Pathalogy Arthlerosis

Atherosclerosis

A broad and narrow view on the number one killer in the world

Shanghai University of Traditional Chinese Medicine
Diamantis Koukouvinos 2014-02-13

Abstract  

[1] According to WHO, ischemic heart disease together with stroke are the two leading causes of death world wide standing for 13.2 million deaths where cardiovascular diseases (CVD) as a whole stands for 17 million deaths 2011. Although millions of dollars have put into research about the etiology and the production of new pharmaceuticals, the disease have increased the last decade killing even more people. [2]Of the total CVD deaths annually, about 8.6 millions are wemen, heart attack and stroke deaths are responsible for twice as many deaths in women as all cancers combined. [3] It is estimated that of the 32 million heart attacks and strokes that occur globally each year, about 12.5 million are fatal. [4] Econimic transition, urbanization, industrialization and globalization bring about lifestyle changes that promote heart disease. These risk factors include tobacco use, physical inactivity and unhealthy diet. Rapid cultural changes and improvement in economic conditions have led the disappearance of the protective effects of a healthy diet. Urban dwellers may believe that a diet high in energy and fat, similar to that of Western countries, is a symbol of their new status. [5] Since 1990 and the groundbreaking Lifestyle Heart Trial conducted by Dr Dean Ornish MD the medical society have seen that an alternative approach and attitude towards cardiovascular is needed. The pathogenesis and etiology of atherosclerosis is a very important part understanding the complexity of the issue but all data worldwide is showing towards the same direction, a direction we no longer can deny. That cardiovascular diseases are lifestyle based diseases and can be avoided.  

Introduction

Cardiovascular diseases are the leading cause world wide claiming more deaths than ever before in the history on mankind. The burden of cardiovascular diseases has first increasing in economically countries as a result of aging population and growth as well. The cardiovascular –associated lifestyle choises include smoking, physical inactivity and what is to be called a “westernized” diet. In this paper I want to provide a deep understanding of the etiology of the disease both on an epidemiologic content and in a physiologic basis. I put a great emphasis of the etiology of the disease but will also comment the findings that can no longer be ignored.

Atherosclerosis

Atherosclerosis is the narrowing of the arteries due to too much cholesterol in the blood, high blood pressure, diabetes, smoking, sugar, and in-activity. All these factors contribute the formation of so called plaques in the arteries. It is often assumed that it is only the heart arteries that gets affected by these plaques but the truth is that all the arteries gets affected, the reason the heart arteries gets most attention is because these are the arteries that is responsible for providing the heart with oxygen and these are the ones that clog up causing heart attack. Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected. Some of the atherosclerosis related diseases are coronary heart disease, coronary microvascular disease, carotid artery disease, peripheral arterial disease, chronic kidney disease and so on. 

Atherosclerosis can lead to many different complications such as angina pectoris, heart attack, stroke, claudication intermittens, trans ischemic attack (TIA). All those diseases have the same etiology which is atherosclerosis and because the incubation time can be several decades, these diseases should not be seen as a cause of old age. [6] Scientists have shown through autopsy and intravascular ultrasound that the majority of 20 to 30 year old people have atherosclerotic plaques and should be tough at early age about the etiology and prevention of heart diseases.

[7] During 2004 a total of 42,9% of all deaths in my home country Sweden was due to coronary artery disease (CAD). Although CAD has a multifactorial etiology there is one factor that carries the biggest cause and that is the total cholesterol, it seems to be a very complex disease but if you break it down to its true nature it isn’t that complicated. The main reason for CAD is high cholesterol that migrates in to the epithelial cell layer of the arteries and causes inflammation. It is therefore important to understand what elevates the cholesterol levels and causes the cholesterol migration into the cell walls of the arteries.

Etiology – Lifestyle and Genetics

Atherosclerosis being the cause for many different lifestyle diseases is caused by the choices we do in life. We know that diets high in saturated fats and trans fats rises the LDL-cholesterol but there is a genetic factor as well, a extremely small number of people suffer from the genetic disease called as homozygous familial hypercholesterolemia. These patients have no LDL receptors in the liver causing their cholesterol production to deadly levels, it is estimated that 1 in every 400 or even 600 suffers from this genetic disease. In other cases the only thing we inherit from our parents is the lifestyle.

We know today that [8]ethnic groups with high LDL cholesterol have more atherosclerosis than those with low LDL cholesterol. However, to determine if genetics or diet that is most important in hypercholesterolemia, a major international study in Japan (Ni-Hon-San study) where conducted. Men living in three different geographical locations where followed and their diet was analyzed. The Japanese from Japan ate a diet that consisted of 7% saturated fat, Japanese from Hawaii ate a diet that consisted of 12% saturated fat and Japanese from San Francisco were getting 14% saturated fat in their diet. Blood cholesterol levels were directly related to saturated fat intake with the highest rates in San Francisco and the lowest in Japan. The mortality rate of cardio vascular diseases was 1.7 times higher in Hawaii and 2.8 times higher in San Francisco than it was in Japan. This study is a perfect example of that diet is more important than genetics.

[9] In a study from 2000, researchers wanted to find out more information about high cholesterol levels in younger men if they where a long-term risk factor for cardiovascular disease and premature death. Data were collected from three large studies in which younger men with no previous history of type 2 diabetes or heart attack got their cholesterol measured. The first study examined 11,017 men 18-39 years old. Other study examined 1,266 men 25-39 years old and in the third study examined 69,205 men 35-39years old. All in the first study re-examined after 25 years, in the second study after 34years and in third study after 16years.