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Arterioscleris is a general term for several diseases in which the wall of the Artery becomes less elastic. The most important and most common of these diseases is atherosclerosis, in which fatty material accumulates under the inner lining of the arterial wall.
Atherosclerosis can affect the arteries of the brain, heart, kidneys and vital organs, and the arms and legs.
When atherosclerosis develops in the arteries that supply the brain(carotid arteries) a stroke may occur, when it develops in the arteries that supply the heart (coronary arteries), a heart attack may occur.
In the past in the United States and other western countries atherosclerosis is the leading cause of illness and death. But now in Africa generally and Nigeria in particular, affluence and the consumption of junk foods, atherosclerosis is gradually becoming the bane of most Nigerians. We call it development of sweet tooth. All these junk foods viz cakes, doughnuts meat pies, fish pies and other pessaries have inflicted inculcable damage to our health.
In Nigeria alone, according to a research from University of Jos, atherosclerosis caused almost one million deaths in 1992, this is twice as many as from cancer and 10 times as many as from accidents.
Despite significant medical advances, coronary artery disease which results from atherosclerosis and causes heart attacks and atherosclerosis stroke are responsible for more deaths than all other causes combined.
Atherosclerosis begins when white blood cells, monocytes migrate from the blood stream into the wall of the artery and are transformed into cells, that accumulate fatty materials. In time, these fat ladden monocytes accumulate, leading to a patchy thickening in the inner lining of the artery. Each area of thickening is called an atherosclerotic plaque or atheroma, which is filled with a soft cheese like substance consisting of various fatty materials, principally cholesterol, smooth muscle cells, and connective tissue cells.
Atheromas may be scattered through out the medium and large arteries, but usually, they form where the arteries branch off – presumably because the constant, turbulence at these areas injures the arterial wall making it more susceptible to atheroma formation.
Arteries affected with atherosclerosis lose their elasticity, and as the atheromas grow, the arteries narrow. With time the atheromas collect calcium deposits, may become brittle, and may rupture. Blood may enter a ruptured atheroma, making it larger, so that it narrows the artery even more. A ruptured atheroma also may spill its fatty contents and trigger the formation of a blood clot (thrombus). The clot may further narrow or even occlude the artery, or it may detach and float downstream, where it causes an occlusion – embolism.
Usually, atherosclerosis does not produce symptoms until it severely narrows the artery, or until it causes a sudden obstruction. Symptoms depend on where the atherosclerosis develops; thus, they may reflect problems in the heart, brain, the legs, or almost anywhere in the body.
As atherosclerosis severely narrows an artery, the areas of the body it serves may not receive enough blood, which carries oxygen to the tissues.
The first symptoms of a narrowing artery may be pain or cramps, at times when blood flow cannot keep up with the body’s demand for oxygen. For instance during exercise a person may feel chest pains – angina, because of lack of oxygen to the the heart, or while walking a person may feel leg cramps – intermittent claudication, because of lack of oxygen to the legs. Typically, these symptoms develop gradually as the atheroma slowly narrows the artery.
However when an obstruction occurs suddenly for example when a blood clot in an artery, the symptoms come on suddenly.
The risk of developing atherosclerosis increases with
· High blood pressure
· High blood cholesterol levels
· Cigarette smoking
· Diabetes
· Obesity
· Lack of exercise
· Advance in age
· Having a close relative who developes atherosclerosis at an early age also puts a person at risk
· Men have a higher risk than women, though after menopause the risk increases in women and eventually equals that of men
· People with inherited homocystenuria develop extensive atheroma formation, particularly at a young age. The disease affects many arteries, but does not primarily affect the coronary arteries which supply the heart. In contrast, in the inherited disease familial hypercholesterolemia extremely high levels of blood cholesterol, cause atheroma to form in the coronary arteries much more than in other arteries
To help prevent atherosclerosis a person needs to eliminate the controllable risk factors – high blood pressure, cigarette smoking, obesity, and lack of exercise.
So depending on a particular person, risk factors, prevention may consist of lowering cholesterol levels, quitting smoking, losing weight, and beginning an exercise program.
Fortunately taking steps to achieve some of these goals help achieve others. For instance, starting an exercise program helps a person lose weight, which in turn helps lower cholesterol levels and blood pressure.
Quitting smoking helps lower cholesterol levels and blood pressure. In people who already have a high risk of heart disease, quitting smoking helps lower cholesterol levels and blood pressure.
I have been asked severally by my patients how smoking aggravates risks of heart disease. Let me explain, in people who already have a high risk of heart disease smoking, is particularly dangerous. Cigarette smoking decreases the level of good cholesterol – High Density Lipoprotein (HDL), and increase the level of bad cholesterol Low Density Lipoprotein(LDL) cholesterol. Smoking also raises the level of carbon monoxide in the blood, which may increase the risk of injury to the lining of the arterial wall, and smoking constricts arteries already narrowed by atherosclerosis further lowering and decreasing the amount of blood reaching the tissues. Plus, smoking increases the blood’s tendency to clot, so it increases the risk of peripheral arterial disease, coronary artery disease, stroke, and obstruction of an arterial graft after surgery.
A smoker’s risk of coronary artery disease is directly related to the number of cigarettes smoked daily. People who quit smoking have only half the risk of those who continue to smoke regardless of how long they smoked before quitting.
Quitting smoking decreases the risk of death after coronary – artery – bypass-surgery, or heart attack. Additionally, quitting smoking decreases illness and the risk of death in those who have atherosclerosis in arteries, other than those that supply the heart and brain..
In short the best treatment for atherosclerosis is prevention. When atherosclerosis becomes severe enough to cause complications, a doctor must treat the complications themselves – viz angina, heart attack, abnormal heart rhythms, heart failure, kidney failure, stroke or obstructed peripheral arterial disease. Always be medically guided.
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