbohydrates and Sugars: High sugar intake contributes to insulin resistance, inflammation, and obesity, all of which increase cardiovascular risk: * Sugary drinks, candies, and baked goods. * Refined grains like white bread, pasta, and rice. 5- Choose Plant-Based Proteins: Beans, lentils, tofu, tempeh. Nuts and seeds. 6- Increase Antioxidant-Rich Foods: Antioxidants reduce oxidative stress and inflammation, protecting the arteries. * Colorful vegetables and fruits (e.g., spinach, kale, bell peppers, blueberries). * Green tea. * Dark chocolate (minimum 70% cocoa). Moderate Salt Intake: Excess salt can raise blood pressure, worsening atherosclerosis risk. * Use herbs and spices for flavor instead of salt. * Avoid processed and packaged foods high in sodium.  Cholesterol content of some foods Food item Quantity Cholesterol (mg) Full fat milk 240 34 Egg 50 242 Fish & meat 30 21 Chicken with skin 30 24 Liver 30 131 shrimp 30 45 Cheddar cheese 30 28 Butter 14 35 Vegetables oils 14 0  sodium content of some foods Food item Quantity Cholesterol (mg) Milk 240 120 Meat 30 25 Egg 50 70 Vegetables 100 9 Fruits 2 Bread 30 5 fat 5 0  Cholesterol functions: 1- Bile Acid Production 2- Synthesis of Vitamin D 3- Precursor for Steroid Hormones (Sex Hormones, aldosterone: Maintains blood pressure and electrolyte balance) 4- Structural Component of Cell Membranes