What does atherosclerosis mean? Vascular atherosclerosis: causes, symptoms, treatment. The mechanism of development of the disease

Atherosclerosis ICD code 10 I70. The name is well known “among the people”, but few people think about the consequences. The name is made up of the Greek ἀθέρος - “chaff, gruel” and σκληρός - “hard, dense”. For various reasons, cholesterol is deposited in the intima of the vessels in the form of a rather dense gruel (plaque).

As a result, the lumen of the vessel is narrowed up to complete blockage (obliteration) with the cessation of the passage of blood. There is a pathology similar in symptoms - Menckeberg's arteriosclerosis, however, in this case, the middle membrane of the arteries suffers, in which calcium salts are deposited, cholesterol plaques are absent and vascular aneurysms develop (not blockage).

Atherosclerosis affects the walls of blood vessels, reducing their elasticity and creating an obstacle to the movement of blood flow. As a result, there is a violation of the blood supply to the internal organs.

Important. Detachment of an atherosclerotic plaque is dangerous by the development of such formidable emergency conditions as myocardial infarction or stroke.

At the moment, vascular atherosclerosis is no longer considered a pathology of elderly people. An unhealthy lifestyle, low physical activity, smoking, stress, excessive consumption of fatty foods and alcohol lead to the fact that atherosclerosis can develop as early as 30-35 years.

Atherosclerosis is a chronic vascular pathology that appears due to an imbalance in the metabolism of fats and proteins in the body and is accompanied by the accumulation of lipids, followed by the proliferation of connective tissue fibers in the vascular wall.

The progression of atherosclerosis is accompanied by a violation of the elastic properties of the vessel, its deformation, narrowing of the lumen, and, consequently, a violation of the patency for blood flow.

Attention. The main insidiousness of the disease lies in the fact that the first stages of vascular atherosclerosis are asymptomatic, and a vivid clinical picture develops only after the occurrence of irreversible changes in the vessels and significant violations of the blood supply to the organs.

It should also be noted that many patients do not pay attention to the first nonspecific signs of atherosclerosis and ischemia, such as:

decreased performance,
chronic fatigue
dizziness,
memory impairment
shortness of breath
violation of the rhythm of the heart,
tachycardia, etc.

Most of the symptoms are attributed to hard work and lack of sleep.

Most often, patients first go to the doctor only after the symptoms of the disease caused by atherosclerosis of the vessels begin to significantly complicate their life (inability to climb stairs without severe shortness of breath, tachycardia and a feeling of lack of air at rest, inability to move independently due to pain in the legs, etc.).

For reference. In some cases, patients learn that they have severe atherosclerosis after an acute attack of angina pectoris, heart attack, transient ischemic attack (transient cerebral ischemia).

Chronic cerebral ischemia can lead to tinnitus, significant memory loss, mental changes, impaired gait and coordination, etc. This complex of symptoms is most often ignored by the elderly, writing off the manifestations of cerebral ischemia due to vascular atherosclerosis on senile changes.

Causes of atherosclerosis

For reference. There is currently no unified theory of the onset of vascular atherosclerosis.

The development of plaques in the vascular intima can be provoked by:

autoimmune diseases (primary infiltration of the vascular wall by macrophages and leukocytes occurs);
infections (viruses, bacteria, etc.);
violation of antioxidant systems;
hormonal disruptions (gonadotropic and adenocorticotropic hormones provoke an increase in cholesterol synthesis);
congenital defects of the vascular walls;
imbalance of lipoproteins and the accumulation of LDL and VLDL in the walls of blood vessels.

For reference. All these factors can serve as triggers for the development of atherosclerosis, however the leading role in the pathogenesis of vascular wall damage remains behind lipid imbalance.

Risk factors for the development of vascular atherosclerosis:

Uncontrolled risk factors for the development of vascular atherosclerosis are those that cannot be influenced. They can contribute to the development of atherosclerosis, but in the absence of controlled factors, they do not lead to the development of the disease.

For the development of vascular atherosclerosis, a combination of several risk factors is necessary.

This means that, even with a hereditary predisposition to the development of atherosclerosis, serious complications can be avoided if:

lead a healthy lifestyle (an adequate level of physical activity, quitting smoking and drinking alcohol, a diet with an increased amount of fresh fruits, vegetables, lean fish and limiting the intake of fatty meats, sweets, etc.);
be monitored regularly by the attending physician;
monitor lipid profile indicators (, HDL, LDL, VLDL,);
take the prescribed treatment for background pathologies (diabetes mellitus, hypertension, etc.).

Maximum risk factors

Any of these factors can lead to the appearance of atherosclerosis and CVS pathologies:

Classification of atherosclerosis

As such, there is no classification of atherosclerosis. The disease can be divided into stages and localization.

The most common localizations of atherosclerotic foci are:

coronary vessels;
thoracic aorta;
cervical and cerebral vessels (cerebral atherosclerosis);
vessels of the kidneys;
abdominal aorta;
arteries of the legs.

Atherosclerosis of the thoracic aorta, in the overwhelming majority of cases, is combined with damage to the coronary vessels of the heart, and atherosclerosis of the abdominal aorta, with ischemia of the lower extremities.

How to clean blood vessels, or rather how to remove atherosclerotic plaques, is the topic of this article. The circulatory system includes vessels and cavities that serve for constant circulation of blood flow. The blood fluid, in turn, carries oxygen and nutrients to the cells of the entire body. Since all food, after going through the process of processing in the digestive tract, enter the bloodstream, it is very important what a person eats. When hard-to-digest animal products are consumed, sclerotic plaques accumulate on the vascular walls, and vascular atherosclerosis develops.

Concept

Initially, consider what is this atherosclerosis of the vascular system? The definition of atherosclerosis is literally translated from Greek as "gruel", "hardening". Based on these concepts, one can judge the cause of vascular atherosclerosis. In the capacity of "gruel" is harmful and excess cholesterol, as well as any fats of predominantly animal origin. But not only animal fats are the culprits of vascular sclerosis. Some vegetable oils, those that undergo the process of hybridization, the so-called trans fats, are no less dangerous for the human body.

Atherosclerotic plaques, including those formed from frequent consumption of palm and coconut oil or products in which they are present.

From all of the above, it follows that the causes of atherosclerosis are expressed in the violation of protein and lipid metabolism. As a result, there is an accumulation of cholesterol and other lipoproteins in the vascular lumen, thus forming atherosclerotic plaques. The manifestation of the disease of atherosclerosis is expressed in the proliferation of foreign tissue, a process called vascular sclerosis.

This leads to a gradual narrowing of the lumen of the bloodstream, which entails the danger of its complete overlap (obstruction).

There is another pathology, expressed by vascular sclerosis, referred to in medicine as arteriosclerosis. The disease ranks second in prevalence among vascular sclerosis. Arteriosclerosis, discovered for the first time by Menckeberg, is characterized by the accumulation in the middle membrane of the arteries, not cholesterol, but calcium salts. Such arteriosclerosis has identical names: arterial calcification, arterial calcification, medial calcification of the arteries, and other definitions.

Atherosclerosis of arteries and arteriosclerosis are distinguished not only by a vascular clogging substance. But also a feature of deposits - atherosclerotic plaques grow in the cavity of the vessel and lead to its blockage. Whereas calcium salts, deposited in the media (media is the middle shell of the vessel), entail its stretching, a kind of protrusion of the artery (aneurysms) occurs.

Causes

The conditions and causes of the appearance of plaques in the vessels are often determined by external factors, the way of existence and nutrition, and the peculiarities of physiology. Less often, atherosclerotic plaques arise through the fault of acquired and, moreover, congenital pathologies. The main reason for this disease lies, of course, in excess cholesterol. Therefore, to get rid of the external causes of vascular sclerosis will take less effort, it will be enough to change the behavioral factors in relation to food, stressful situations and bad habits.

Causes of vascular atherosclerosis:

Are common:
- Smoking tobacco and drinking alcohol.
- Advanced age, after 50 and above.
- Overweight.
- Eating unhealthy foods.
- Sedentary lifestyle, physical inactivity.
- Stress and psycho-emotional stress.
- For women, the period of menopause.
Pathological:
- Genetic addiction (homocystinuria).
- High blood pressure.
- Diabetes mellitus.
- Lack of thyroid hormones.
- Increased fibrinogen in the blood.
- Excessively elevated levels of lipoproteins, lipids in the bloodstream.

The situation is different if arteriosclerosis is caused by pathological processes in the body. Then, in the fight against atherosclerotic plaques, you will have to use "heavy artillery", in the correct language, drug treatment. And in especially advanced cases, you may have to resort to surgical intervention.

Subdivision

The classification of vascular atherosclerosis is carried out depending on the alleged reasons that triggered the progression of atherosclerosis of the vascular system. Scientists in the medical field have identified the most common variants of the pathogenesis of the formation of atherosclerotic plaques.

Atherosclerosis WHO classification:

The metabolic atherosclerotic process develops due to hereditary and constitutional failures of lipid metabolism, pathologies of the endocrine system.
Hemodynamic atherosclerotic pathology occurs against the background of vascular pathologies, for example, arterial hypertension and other abnormalities.
Mixed, with a combination to varying degrees of the first two types.

Systematization of atherosclerosis depending on the area of the lesion:

cerebral atherosclerosis;
cardiac arteries;
atherosclerosis of the aorta;
respiratory organs (thromboembolism);
atherosclerotic lesions of the arteries of the kidneys, intestines;
atherosclerotic changes in the veins of the lower extremities.

Effects on the body

The consequences of vascular atherosclerosis can be fatal, because death occurs with a complete blockage of the blood duct. But even during the development of a pathological condition, cholesterol plaques in the vessels make themselves felt, strongly poisoning a full-fledged existence. Any of the previously listed classifications poses a huge danger not only to healthy well-being, but also to life and gives rise to complications of vascular atherosclerosis.

Vascular atherosclerosis, localization-dependent complications:

Atherosclerosis of the cerebral vessels provokes complications such as paralysis, hemorrhages, failure of certain body functions (motor, visual, speech, auditory, mental and others). And also leads to ischemic stroke or otherwise cerebral infarction.
Atherosclerosis of the vessels of the heart is expressed in coronary artery disease, heart failure, hypoxia, angina pectoris, myocardial infarction, sudden cardiac arrest, atrophic and dystrophic changes, rupture of an aneurysm, which ends in death.
Atherosclerosis of the blood ducts in the aorta leads to systolic hypertension, aneurysm and thromboembolism of the systemic circulation.
Pulmonary embolism is fraught with the development of signs of pulmonary heart disease, pulmonary infarction, and respiratory arrest.
Complications of atherosclerosis of the vessels of the lower extremities are dangerous by the appearance of intermittent lameness, gangrene of the feet and fingers, trophic ulcers.
Atherosclerosis of the renal vessels leads to hypertension and renal failure. Atherosclerotic deviations of the intestinal tract threaten with necrosis of the tissues of the intestinal walls.

Vascular atherosclerosis consequences directly depend on the stage of the pathological course. In medicine, it is customary to classify four main periods of atherosclerosis progression - preclinical, initial, severe, with complications. The least harmless are the first two periods when you can quickly restore a healthy state of the circulatory system and prevent serious consequences from occurring.

Stages

Cholesterol is characterized by the gradual accumulation of cholesterol in the body. Therefore, the development of the disease of vascular atherosclerosis has been increasing for many years. Cholesterol is usually chronic and aggravated over time. What are the stages of atherosclerosis?

Microscopic indicators of atherosclerotic changes in the circulatory system:

Preclinical form of pathology, when lipid spots are noticeable here and there on the inner layer of the vessel (intima).
The initial stage of atherosclerosis with mild signs such as damage to lipid metabolism, rare atherosclerotic and fibrous plaques.
The pronounced symptoms of atherosclerosis are a failure of lipid metabolism, atheromatous vascular changes, and developing atherocalcinosis.
Sharply manifested atherosclerotic pathology with consequences in the form of a critical violation of intracellular lipid metabolism, severe atheromatosis and atherocalcinosis.

Stages of vascular atherosclerosis, morphogenesis and pathogenesis:

Dolipid is expressed by noticeable edema, microthrombi in the parietal region of the veins, "ribbing" of the elastic layer of the aorta. In the intima, there is an accumulation of acidic glycosaminoglycans.
Lipoidosis, the phase is characterized by the appearance of yellow lipid marks that do not protrude above the surface of the vessels. At this stage, the pathology can not only be stopped, but also completely cured atherosclerosis of the vessels.
Liposclerosis is caused by the onset of atherosclerotic plaque formation from connective tissue, which consists of tissue, necrotic mass (detritus).
Atheromatosis, characterized by increased growth of atheromatous masses. Due to the progression of these accumulations, atherosclerotic plaque can undergo ulceration, internal hemorrhage, and the formation of thrombotic deposits. Ulceration is expressed in the appearance of atheromatous ulcers. This pathology leads to acute blockage of the vessel and infarction of the organ supplied with blood through this artery.
Atherocalcinosis is the final and most severe stage. The phase is characterized by the fossilization of the sclerosed plaque due to calcium salts. At this stage, when the patient is interested in how to clear blood vessels from cholesterol plaques, the answer is in favor of surgery.

At the stage of atheromatosis, in the case of thinning of the surface membrane of an atherosclerotic plaque, its rupture occurs. And then the release of detritus into the cavity of the vessel, which leads to its blockage and entails serious consequences in the form of myocardial infarction, ischemic stroke and similar complications. The second scenario is when the cholesterol plaque membrane does not become thinner, but, on the contrary, becomes denser. This process is typical for chronic atherosclerosis, which is fraught with heart ischemia, discirculatory encephalopathy and others.

Diagnostics

How to diagnose vascular atherosclerosis? The diagnosis of atherosclerosis can only be made by a doctor on the basis of a multifaceted examination of the patient. Depending on the area of the lesion of the circulatory system with atherosclerotic changes, an examination by different specialists will be required. For example, in order to find out how to cure atherosclerosis of the vessels of the heart, you need to contact a cardiologist. If atherosclerosis of the vessels of the brain is observed, then the treatment will be carried out by a neurologist. How to get rid of atherosclerosis of the renal vessels will be recommended by a nephrologist. And how to remove cholesterol plaques in the aorta, intestines or lower extremities will have to inquire with a vascular surgeon.

Diagnosis of vascular atherosclerosis consists of the following activities:

Visual examination of the patient for signs of atherosclerosis.
Clarification of disturbing symptoms.
Feeling (palpation) of the arteries.
Determination of the density of arterial walls.
Taking blood samples for analyzes for atherosclerosis of blood vessels, including clarification:
- cholesterol levels;
- triglyceride content;
- indicators of lipid metabolism;
- coefficient of atherogenicity.
Auscultation of the heart vessels can reveal systolic murmurs.

Atherosclerosis diagnosis by instrumental methods:

Doppler ultrasound (ultrasound) and rheovasography of the veins of the lower extremities.
Ultrasound of the abdominal region and cardiac area.
Coronography and aortography.
Magnetic resonance imaging (MRI) will allow you to view in great detail the walls of the arteries in order to detect atherosclerotic formations and determine the stage of the pathological process.
Chest X-ray and other tests recommended by your doctor.

Diagnosis of atherosclerosis of the vascular system is not an easy undertaking, since the disease often proceeds without symptoms and does not bother a person in any way. The insidiousness of atherosclerotic pathology lies precisely in the fact that it is revealed even when there are characteristic indicators of vascular atherosclerosis. By this time, already irreversible processes often develop in the patient's body, which require either drastic measures, that is, surgical intervention. Or long-term drug treatment not only for atherosclerotic disease. But also the consequences of the impact of pathology on organs and systems that have acquired damage as a result of atherosclerosis.

Symptoms

Signs of vascular atherosclerosis begin to reveal themselves closer to the second stage of pathology. That is, between the period of the appearance of lipid spots and the initial stage of the formation of cholesterol plaques.

The first signs indicating atherosclerotic processes in the vessels do not refer to specific symptoms and may indicate other pathologies.

Therefore, the study of the clinical picture of atherosclerosis occurs in conjunction with the damaged area. Atherosclerosis symptoms and treatment should be carried out in accordance with the localization of the lesion of a particular organ.

Symptoms of vascular atherosclerosis are subdivided depending on:

Atherosclerotic manifestations in the brain occur with some symptoms:
- cephalalgia, a feeling of clouding of consciousness, fainting;
- hypertension accompanied by tinnitus;
- violation of sleep phases, expressed in difficulty falling asleep and drowsiness during daylight hours;
- mental disorders, irritability, nervousness;
- severe fatigue, not associated with appropriate loads;
- failures in the speech apparatus;
- problems with orientation in space and coordination of movements;
- impairment of memory and memorization of various events;
- shortness of breath, shortness of breath, pain in the lungs.
Coronary atherosclerosis can be judged by such signs as:
- pain in the chest with echoes to the left area of the body in front and from the back;
- a feeling of heaviness in the sternum;
- change in the normal rhythm of the heart in the direction of increasing or weakening;
- pressing, dull pain syndrome in the lower jaw with recoil to the left ear and neck region;
- clouding of consciousness up to a fainting state;
- weakness in the limbs, a state of chills, coldness, increased perspiration.
Atherosclerotic changes in the cardiac aorta are characterized by the following symptoms:
- burning sensation in the chest;
- frequent increase in systolic blood pressure;
- dizziness;
- difficulty swallowing while eating;
- detection of a large number of wen, especially in the face area;
- severe graying and external aging, unusual for age;
- abundant growth of hair in the auricles.
Atherosclerotic formations in the abdominal organs are expressed by the following signs:
- In the abdominal aorta, cholesterol plaques make themselves felt by a violation of bowel movements, an unreasonable decrease in body weight, an aching feeling after eating, an increase in gas formation. And also sometimes there is hypertension, renal failure, pain in the peritoneum, not responding to taking painkillers.
- In the brisketal arteries of the intestine, symptoms appear as aggravated pain after eating, stomach distention, vomiting, and nausea.
- In the renal arteries, the presence of cholesterol plaques is signaled by renal failure, arterial hypertension.
Atherosclerosis of the lower extremities is characterized by the following signs:
- paleness of the body in the area of the location of cholesterol plaques in the blood ducts of the legs;
- feeling of numbness and "goose bumps" after finding the body in an uncomfortable or unchanged position for a long time;
- chilliness of hands and feet.

Atherosclerosis of the vessels, symptoms and treatment are more productive if it is carried out in conjunction with therapy of the affected organ or system. The process of atherosclerotic plaque formation can rather be attributed not to a disease, but to a lifestyle. In fact, this is so, like many other pathologies. Therefore, people aiming at full treatment of vascular atherosclerosis need to be prepared for dramatic changes in motor activity, dietary characteristics and definitely get rid of addictions, we are talking about smoking and alcohol. The elimination of harmful factors from your life is already half the success on the way of cleansing blood vessels from cholesterol plaques.

Treatment

Almost 100% of the population suffers from atherosclerotic vascular changes to one degree or another, especially those who have crossed the 30-year mark. In view of this, healthcare professionals are concerned with the prevention and early diagnosis of atherosclerosis. And many people are interested in whether it is possible to cure atherosclerosis and how to get rid of cholesterol plaques?

It is possible to completely cure vascular atherosclerosis, as mentioned earlier, only before the formation of atherosclerotic plaques. It will not be possible to answer unequivocally how to get rid of the plaques; a detailed consideration of the issue will be required. The only thing that can be said right away is that each clinical case of atherosclerosis is unique. Because the pathogenesis of atherosclerotic pathology is different, and the health potential of each patient is different, the same therapy for atherosclerosis has a lot of reactions from the body.

Considering the question of how to treat vascular atherosclerosis, it is necessary to highlight several areas:

Medicines.
Surgically.
Through complementary medicine.
By sticking to a cholesterol-free diet.
Through sports activities.
Giving up bad habits.

Drug therapy

Often, doctors for a full-scale and successful atherosclerosis treatment use an integrated approach. Removal of the initial atherosclerotic symptoms may be limited to the exclusion of cholesterol-rich foods from the daily diet, or the normalization of the level of fat-like substance. Sparing therapy is justified only in the preclinical phase of vascular atherosclerosis, treatment of the next clinical phase of lipoidosis, and even more so the rest, should be carried out using drug therapy.

Cholesterol plaque treatment aims to achieve:

Blood pressure normalization.
Correction of lipid metabolism.
Controlling blood sugar levels.
Maintaining normal overall metabolism.

In accordance with the effect on the development of atherosclerosis, drugs are divided into several main classes:

Reducing the production of triglycerides, cholesterol in the liver and at the same time lowering the concentration of these substances in the bloodstream. These drugs include bile acid sequestrants.
Blocking the assimilation of cholesterol in the circulatory system. These drugs include:
- The first group is anion exchange resins (IA) and vegetable sorbents (IB).
- The second group - statins (IIA), fibrates (IIB), nicotinic acid (IIC), probucol (IID).
Stimulating the destruction and utilization of lipoproteins and atherogenic lipids. Unsaturated fatty acids belong to such healing substances.
As ancillary drugs in order to treat cholesterol plaques, endotheliotropic agents are prescribed.

It is advisable to remove cholesterol plaques surgically only in case of a potential danger of vessel occlusion, when the cholesterol plaque has come off. In other situations, it is better to treat atherosclerosis with pharmaceuticals. In addition to medication, a low cholesterol diet is recommended, and it is also possible to use traditional medicine for atherosclerosis.

Traditional therapy

Traditional medicine has not always been developed as it is today. Therefore, people massively used the gifts of nature to heal atherosclerosis. Atherosclerotic vascular lesions are no exception. Often it was only thanks to the systematic use of certain ingredients that it was possible to completely cure vascular atherosclerosis.

Cleaning blood vessels from cholesterol plaques with natural ingredients:

Garlic.
Lemon.
Walnut.
Carrots (fresh juice) and many other crops.

Atherosclerosis of the vessels is excellently treated, and the vessels are cleared of plaque, a composition tested by many people from the main atherosclerotic components - lemon and garlic. To prepare a mixture for atherosclerosis, you will need a head of garlic and a lemon. Grind the ingredients thoroughly (lemon with zest) and place in a glass container. Pour gruel with boiled and cooled water in the amount of half a liter.

Put the drug for atherosclerosis in a dark place and infuse for three days. After the right time, the mixture can be taken on an empty stomach in two tablespoons. The course can be repeated, cleaning the circulatory system from manifestations of atherosclerosis thanks to this method occurs in a mild form, simultaneously restoring the entire body. There are many recipes for the preparation of natural medicines for atherosclerosis, you only need to choose the right one. How to deal with atherosclerosis is everyone's personal business, the main thing is that this pathological process is curable.

In contact with

Signs of vascular atherosclerosis have not been associated with old age for a long time. A feature of the disease is a gradual and asymptomatic development, therefore, it is known about its presence only with obvious clinical disorders. Symptoms of atherosclerosis vary greatly depending on which part of the blood vessels are affected by sclerotic changes. Most often, vessels of large, medium diameter are affected. Cholesterol is deposited on their walls in the form of formations, plaques, therefore, the lumen gradually narrows. Violation of the blood supply to certain organs over time leads to the appearance of corresponding symptoms.

How does atherosclerotic plaque form

Atherosclerosis affects the vessels containing elastic fibers. It does not affect the vessels of the lymphatic system, veins and capillaries. The formation of atherosclerotic plaques is associated with a disorder of the metabolism of fats in the body, namely, with an excessive amount of low-density lipoproteins (the lipid part is represented by cholesterol). Therefore, when considering the symptoms and treatment of atherosclerosis, special attention is paid to metabolic disorders.

Cholesterol plaque - what is it? The place of its formation is microtrauma of the vascular wall. Such damage can result from exposure to a virus. The plaque itself is formed in several stages.

First, in the area of microtrauma of the vessel wall, a fatty accumulation (stain) appears. Gradually the stain becomes saturated with cholesterol, and then it turns from loose to dense. At this time, it is still possible to influence the formation in order to dissolve it. Later, the plaque becomes very dense, protrudes, deforming the vessel, interfering with the normal blood flow. After the salts are deposited in it, growth stops. The formation of atherosclerotic plaques, which occurs quickly, leads to an acute form of the disease. Otherwise, the disease proceeds chronically, gradually acquiring a larger scale.

What is the cause of the violation?

Symptoms and treatment of vascular atherosclerosis depend on the cause that caused its development. As a rule, the factors provoking the deposition of cholesterol plaques on the vascular walls are divided into two types: those that depend on the person himself and those that cannot be influenced.

Causes of atherosclerosis, which depend on the actions of the person.

Smoking. It is the most significant factor in the development of atherosclerotic changes in the vascular wall. Nicotine, entering the bloodstream, upsets the balance between lipoproteins, shifting it towards compounds with a low density, which leads to their deposition.
High blood pressure. High blood pressure leads to the fact that lipoproteins, which have a low density, "get stuck" on the vessel wall. This significantly accelerates the formation of cholesterol deposits.
Lack of physical activity. Provokes the emergence of stagnant blood, depletion of oxygen and nutrients. Contributes to the weakening of the muscular frame of the vascular wall.
Excess body weight. It is associated with a violation of metabolic processes in the body, including lipid.
Fatty food. Gradually causes liver dysfunction, leading to the inability of the latter to produce enough enzymes to process cholesterol.
Diabetes. Leads to disruption of lipid metabolism.
Infectious diseases. Infections have a damaging effect on the vascular walls, provoking the formation of plaques at the site of microtrauma.

Factors that cause the development of atherosclerosis, which do not depend on the person.

Genetic predisposition. The likelihood of the disease increases if relatives have had strokes, heart attacks, hypertension.
Age. Despite the fact that atherosclerosis is rapidly growing younger, old age still remains the leading factor in its development. This is associated with age-related loss of the body's protective functions.
Floor. According to statistics, men are more prone to developing atherosclerosis. However, after menopause, the likelihood of atherosclerotic changes in both sexes is the same.

How is atherosclerosis manifested?

Since cholesterol is deposited on the vascular wall in the form of formations, plaques, gradually, as a compensatory reaction, this part of the artery bulges outward. During this period, the clinical manifestations of atherosclerosis are not yet evident. Gradually, as a result of the further influence of negative factors (stress, high blood pressure, excessive physical activity, and others), the deposition on the artery wall becomes unstable. Microcracks are formed on it, and then blood clots, which leads to a significant narrowing of the vascular lumen. During this period of development, the disease begins to manifest itself, the first signs appear.

Most often, atherosclerotic deposits affect large and medium-sized vessels of the circulatory system. First, the disease affects the abdominal and thoracic aorta, the vessels of the head, neck, and lower extremities. Atherosclerosis of coronary arteries, mesenteric, renal arteries is also widespread.

Almost each of the listed variants of the disease has a latent origin, develops gradually and imperceptibly. In this regard, an asymptomatic period of development is distinguished, as well as a clinical one. In the first case, a pathological process can be suspected on the basis of a laboratory blood test, which will show a high content of cholesterol or betalipoproteins. The clinical period is characterized by a sufficient degree of severity of symptoms. Narrowing of the lumen of blood vessels by more than half are manifested by the corresponding signs.

The clinical period of the disease can be divided into three stages.

Ischemic. It is characterized by impaired blood circulation of any organ with the ensuing symptoms. For example, renal tissue ischemia due to renal artery atherosclerosis.
Trombonecrotic. Vascular thrombosis develops. For example, in atherosclerotic lesions of the mesenteric arteries, thrombosis leads to gangrene.
Fibrous. The organs' own tissues, which are insufficiently supplied with blood due to the affected arteries, begin to be replaced by connective tissue cells.

For people who suffer from atherosclerosis, a tired, bad appearance is characteristic. Most often, they can be given more years than they actually are. In addition, with this disease, xanthomas are formed on the eyelids and elbows. These are plaques of a yellow or yellow-brown hue, provoked by a high cholesterol content.

Depending on the nature of the pathological process and the dynamics of symptoms, three types of pathology are distinguished.

Progressive. In this case, the signs of the disease only intensify, and the formation of atherosclerotic deposits on the walls of blood vessels continues.
Stabilized. Cholesterol is no longer deposited, the growth of atherosclerotic plaques is inhibited, but the symptoms remain the same.
Retrogressive. There is an improvement in all indicators, the intensity of symptoms is markedly reduced.

Symptoms of aortic involvement

Aortic atherosclerosis is the most common type of vascular damage by cholesterol plaques. Symptoms when this part of the circulatory system is affected will vary due to the fact that the thoracic region of the vessel or its abdominal region may be affected. At the same time, regardless of the area of the lesion, the signs of the disease may not manifest themselves in any way for a sufficiently long time.

In the thoracic region of the aorta, atherosclerotic changes are often accompanied by similar disorders of the brain or coronary arteries. Symptoms begin to manifest themselves, as a rule, at the age of 60-70. At this time, the disease reaches significant development, the vascular walls are already greatly changed by the pathological process. A person complains of signs such as:

burning sensation, pain behind the breastbone;
it becomes difficult to swallow;
frequent dizziness is observed;
breathing problems;
high blood pressure is observed.

Less specific signs include:

gray hair appears early;
early aging of the body occurs;
wen appear on the surface of the face;
in the area of the auricles, hair follicles are activated, which causes the growth of a large volume of hair;
along the iris (along the edge) a strip is formed, of a lighter shade.

The share of atherosclerotic lesions of the abdominal aorta accounts for almost half of the total cases of the development of the disease. Vascular pathology in this area provokes the occurrence of abdominal ischemia, which, by analogy with cardiac ischemia, is characterized by impaired blood flow in the corresponding organs. The defeat of the aorta in this case will be manifested by the following symptoms.

Pain in the abdomen. The pain characteristic of atherosclerosis of the abdominal aorta appears after eating. It is aching in nature, manifests itself in the form of seizures, does not have a specific localization, passes after a while without taking medications.
Digestive disorders. Manifested in the form of increased gas production, possibly alternating diarrhea and difficult bowel movements.
Weight loss. It is caused by a disorder of the digestive function and a lack of appetite. As the disease progresses, weight loss increases.
Renal failure It develops as a result of the replacement of the renal tissue with connective structures, which leads to disruption of blood flow in them and the occurrence of necrosis.
Increased blood pressure. It occurs due to a violation of blood flow in the renal tissue.

In the absence of timely treatment as a result of atherosclerotic changes in the abdominal aorta, deadly complications develop: aortic aneurysm and thrombosis of the visceral arteries.

Signs of damage to the vessels of the brain

The cerebral vessels are very sensitive to the lack of nutrition and oxygen, but often the manifestations of atherosclerosis in this part of the body are mistaken for signs of aging. This is due to the fact that the main symptoms characteristic of atherosclerotic changes in the vessels of the head appear at the age of over 60 years. In addition, the initial signs of the disease can be interpreted as symptoms of osteochondrosis, hypertensive encephalopathy, or another disorder.

Symptoms of atherosclerotic disorders of the cerebral vessels do not manifest themselves immediately, but gradually. In addition, some neurological manifestations may appear only for a certain period of time and then disappear. This:

loss or decrease in sensitivity;
muscle weakening, which can manifest as paresis;
paralysis;
hearing impairment;
deterioration of vision;
problems with speech skills.

In some cases, if atherosclerotic changes are very pronounced, due to the loss of blood supply, necrosis of brain regions is possible, a stroke occurs. Then the above symptoms become resistant and practically do not lend themselves to therapeutic action.

What other symptoms are characteristic of cerebrovascular lesions? Other signs include:

a bursting headache, which, as a rule, spreads throughout the head;
high fatigue;
ringing or noise in your ears;
anxiety and nervousness;
lethargy, apathy;
difficulties with coordination in space;
sleep disorders (expressed both in its absence and in increased drowsiness, nightmares are characteristic);
memory and concentration disorders;
psychological changes in personality (pickiness, resentment and others appear);
depression.

If therapeutic treatment is not prescribed in a timely manner, then senile dementia develops.

Signs of atherosclerotic lesions of the lower extremities

As well as the above-described options for the development of atherosclerosis, impaired blood supply to the extremities is absolutely asymptomatic for a long period of time. This course of the disease can continue until the moment when the blood flow is not disturbed at all. Prior to this, limb pathology can manifest itself in various disorders, which is the reason for a thorough differential diagnosis.

Violation of blood circulation in the vessels leads to an acute lack of oxygen and nutrition. Oxygen starvation of muscle tissue, in turn, causes pain. Pain, in this case, is a classic symptom indicating the development of atherosclerotic changes. As the disease progresses, the so-called "intermittent claudication" occurs. What does it mean? Painful sensations due to damage to the arteries over time spread throughout the muscle tissue of the legs: on the thighs, calves, and the annual area. This manifests itself in the form of seizures, and leads to the fact that the person is forced to limp. In addition, paroxysmal pain causes him to stop during movement in order to wait for the pain to subside.

At the initial stage of development of vascular disorders of the extremities, episodic manifestations of other symptoms can be noted.

Legs and arms periodically "get cold", there is a feeling of chilliness.
There is a feeling of crawling "goose bumps" along the limbs, just like in the case of a long stay in one position, but with atherosclerosis - in a normal state.
The surface of the skin becomes so pale that the course of the blood vessels begins to show through.

With the further development of the disease (in the last stages), a person develops more severe signs of vascular lesions in the extremities.

Tissues, due to lack of oxygen and nutrients, begin to atrophy. In this case, degeneration occurs not only in the muscles. Thinning of subcutaneous fatty tissue and nail plates occurs. Hair becomes thin and colorless, and then irrevocably falls out due to atrophy of hair follicles.
Trophic lesions - ulcers - appear on the surface of the skin.
There is an accumulation of fluid in the intercellular space, and persistent edema of the extremities develops.
The fingers turn red.
A characteristic sign of atherosclerotic changes in the vessels is the absence of a pulse during pressure on the artery (for example, in the popliteal fossa).
As the final stage of atherosclerotic changes in the extremities, gangrene and necrosis develop.

Severe pain in the legs gradually increases, and over time it begins to appear even in the absence of any movement, which indicates arterial insufficiency. Depending on the intensity of the pain syndrome, four degrees of its development can be distinguished.

Functional compensation. The pain begins to bother as a result of prolonged walking long distances (more than 1 km) or other, no less intense load. It is localized in the calves, feet. During this period, the patient complains of a feeling of chilliness or loss of sensitivity in the limbs. Possible manifestations of impaired blood circulation, such as: burning, tingling; convulsive seizures may disturb.
Subcompensation. Pain syndrome appears when moving at a distance of no more than 0.2 km. External signs of atherosclerosis appear, which are characterized primarily by dry skin. Peeling and loss of elastic properties of the epidermis are caused by the ongoing disorders of tissue trophism. During this period, there is a change in the nail plate and hair. The lower surface of the feet undergoes increased keratinization due to lack of nutrition. Thinning hair and the death of hair follicles lead to the emergence of foci of baldness. In addition, there is a gradual atrophy of the muscle tissue of the feet, and the subcutaneous tissue layer becomes very thin.
Decompensation. At the third stage of arterial insufficiency, a person is not able to overcome more than 25 m, or the pain worries even in the absence of movement. Trophic disorders in tissues at this stage are significantly aggravated. Thinned skin becomes easily vulnerable, which causes deep damage even in the case of a minor scratch. The surface of the epidermis in the position of the limb "down" becomes a red hue.
Destructive changes. The fourth, last, stage of the disease is characterized by the presence of ulcerative lesions and the development of tissue necrosis. The quality of life is reduced to a minimum due to constant unbearable pain. Characterized by the presence of trophic ulcers, especially on the fingers, which do not lend themselves to targeted treatment. The tissues of the limbs are swollen. At this stage in the development of the disease, gangrene develops.

With atherosclerotic disorders that develop in the upper limbs, they become chilly and weak. A person has high fatigue, decreased performance, decreased muscle strength in the hands. If the pathological process is one-sided, narrowing of the lumen occurs in the subclavian artery, then an asymmetric pulse is observed. In this case, on the affected limb, the upper pressure can be up to 80 mm Hg. Art.

Manifestations of atherosclerosis of the coronary arteries of the heart

It is not easy to identify the beginning of the formation of atherosclerotic changes in the coronary arteries of the heart. Deposits on the vascular walls interfere with the normal nutrition of the heart tissues, as a result of which the activity of the myocardium is disrupted. Diseases such as angina pectoris or ischemia develop. As complications, cardiosclerosis and heart attack occur. Therefore, the symptomatology of atherosclerosis in this case will manifest itself as signs of these disorders.

So, with angina pectoris, atherosclerosis of the coronary arteries of the heart manifests itself as the following symptoms.

Pain syndrome localized in the chest area. The pain can burn, press, move towards the shoulder, back (on the left side). As a rule, it occurs during physical activity or nervous strain.
Dyspnea. It can accompany pain, or it occurs on its own during movement or any action. It manifests itself as a feeling of acute lack of air. It intensifies when lying down, so a person has to take a sitting position so as not to suffocate.
Headache and dizziness (manifested as a consequence of impaired blood circulation and lack of oxygen).
Vomiting and / or nausea can also accompany an angina attack.

If cardiosclerosis develops as a result of atherosclerotic disorders, then an additional sign of shortness of breath will be the occurrence of severe edema. Heart failure appears gradually. Physical performance also decreases as the condition worsens.

Myocardial infarction, as a consequence of atherosclerosis of the coronary vessels of the heart, manifests itself in almost the same symptoms as angina pectoris. There is an acute shortage of air, shortness of breath, up to fainting. The use of nitroglycerin, in contrast to an attack of angina pectoris, does not bring relief.

Symptoms of atherosclerosis of the mesenteric arteries

With the development of atherosclerosis of the mesenteric arteries, vascular changes occur in the upper abdomen, therefore, the blood supply to the digestive organs located in this area of the body is disrupted. The volume of blood that is required to ensure the normal functioning of the digestive tract is insufficient. This is evidenced by the corresponding external and internal manifestations. Symptoms occur most often in the evening after a meal. The symptomatology in this case of atherosclerotic changes is collectively called "abdominal toad", and the complex of characteristic signs is a kind of marker of the disease.

Pain. Moderate. It resembles that of a peptic ulcer, but in the latter case it is longer. The duration of the pain syndrome in atherosclerosis of the mesenteric arteries is different, from a couple of minutes to an hour.
Increased gas formation.
Moderate muscle tension.
Hypotension or intestinal atony. As a result of weakened motor skills, there are difficulties with defecation, bloating.
Belching.

Atherosclerosis of the mesenteric arteries can provoke their thrombosis. Usually, this complication develops sharply and is characterized by severe gas formation, intense vomiting, nausea and pain. Pain with thrombosis is diffuse or wandering, prolonged, can concentrate in the navel. Vomit may contain blood or bile.

In many cases, the result of mesenteric artery thrombosis is gangrene and peritonitis. Symptoms of vascular atherosclerosis are manifested, such as: a sharp increase in temperature, a decrease in blood pressure, profuse sweating, a sharp severe pain in the abdomen and incessant vomiting.

Manifestations of atherosclerotic vascular lesions of the renal arteries

Atherosclerosis of the renal arteries also has features in the symptoms. This variant of the disease over time provokes the onset of ischemia, which leads to a persistent increase in blood pressure. Sometimes specific signs of the disease may be absent. However, most often atherosclerotic vascular changes cause obstruction of blood flow and the development of secondary hypertension. In this case, high blood pressure becomes an obvious symptom of atherosclerosis, and indicates that the vessel lumen is closed by more than 70%.

A feature of blood pressure in atherosclerosis of the renal artery is an increase in blood pressure and systolic and diastolic. As a result of the violations occurring, the brain pressure also rises, which is expressed in severe pain and heaviness in the head, the occurrence of dizziness, visual disturbances, and tinnitus.

If only one artery is affected by the pathological process, then the disease develops gradually and is characterized by frequent manifestations of hypertension. When the lumen is narrowed by atherosclerotic deposits of both arteries, the development of the disease occurs abruptly, quickly, and is accompanied by additional symptoms:

pain in the abdomen, lumbar region (duration can be up to several days);
vomiting and nausea;
increased body temperature;
aching pain occurs in the region of the heart;
the heart rate increases.

A complication such as a kidney infarction is characterized by a sharp pain syndrome in the lumbar region, as well as the presence of blood traces in the urine.

As a result, the person's condition deteriorates sharply.

Symptoms of carotid atherosclerosis

Another part of the circulatory system that can be affected by atherosclerotic deposits is the carotid arteries. Usually carotid atherosclerosis is found after a stroke has occurred. Just like other forms of the disease, disturbances in this area occur gradually and do not reveal themselves in any way. However, with a more attentive approach to your well-being, you can identify the following manifestations of the disease:

itching sensation in the legs and arms;
numbness and / or tingling;
loss of control over the movement of any limb;
weakening or loss of vision in one eye;
problems with speech skills, difficulty in pronunciation.

In addition, atherosclerosis of the carotid arteries is manifested by weakness and numbness of the body.

Diagnosis of the disease

It is quite problematic to detect the development of atherosclerosis at an early stage.

Usually, a specialist is approached with complaints that correspond to a specific atherosclerotic disorder. At the same time, vascular damage has already reached a significant degree. Depending on the nature of the signs, in addition to laboratory diagnostics, the doctor may prescribe such studies as:

electrocardiogram;
ultrasound dopplerography;
cardiac catheterization;
magnetic resonance imaging or computed tomography;
angiography and others.

In each case, its own complex of diagnostic examination will be drawn up, which will make it possible to detect changes in the vessels to the greatest extent and make the correct diagnosis.

Forecast and prevention

The prognosis of atherosclerosis is considered favorable, provided that the patient completely revises his lifestyle, making adjustments to diet, habits, and physical activity.

In addition, strict adherence to the doctor's prescriptions for taking medications will be required. Only in this case is it possible not only to stabilize the state and stop further growth and development of atherosclerotic deposits, but also to completely regress the disease. However, the latter is possible only if atherosclerosis was detected at an early stage of development. If the patient refuses to make adjustments to the lifestyle, and also ignores the prescribed therapeutic treatment, then the prognosis for the development of the disease is unfavorable.

Timely preventive measures taken will prevent the occurrence of atherosclerotic vascular lesions, and, if present, will make it possible to stop the pathological process and maintain health. Prevention includes simple, affordable lifestyle rules:

monitor the diet, excluding fatty and fried foods;
increase stress resistance;
normalize and maintain body weight;
say goodbye to bad habits;
increase physical activity.

In addition, people who are predisposed to diabetes or high blood pressure should undergo preventive examinations by a specialist in a timely manner.

This is a systemic lesion of arteries of large and medium caliber, accompanied by the accumulation of lipids, proliferation of fibrous fibers, dysfunction of the endothelium of the vascular wall and leading to local and general hemodynamic disorders. Atherosclerosis can be the pathomorphological basis of ischemic heart disease, ischemic stroke, obliterating lesions of the lower extremities, chronic occlusion of mesenteric vessels, etc. The diagnostic algorithm includes determining the level of blood lipids, performing ultrasound of the heart and blood vessels, angiographic studies. With atherosclerosis, drug therapy, diet therapy, and, if necessary, revascularizing surgical interventions are performed.

General information

Atherosclerosis is a lesion of the arteries, accompanied by cholesterol deposits in the inner lining of blood vessels, narrowing of their lumen and malnutrition of the blood-supplied organ. Atherosclerosis of the vessels of the heart is manifested mainly by attacks of angina pectoris. Leads to the development of coronary heart disease (CHD), myocardial infarction, cardiosclerosis, vascular aneurysm. Atherosclerosis can lead to disability and premature death.

In atherosclerosis, arteries of medium and large caliber, elastic (large arteries, aorta) and muscular-elastic (mixed: carotid, arteries of the brain and heart) types are affected. Therefore, atherosclerosis is the most common cause of myocardial infarction, ischemic heart disease, cerebral stroke, circulatory disorders of the lower extremities, abdominal aorta, mesenteric and renal arteries.

In recent years, the incidence of atherosclerosis has reached alarming proportions, outstripping such causes as injuries, infectious and oncological diseases in terms of the risk of loss of working capacity, disability and mortality. With the greatest frequency, atherosclerosis affects men over 45-50 years of age (3-4 times more often than women), but it occurs in younger patients.

Causes of atherosclerosis

The factors influencing the development of atherosclerosis are divided into three groups: irreparable, removable and potentially removable. Fatal factors include those that cannot be excluded by volitional or medical influence. These include:

Age. The risk of developing atherosclerosis increases with age. Atherosclerotic vascular changes are observed to some extent in all people after 40-50 years.
Floor. In men, the development of atherosclerosis occurs ten years earlier and exceeds the incidence rate of atherosclerosis among women by 4 times. After 50-55 years, the incidence of atherosclerosis among women and men levels off. This is due to a decrease in the production of estrogens and their protective function in women during menopause.
Complicated family heredity. Often, atherosclerosis develops in patients whose relatives suffer from this disease. It has been proven that heredity for atherosclerosis contributes to the early (up to 50 years) development of the disease, while after 50 years of age genetic factors do not play a leading role in its development.

Removable factors of atherosclerosis are those that can be eliminated by the person himself by changing his usual lifestyle. These include:

Smoking. Its influence on the development of atherosclerosis is explained by the negative effect of nicotine and tar on the vessels. Long-term smoking several times increases the risk of hyperlipidemia, arterial hypertension, ischemic heart disease.
Unbalanced diet. Eating large amounts of animal fats accelerates the development of atherosclerotic vascular changes.
Physical inactivity. Leading a sedentary lifestyle contributes to the violation of fat metabolism and the development of obesity, diabetes mellitus, vascular atherosclerosis.

Potentially and partially avoidable risk factors include those chronic disorders and diseases that can be corrected through the prescribed treatment. These include:

Arterial hypertension. Against the background of high blood pressure, conditions are created for increased saturation of the vascular wall with fats, which contributes to the formation of an atherosclerotic plaque. On the other hand, the decreased elasticity of the arteries in atherosclerosis contributes to the maintenance of high blood pressure.
Dyslipidemia. Violation of fat metabolism in the body, manifested by an increased content of cholesterol, triglycerides and lipoproteins, plays a leading role in the development of atherosclerosis.
Obesity and diabetes mellitus. Increase the likelihood of atherosclerosis by 5-7 times. This is due to the violation of fat metabolism, which underlies these diseases and is the trigger mechanism for atherosclerotic vascular lesions.
Infection and intoxication. Infectious and toxic agents have a damaging effect on the vascular walls, contributing to their atherosclerotic changes.

There are opinions that infectious agents play a role in the development of atherosclerosis (herpes simplex virus, cytomegalovirus, chlamydial infection, etc.), hereditary diseases accompanied by an increase in cholesterol levels, mutations of vascular wall cells, etc.

Knowledge of the factors contributing to the development of atherosclerosis is especially important for its prevention, since the influence of removable and potentially removable circumstances can be weakened or completely eliminated. Elimination of unfavorable factors can significantly slow down and facilitate the development of atherosclerosis.

Pathogenesis

In atherosclerosis, systemic damage to the arteries occurs as a result of lipid and protein metabolism disorders in the walls of blood vessels. Metabolic disorders are characterized by a change in the ratio between cholesterol, phospholipids and proteins, as well as excessive formation of β-lipoproteins. It is believed that in its development, atherosclerosis goes through several stages:

Stage I- lipid (or fat) stain. For the deposition of fat in the vascular wall, microdamage to the walls of the arteries and local slowing down of blood flow play an essential role. Areas of branching of blood vessels are most susceptible to atherosclerosis. The vascular wall loosens and swells. Arterial wall enzymes strive to dissolve lipids and protect its integrity. When the defense mechanisms are depleted, complex complexes of compounds are formed in these areas, consisting of lipids (mainly cholesterol), proteins, and they are deposited in the intima (inner lining) of the arteries. The duration of the lipid spot stage is different. Such fatty spots are visible only under a microscope and can be found even in infants.
Stage II- liposclerosis. It is characterized by the growth of young connective tissue in the areas of fatty deposits. The formation of an atherosclerotic (or atheromatous) plaque, consisting of fats and connective tissue fibers, is gradually taking place. At this stage, atherosclerotic plaques are still liquid and can be dissolved. On the other hand, they are dangerous, since their loose surface can rupture, and plaque fragments can clog the lumen of the arteries. The vessel wall at the site of attachment of the atheromatous plaque loses its elasticity, cracks and ulcerates, leading to the formation of blood clots, which are also a source of potential danger.
Stage III- atherocalcinosis. Further formation of the plaque is associated with its compaction and the deposition of calcium salts in it. Atherosclerotic plaque can behave stably or gradually grow, deforming and narrowing the lumen of the artery, causing a progressive chronic disturbance of the blood supply to the organ fed by the affected artery. At the same time, there is a high probability of acute blockage (occlusion) of the lumen of the vessel by a thrombus or fragments of a disintegrated atherosclerotic plaque with the development of a site of infarction (necrosis) or gangrene in the blood-supplied artery of a limb or organ.

Symptoms of atherosclerosis

With atherosclerosis, the thoracic and abdominal parts of the aorta, coronary, mesenteric, renal vessels, as well as the arteries of the lower extremities and the brain are more often affected. In the development of atherosclerosis, preclinical (asymptomatic) and clinical periods are distinguished. In the asymptomatic period, an increased content of β-lipoproteins or cholesterol is found in the blood in the absence of symptoms of the disease. Clinically, atherosclerosis begins to manifest itself when there is a narrowing of the arterial lumen by 50% or more. During the clinical period, three stages are distinguished: ischemic, thrombonecrotic and fibrous.

In the stage of ischemia, insufficient blood supply to one or another organ develops (for example, myocardial ischemia due to atherosclerosis of the coronary vessels is manifested by angina pectoris).
In the thrombonecrotic stage, thrombosis of the altered arteries joins - atherothrombosis (for example, the course of atherosclerosis of the coronary vessels can be complicated by myocardial infarction).
At the stage of fibrotic changes, connective tissue proliferates in poorly perfused organs (for example, atherosclerosis of the coronary arteries leads to the development of atherosclerotic cardiosclerosis).

The clinical symptoms of atherosclerosis depend on the type of arteries affected. The manifestation of atherosclerosis of the coronary vessels is angina pectoris, myocardial infarction and cardiosclerosis, consistently reflecting the stages of circulatory insufficiency of the heart.

The course of aortic atherosclerosis is long and asymptomatic for a long time, even in severe forms. Clinically, atherosclerosis of the thoracic aorta is manifested by aorthalgia - pressing or burning pains behind the sternum, radiating to the arms, back, neck, upper abdomen. Unlike pain in angina pectoris, aorthalgia can last for several hours and days, periodically weakening or worsening. A decrease in the elasticity of the aortic walls causes an increase in the work of the heart, leading to hypertrophy of the left ventricular myocardium.

Complications of atherosclerosis

Complications of atherosclerosis are chronic or acute vascular insufficiency of the blood-supplied organ. The development of chronic vascular insufficiency is associated with a gradual narrowing (stenosis) of the lumen of the artery by atherosclerotic changes - stenosing atherosclerosis. Chronic insufficiency of blood supply to an organ or part of it leads to ischemia, hypoxia, dystrophic and atrophic changes, proliferation of connective tissue and the development of small focal sclerosis.

Acute blockage of blood vessels by a thrombus or embolus leads to the occurrence of acute vascular insufficiency, which is manifested by the clinic of acute ischemia and organ infarction. In some cases, a fatal arterial aneurysm may rupture.

Diagnosis of atherosclerosis

Initial data for atherosclerosis are established by clarifying the patient's complaints and risk factors. Consultation with a cardiologist is recommended. General examination reveals signs of atherosclerotic lesions of the vessels of internal organs: edema, trophic disorders, weight loss, multiple wen on the body, etc. Auscultation of the vessels of the heart and aorta reveals systolic murmurs. Atherosclerosis is evidenced by a change in arterial pulsation, an increase in blood pressure, etc.

Laboratory data indicate an increased level of blood cholesterol, low density lipoproteins, triglycerides. Radiographically, aortography reveals signs of aortic atherosclerosis: its lengthening, induration, calcification, expansion in the abdominal or thoracic regions, the presence of aneurysms. The condition of the coronary arteries is determined by coronary angiography.

Disturbances of blood flow in other arteries are determined by angiography - contrast radiography of the vessels. In atherosclerosis of the arteries of the lower extremities, according to angiography, their obliteration is recorded. With the help of USDG of the vessels of the kidneys, atherosclerosis of the renal arteries and the corresponding impairment of renal function are detected.

Methods of ultrasound diagnostics of the arteries of the heart, lower extremities, aorta, carotid arteries record a decrease in the main blood flow through them, the presence of atheromatous plaques and blood clots in the lumens of the vessels. Decreased blood flow can be diagnosed with rheovasography of the lower extremities.

Treatment of atherosclerosis

In the treatment of atherosclerosis, the following principles are adhered to:

limiting cholesterol entering the body and reducing its synthesis by tissue cells;
increased excretion of cholesterol and its metabolites from the body;
the use of estrogen replacement therapy in postmenopausal women;
impact on infectious pathogens.

Limiting the intake of cholesterol from food is made by prescribing a diet that excludes cholesterol-containing foods.

For the drug treatment of atherosclerosis, the following groups of drugs are used:

Nicotinic acid and its derivatives - effectively reduce the content of triglycerides and cholesterol in the blood, increase the content of high density lipoproteins, which have antiatherogenic properties. The prescription of nicotinic acid preparations is contraindicated in patients with liver disease.
Fibrates (clofibrate) - reduce the synthesis in the body of its own fats. They can also cause abnormalities in the liver and the development of gallstone disease.
Bile acid sequestrants (cholestyramine, colestipol) - bind and remove bile acids from the intestine, thereby lowering the amount of fat and cholesterol in cells. When using them, constipation and flatulence may occur.
The drugs of the statin group (lovastatin, simvastatin, pravastatin) are the most effective for lowering cholesterol, since they reduce its production in the body itself. Statins are used at night, since cholesterol synthesis increases at night. Can lead to liver problems.

Surgical treatment for atherosclerosis is indicated in cases of high threat or development of arterial occlusion by plaque or thrombus. Both open operations (endarterectomy) and endovascular operations are performed on the arteries - with dilatation of the artery using balloon catheters and the installation of a stent at the site of narrowing of the artery, which prevents blockage of the vessel.

With severe atherosclerosis of the vessels of the heart, threatening the development of myocardial infarction, coronary artery bypass grafting is performed.

Forecast and prevention of atherosclerosis

In many ways, the prognosis of atherosclerosis is determined by the behavior and lifestyle of the patient himself. Elimination of possible risk factors and active drug therapy can delay the development of atherosclerosis and improve the patient's condition. With the development of acute circulatory disorders with the formation of foci of necrosis in the organs, the prognosis worsens.

In order to prevent atherosclerosis, it is necessary to quit smoking, eliminate the stress factor, switch to low-fat and cholesterol-poor food, systematic physical activity in proportion to opportunities and age, normalization of weight. It is advisable to include in the diet foods containing fiber, vegetable fats (flaxseed and olive oils) that dissolve cholesterol deposits. The progression of atherosclerosis can be slowed down by taking cholesterol-lowering drugs.

Atherosclerosis Is a common progressive disease that affects the large and medium arteries as a result of the accumulation of cholesterol in them, leading to impaired circulation.
In economically developed countries, atherosclerosis is the most common cause of morbidity and overall mortality.

Causes of atherosclerosis

In the emergence and formation of atherosclerosis play a role:
- disorders of lipid (fat) metabolism;
- hereditary genetic factor;
- the state of the vascular wall.

Cholesterol is a lipid (fat) and has many important functions in the human body. It is a building material for the walls of the body's cells, is a part of hormones, vitamins, without which normal human existence is impossible. Up to 70% of cholesterol in the body is synthesized in the liver, the rest comes from food. In the body, cholesterol is not in a free state, but is part of lipoproteins (complex compounds of protein and fats) that transport it through the bloodstream from the liver to the tissues, and in case of excess cholesterol, from the tissues back to the liver, where excess cholesterol is utilized. In case of violation of this process, atherosclerosis develops.

The main role in the development of atherosclerosis belongs to low-density lipoproteins (LDL), which transport cholesterol from the liver to the cells, it must be in a strictly necessary amount, when its level is exceeded, the risk of atherosclerosis is determined.

The reverse transport of cholesterol from tissues to the liver is provided by high density lipoproteins (HDL), an antiatherogenic class of lipoproteins. It cleans the cell surface of excess cholesterol. Raising LDL cholesterol and lowering HDL cholesterol increases the risk of atherosclerosis.

Initial changes in the wall of large and medium-sized arteries occur at a young age and evolve to fibroadenomatous plaques, which often develop after 40 years. Atherosclerotic vascular disease occurs already in persons under 20 years of age in 17% of cases, up to 39 years in 60% of cases, and at 50 years of age and older in 85% of cases.

Cholesterol, fibrin and other substances penetrate into the middle of the arterial wall, which later form an atherosclerotic plaque. Under the influence of excess cholesterol, the plaque increases, and there are obstacles for the normal blood flow through the vessels at the site of narrowing. The blood flow decreases, the inflammatory process develops, blood clots form and can come off, with the danger of blocking vital vessels, stopping the delivery of blood to the organs.

Factors play a role in the development and progression of atherosclerosis:
- modifiable (which can be eliminated or corrected)
- not modifiable (they cannot be changed).

Modifiable factors include:

1.Lifestyle:
- physical inactivity,
- abuse of fatty, cholesterol-rich foods,
- personality and behavior features - stressful character type,
- alcohol abuse,
- smoking.
2. Arterial hypertension, arterial pressure 140/90 mm Hg. and higher.
3. Diabetes mellitus, fasting blood glucose more than 6 mmol / l.
4. Hypercholesterolemia (increased blood cholesterol levels).
5. Abdominal obesity (waist for men over 102 cm and over 88 cm for women).

Non-modifiable factors include:

1. Age: men over 45 and women over 55 or with early menopause.
2. Male sex (men 10 years earlier than women develop atherosclerosis).
3. A family history of early atherosclerosis. Familial hypercholesterolemia with a genetic basis. Myocardial infarction, stroke, sudden death in the next of kin under the age of 55 for a man and 65 for a woman.

The unfavorable influence of risk factors leads to a violation of the integrity of the endothelium (the inner layer of blood vessels), which loses its barrier function, against the background of lipid metabolism disorders lead to the development of atherosclerosis.

Symptoms of atherosclerosis.

The deposition of cholesterol in the arterial wall is accompanied by its compensatory bulging outward, due to this, for a long time, there are no obvious symptoms of atherosclerosis. But over time, the atherosclerotic plaque transforms from stable to unstable under the influence of systemic factors: physical activity, emotional stress, arterial hypertension, heart rhythm disturbances. They lead to cracks or rupture of the plaque. Blood clots form on the surface of an unstable atherosclerotic plaque - atherothrombosis is formed, leading to progressive vasoconstriction. There is a violation of blood circulation in organs and tissues, there are clinical symptoms that are noticeable to the patient.

Depending on the localization in the vascular system, atherosclerosis is the basis of such diseases:

1. Ischemic heart disease (angina pectoris, myocardial infarction, sudden cardiac death, arrhythmias, heart failure).
2. Cerebrovascular diseases (transient ischemic attack, ischemic stroke).
3. Atherosclerosis of the arteries of the lower extremities (intermittent claudication, gangrene of the feet and legs).
4. Atherosclerosis of the aorta.
5. Atherosclerosis of the renal arteries.
6. Atherosclerosis of the mesenteric arteries (intestinal infarction).

The atherosclerotic process leads to damage to several vascular regions. With a stroke, the likelihood of developing myocardial infarction in such patients is 3 times higher, and damage to peripheral arteries increases the risk of developing myocardial infarction 4 times, stroke - 3 times.

Atherosclerosis of the coronary arteries has many symptoms, depending on the severity of atherosclerosis, manifested by angina pectoris or acute coronary insufficiency, characterized by the development of myocardial infarction, heart failure. All forms of coronary heart disease occur against the background of atherosclerosis. Cardiac manifestations of atherosclerosis account for about half of all atherosclerotic lesions.

Aortic atherosclerosis often appears after 60 years. With atherosclerosis of the thoracic aorta, intense burning pains appear behind the sternum, radiating to the neck, back, upper abdomen. With exercise and stress, the pain increases. Unlike angina pectoris, the pain continues for days, periodically increasing and weakening. Swallowing disorders, hoarseness, dizziness, fainting may appear. Atherosclerosis of the abdominal aorta is characterized by abdominal pain, bloating, and constipation. With atherosclerotic lesions of the aortic bifurcation (the place where the aorta is divided into branches), Leriche's syndrome develops with such manifestations as: intermittent claudication, coldness of the lower extremities, impotence, ulcers of the toes. A formidable complication of aortic atherosclerosis is an aneurysm (dissection) and rupture of the aorta.

Atherosclerosis of mesenteric vessels is manifested by sharp, burning, cutting pains in the abdomen during meals, lasting 2-3 hours, bloating, abnormal stool.

Atherosclerosis of the renal arteries is characterized by a persistent increase in blood pressure, changes in urine analysis.

Atherosclerosis of the peripheral arteries is manifested by weakness and increased fatigue of the muscles of the legs, a feeling of chilliness in the limbs, intermittent claudication (pain in the limbs appears while walking, forcing the patient to stop).

Examination for atherosclerosis.

The primary diagnosis of atherosclerosis is carried out by a therapist, family doctor during the annual dispensary examination. Measures blood pressure, determines body mass index, identifies risk factors (hypertension, diabetes mellitus, obesity).

1. Determination of lipid levels, after 30 years:
- total cholesterol (the norm is less than 5.0 mmol / l);
- LDL cholesterol (the norm is below 3.0 mmol / l);
- HDL cholesterol (the norm is above 1.0 mmol / l (in men) and above 1.2 mmol / l (in women);
- triglycerides of blood plasma (the norm is below 1.2 mmol / l);
- the ratio of total cholesterol / HDL cholesterol (atherogenic index - a factor in the development of cardiovascular complications). Low risk from 2.0 to 2.9, medium risk - from 3.0 to 4.9, high risk - more than 5.

2. Determination of the risk group in patients without clinical manifestations of atherosclerosis. The SCORE scale (systemic assessment of coronary risk) allows to determine the individual degree of risk for patients, with the help of which the probability of fatal cardiovascular events (myocardial infarction, stroke) within 10 years can be assessed. Low risk -<4%, умеренный риск - 4–5%, высокий риск - 5–8% и очень высокий риск - >8%.

If atherosclerotic changes are suspected, specialist advice is indicated:
- cardiologist (with ischemic heart disease);
- ophthalmologist (atherosclerosis of the vessels of the fundus);
- neurologist (cerebral atherosclerosis);
- nephrologist (atherosclerosis of the renal arteries);
- vascular surgeon (atherosclerosis of the vessels of the lower extremities, aorta).

To clarify the degree of atherosclerotic lesions, additional instrumental research methods can be prescribed:

1. Electrocardiography, with stress tests, ultrasound examination of the heart and aorta.
2. Angiography, coronary angiography, intravascular ultrasound. These are invasive research methods. Atherosclerotic plaques are detected, and the total atherosclerotic lesion can be assessed. It is used in patients with clinical manifestations of atherosclerosis (coronary heart disease).
3. Duplex and triplex scanning. Study of blood flow with ultrasound imaging of blood vessels: carotid arteries, abdominal aorta and its branches, arteries of the lower and upper extremities. Reveals atherosclerotic plaques in the arteries, assesses the state of blood flow in the vessels.
4. Magnetic resonance imaging. Visualization of the artery wall and atherosclerotic plaques.

Treatment of atherosclerosis.

1. Without clinical manifestations of atherosclerosis, a lifestyle modification is recommended for a patient with moderate risk (up to 5% on the SCORE scale) and a total cholesterol level above 5 mmol / L. It includes: quitting smoking, drinking alcohol, anti-atherosclerotic diet, increasing physical activity. Upon reaching the target cholesterol level (total cholesterol up to 5 mmol / L, LDL cholesterol below 3 mmol / L), a second examination should be carried out at least once every 5 years.

The initiation of treatment in a patient with a high risk (above 5% on the SCORE scale) and a total cholesterol level above 5 mmol / L should also begin with recommendations for a change in lifestyle for 3 months and reevaluate at the end of this period. When the patient reaches the target levels of total cholesterol up to 5 mmol / L and LDL cholesterol below 3 mmol / L, the lipid level is monitored annually. If the risk remains high (above 5% on the SCORE scale), drug therapy is prescribed.

2. Patients with signs of atherosclerotic lesions of any localization are recommended lifestyle modification and drug therapy.

Diet recommendations are given to all patients taking into account the level of cholesterol and other risk factors: obesity, arterial hypertension, diabetes mellitus. The diet should be varied, in accordance with the patient's cultural traditions. The calorie content of the daily diet should be sufficient to achieve and maintain a normal weight.

Total fat intake should not exceed 30% of the calorie intake.
It is recommended to limit the consumption of animal fats (butter, cream, meat, lard), replacing them with vegetable fats. The daily intake of fresh vegetables and fruits should be at least 400g per day.

It is recommended to consume lean meat and poultry without skin, dairy products, low-fat cottage cheese, grain bread, with bran, foods enriched with ω3-unsaturated fatty acids (sea and ocean fish - salmon, mackerel, tuna, etc.). Limiting the consumption of table salt to 6 g per day, which corresponds to 1 teaspoon. Dieting can reduce cholesterol levels by up to 10%.

Normalization of body mass indicators.

Overweight and obesity, especially abdominal obesity (waist in men over 102 cm and over 88 cm in women), increase the risk of developing cardiovascular diseases. For weight loss, an individual diet is selected taking into account age and concomitant diseases.

Physical activity for atherosclerosis.

Increasing physical activity has a positive effect on patients with atherosclerosis.
Patients without clinical manifestations of atherosclerosis are shown physical activity for 40 minutes, daily. The intensity of the exercise should be 60% of the maximum heart rate (calculated = 220 - age).

Patients with cardiovascular diseases need a constant regime of dynamic physical activity, taking into account the results of stress tests. Walking, swimming, dancing are useful - of moderate intensity 60-90 minutes per week. Isometric (power) loads are unacceptable.

Smoking cessation.

Smoking (active and passive), as a result of a sharp decrease in HDL (antiatherogenic class of lipoproteins), pathological effects on the vascular system, impaired rheological properties of blood - increases the risk of morbidity and mortality from cardiovascular complications by 20%. Smokers have a 2 times higher risk of ischemic stroke than nonsmokers.

Alcohol consumption.

Safe for health consumption of alcohol - no more than 20-30 ml of pure ethanol per day for men and no more than 20 ml per day - for women, only for practically healthy individuals, reduces mortality from cardiovascular complications. Drinking alcohol (12-24 g per day of pure ethanol) reduces the risk of cardiovascular complications (heart attack and stroke) by 20%, and drinking 5 servings of alcohol (60 g per day) increases the risk of cardiovascular complications by 65%.

Drugs.

The use of drugs such as cocaine, amphetamine, heroin, cause sharp changes in blood pressure, inflammatory changes in the vascular system, lead to a violation of the rheological properties of blood. Increase the risk of stroke by 6.5 times in people under 35 years old, and over 35 years old - 11.2 times.

Medical treatment of atherosclerosis.

Drug therapy for atherosclerosis involves the use of 4 groups of lipid-lowering (lipid-lowering) drugs: bile acid sequestrants, nicotinic acid, fibrates, statins. These funds have a stabilizing effect on atherosclerotic plaque, improve the function of the endothelium (inner lining of blood vessels), inhibit the development of atherosclerosis, while differing in the severity of the effect on various indicators of lipid metabolism.

Only the attending physician will recommend the necessary drug and its dosage. Statins are most commonly used. Statin therapy can significantly reduce mortality and prevent cardiovascular complications. The required dose of statins is selected individually for each patient. The drug is taken once a day - in the evening before bedtime.

Preparations based on fish oil and essential phospholipids are of secondary importance. They are used only in combination with statins.

With the threat of complications of atherosclerosis, surgical treatment is indicated, which restores the patency of the arteries (revascularization). In coronary artery disease, coronary artery stenting or bypass grafting is performed to prevent the development of a heart attack. In cerebral atherosclerosis, stenting of the carotid arteries is performed to prevent the development of stroke. To prevent the development of gangrene of the lower extremities, prosthetics of the main arteries are performed. The need and scope of the surgical intervention is determined by the surgeon (cardiac surgeon, vascular surgeon).

Surgical treatment of atherosclerosis does not provide a complete cure. The complication is eliminated, not the cause that caused it (atherosclerosis). Therefore, after the operation, changes in lifestyle, nutrition and conservative treatment are required.

Prevention of atherosclerosis.

Primary prevention of atherosclerosis involves:

1. Control and achievement of the target cholesterol level (total cholesterol up to 5 mmol / l, LDL cholesterol below 3 mmol / l).
2. Quitting smoking, drinking alcohol, taking drugs.
3. Adequate level of physical activity.
4. Normalization of body weight.
5. Limitation of emotional overload.
6. Normal blood glucose levels.
7. Blood pressure below 140/90 mm Hg.
8. Compliance with the principles of anti-atherosclerotic diet.

Secondary prevention measures aimed at preventing complications of an already developed disease, in addition to primary prevention measures, also include the use of cholesterol-lowering drugs (statins), antiplatelet agents (acetylsalicylic acid).

Doctor's consultation on atherosclerosis:

Question: Is it advisable to take statins for elderly and senile people (70-80 years old)?
Answer: Therapy of atherosclerosis with statins in the elderly not only leads to a decrease in the risk of stroke and heart attack, but also reduces overall mortality.

Q: How long should statins be taken?
Answer: To significantly improve the prognosis of life and reduce the risk of cardiovascular complications, statins must be used daily for at least 3-5 years without an unreasonable dose reduction and unauthorized premature termination of treatment.

Physician therapist Vostrenkova I.N.