What Is Atherogenesis?

Atherosclerosis (AS) is the main cause of coronary heart disease, cerebral infarction, and peripheral vascular disease. Impaired lipid metabolism is the basis of atherosclerotic lesions. It is characterized by the involvement of arterial lesions starting from the intima. Generally, lipids and complex sugars accumulate, bleeding and thrombosis first, followed by fibrous tissue hyperplasia and calcium deposition. There is gradual metaplasia and calcification of the middle layer of the artery, which leads to thickening and hardening of the arterial wall and narrowing of the vascular cavity. Lesions often involve the large and medium muscular arteries, and once they develop enough to block the arterial cavity, the tissues or organs supplied by the arteries will be ischemic or necrotic. Because the lipid that accumulates in the intima of the arteries has a yellow atheromatous appearance, it is called atherosclerosis.

Basic Information

English name

atherosclerosis, AS

Visiting department

cardiology

Multiple groups

Dyslipidemia, hypertension, and smoking

Common causes

In addition to hypertension, hyperlipidemia and smoking, it is also related to obesity and genetics

Common symptoms

Depends mainly on vascular disease and ischemia of affected organs

Causes of Atherosclerosis

Atherosclerosis is caused by a combination of factors, and the pathogenesis is complex, which has not been fully elucidated yet. The main risk factors are hypertension, hyperlipidemia and heavy smoking, as well as diabetes, obesity and genetic factors.

Hypertension

The incidence of atherosclerosis was significantly increased in patients with hypertension. Hypertension and atherosclerosis are causal to each other, and the two often coexist.

2. Hyperlipidemia

Hypercholesterolemia is a causative factor for atherosclerosis.

3. Smoking

Smoking significantly increased the incidence of atherosclerosis and was directly proportional to the number of cigarettes smoked per day.

4. Diabetes

The incidence of atherosclerosis in diabetic patients is twice as high as in those without diabetes.

5. Obesity

Central obesity and those who gain weight rapidly in a short period of time are more susceptible to the disease.

6. Genetic factors

There are younger patients with atherosclerosis in the family, and the incidence of close relatives is significantly increased.

7. Other

Age, gender, increased C-reactive protein, engaged in mental work, and eating high-calorie foods are all related to the occurrence of atherosclerosis.

Clinical manifestations of atherosclerosis

The symptoms of atherosclerosis mainly depend on the degree of vascular disease and the ischemia of the affected organs. Aortic atherosclerosis often has no specific symptoms; those with coronary atherosclerosis may have angina pectoris, myocardial infarction, arrhythmia, and even sudden death if the diameter of the tube is narrower than 75%; cerebral atherosclerosis can cause brain deficiency Blood, brain atrophy, or bleeding caused by cerebrovascular rupture; renal atherosclerosis often causes nocturia, refractory hypertension, and severe cases may have renal insufficiency; mesenteric atherosclerosis can manifest as abdominal pain after full meals, indigestion, Constipation, etc. In severe cases, intestinal wall necrosis can cause symptoms such as blood in the stool and paralytic intestinal obstruction; those with severe stenosis of the vascular cavity caused by atherosclerosis of the lower extremities may experience intermittent claudication, disappearance of the dorsal foot artery pulse, and even severe gangrene may occur.

Atherosclerosis

General inspection

Patients often have elevated blood cholesterol and triacylglycerol, reduced high-density lipoprotein, and abnormal lipoprotein electrophoretic patterns. Most patients have type III or type IV hyperlipoproteinemia.

2.X-ray inspection

Aortic atherosclerosis shows aortic elongation, expansion, and distortion, and sometimes calcium deposits.

3. Arteriography

Can show limb arteries, renal arteries and coronary arteries due to atherosclerosis caused by stenosis, lesion site and extent.

4. Doppler ultrasound

It is helpful to judge the smooth blood flow of carotid arteries, limb arteries and renal arteries.

Atherosclerosis diagnosis

Atherosclerosis develops to a certain degree, especially in the presence of organ lesions, and the diagnosis is not difficult. If abnormal blood lipids are found on the examination and angiography shows stenotic lesions in the blood vessels, atherosclerosis should be considered first. It should be noted that atherosclerosis is a systemic disease. The occurrence of atherosclerotic lesions in the blood vessels of an organ means that the same lesions may already exist in blood vessels elsewhere; similarly, the occurrence of vascular events in an organ means that There is an increased risk of vascular events elsewhere.

1. For patients over 40 years old, if the aorta is widened and distorted and other diseases can be ruled out, it may indicate the possibility of aortic atherosclerosis;

2. If there is sudden dizziness or gait instability without signs of increased intracranial pressure, the cerebral blood supply caused by basal atherosclerosis should be suspected;

3. After a short period of sternal pain or pressure in the sternal and anterior regions of the heart, the myocardial insufficiency caused by coronary atherosclerosis should be suspected;

4. Nocturia is often one of the early symptoms of renal atherosclerosis.

In addition, patients are often accompanied by predisposing factors for atherosclerosis, such as hypertension, hypercholesterolemia, hypoHDLemia, diabetes, and smoking. Such as selective electrocardiogram, radionuclide heart, brain, kidney and other organ scans, Doppler ultrasound, and selective angiography, etc., help clear diagnosis.

Differential diagnosis of atherosclerosis

Clinically, it is often necessary to consider the difference between inflammatory arterial disease (such as multiple arteritis, thrombotic occlusive vasculitis, etc.) and congenital artery stenosis (such as aorta, renal artery stenosis, etc.). Inflammatory arterial diseases usually have low fever and rapid erythrocyte sedimentation. Patients with congenital aortic constriction are younger and have no susceptibility to atherosclerosis.

Atherosclerosis treatment

Comprehensive treatment

(1) Reasonable diet. The total calories in the diet should not be too high to prevent overweight. Reduce the intake of saturated fats and carbohydrates a lot. The fat intake is limited to 20g per day, of which the saturated fat is limited to 2g. Increase soluble fiber intake.

(2) Adhere to moderate physical activity. Set the activity intensity according to your own situation, activity habits, and heart function, gradually.

(3) Reasonably arrange work and life.

(4) In other aspects, non-smoking is encouraged, second-hand smoke is avoided, and a small amount of alcohol can be consumed.

(5) Control susceptibility factors. If you have diabetes, you should promptly control blood sugar, including diet control. Antidiabetic drugs for type 2 diabetes should be appropriate without causing hyperinsulinemia, such as Damicon, etc .; if there is high blood pressure, antihypertensive drugs should be given to reduce blood pressure to an appropriate level; if blood cholesterol is increased, it should be Control high cholesterol and give appropriate lipid-lowering drugs.

2. Drug treatment

(1) Lipid-lowering drugs statins; fibrates; nicotinic acid; cholestyramine; antumine; unsaturated fatty acids such as Yishouning, Xuezhiping and Xinmaille; alginate diesters sodium.

(2) Antiplatelet drugs aspirin; pansentin; clopidogrel; cilostam.

(3) Vasodilator drugs Hydrazine (mainly acting on arteries); Nitroglycerin and analgesic (mainly acting on veins); Sodium nitroprusside (acting on arteries and veins); Alpha ₁ receptor blocker Such as prazosin; ₂ receptor blockers such as phentolamine; ₂ receptor stimulants such as Shuchuanling; Captopril, enalapril; heartache, azathiophene; Salbutaine, longanidine, prostaglandin, atrial natriuretic peptide, etc.

(4) Thrombolytic and anticoagulant drugs 1) Thrombolytic drugs such as: urokinase and streptokinase; tissue-type plasminogen activator; single-chain urokinase-type plasminogen activator; TNK- Tissue-type plasminogen activator. 2) Anticoagulant drugs such as: heparin; enoxaparin; natroparin; bivalirudin.

3. Surgical treatment

Surgical procedures such as recanalization, reconstruction, or bypass grafting of narrowed or occluded arteries can also be performed with interventional treatments such as placing a stent in the vessel lumen.

Atherosclerosis prevention

Primary prevention

Promote a light diet, eat more foods rich in vitamin C (such as fresh vegetables, fruits and vegetables) and plant protein (such as beans and their products); do not smoke, do not drink hard alcohol; maintain an optimistic attitude and a relaxed mood; People aged 40 and above insist on a physical examination at least once a year. From childhood, they should not eat high cholesterol and high animal fat diets. They should also avoid overeating to prevent weight gain.

2. Secondary prevention

Actively treat diseases related to this disease, such as hypertension, obesity, hyperlipidemia, gout, diabetes, liver disease, nephrotic syndrome and related endocrine diseases. Lifetime use of aspirin antithrombotic, long-term or lifetime use of statin lipid-lowering drugs, and active use of angiotensin-converting enzyme inhibitors.