The mechanism and therapy of aortic aneurysms
Coronary Artery Disease
Coronary artery disease (CAD; also atherosclerotic heart disease) is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD). Although CAD is the most common cause of CHD, it is not the only one.
CAD is the leading cause of death worldwide. While the symptoms and signs of coronary artery disease are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises. After decades of progression, some of these atheromatous plaques may rupture and (along with the activation of the blood clotting system) start limiting blood flow to the heart muscle. The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women. According to the Guinness Book of Records, Northern Ireland is the country with the most occurrences of CAD. By contrast, the Maasai of Africa have almost no heart disease.
As the degree of coronary artery disease progresses, there may be near-complete obstruction of the lumen of the coronary artery, severely restricting the flow of oxygen-carrying blood to the myocardium. Individuals with this degree of coronary artery disease typically have suffered from one or more myocardial infarctions (heart attacks), and may have signs and symptoms of chronic coronary ischemia, including symptoms of angina at rest and flash pulmonary edema.
A distinction should be made between myocardial ischemia and myocardial infarction. Ischemia means that the amount of blood supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed. Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.
An individual may develop a rupture of an atheromatous plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute myocardial infarction (heart attack).
Symptoms Explained Of Devastating 'underdiagnosed And Undertreated' Heart Disease
The British Heart Foundation estimates that around one in five people over the age of 60 have some degree of peripheral artery disease, which causes arteries supplying the arms and legs to narrow or become blocked with plaque or fatty tissue.
When this happens in the heart, it's called coronary heart disease, but peripheral artery disease (PAD) usually occurs in the legs and can result in severe pain, gangrene or even amputation.
The new study by Intermountain Health focused on the American population, where the condition affects over 10 million people from the age of 40.
It discovered that not only do patients face a 50% chance of dying from the condition due to these failures, but also that women were less likely to receive guideline-directed medical therapy than their male counterparts.
The researchers believe these shocking rates of underdiagnosis and undertreatment are due to "significant challenges" in identifying the condition because of its vague symptoms.
One of the lesser-known yet distinctive symptoms of peripheral arterial disease (PAD) is termed intermittent claudication, a term derived from the Latin word for 'limp'.
It manifests as muscle pain in, for instance, your left leg while walking or engaging in exercise, even over short distances, due to insufficient blood and oxygen reaching the muscles.
However, after resting the affected leg, you may be able to continue the activity only to experience the pain once more at a similar distance.
Additional signs that might be mistaken for poor circulation include pins and needles sensations, coldness at the extremities, discoloured skin, muscle weakness, numbness, and discomfort. The veins could also look enlarged and sores or ulcers might develop on the skin.
While there's no cure for PAD, adopting lifestyle amendments, prescribed medications, and potentially surgery can decelerate its advance, alleviate symptoms, and better patients' quality of life. Such interventions may involve quitting smoking and using anticoagulants.
Up to 10% of patients may develop critical limb ischaemia, the most severe form of the condition, and face a 50% chance of death within five years according to the British Heart Foundation.
Less than 30% of women and about 33% of men with PAD are receiving optimal treatment.
Viet Le, the primary investigator of the study and an associate professor specialising in cardiovascular research, expressed grave concern, stating: "Every single person in these groups should have at least received antiplatelet therapy and statin. Instead, only about one in three did, which demonstrates the need to enhance methods to identify and treat peripheral artery disease."
These insights were shared during the American College of Cardiology's annual scientific sessions conference in Chicago on Sunday, March 30.
Diseases Linked To High Cholesterol
If you have high cholesterol, you have a higher risk of cardiovascular disease. That can include coronary heart disease, stroke, and peripheral vascular disease. High cholesterol has also been tied to diabetes and high blood pressure. In all cases, the underlying cause is that high cholesterol leads to fatty plaques that build up in arteries all over your body.
To prevent or manage these conditions, work with your doctor. You also can take some simple steps that will help you lower your cholesterol -- and your risk of any related diseases.
To understand how cholesterol can lead to diseases, it helps to understand how cholesterol works.
There are different types of cholesterol:
The main risk from high cholesterol is coronary heart disease, which can lead to death from a heart attack. If your cholesterol level is too high, cholesterol can build up in the walls of your arteries. Over time, this buildup -- called plaque -- causes arteries to harden and can restrict blood flow (atherosclerosis). Arteries that feed the heart can narrow in certain areas and slow blood flow to part of the heart muscle. Or cholesterol plaques break off and float to smaller blood vessels and cause a partial or total blockage. Sometimes inflammatory cells might go to the broken plaque area and cause a narrowing there as well. Reduced blood flow can result in chest pain called angina, or in a heart attack if a blood vessel gets blocked completely.
Cholesterol can build up in the walls of your arteries. (Photo Credit: Tetiana Pavliuchenko/Dreamstime)
Cholesterol plaques don't just line your blood vessels in and around your heart. They also narrow certain arteries that lead to your brain. If a vessel carrying blood to the brain is blocked completely, you could have a stroke.
In addition to your heart and your brain, cholesterol plaque can cause symptoms in your legs and other areas outside of your heart and brain (peripheral vascular disease). Your legs and feet are the most common places to notice symptoms. You might notice cramps in your calves when you walk that get better with rest. This is like angina -- it works the same way -- but in your legs instead of your heart.
If you have diabetes, that can upset the balance between levels of HDL, or "good" cholesterol, and LDL or "bad" cholesterol.
People with diabetes tend to have LDL particles that stick to arteries and damage blood vessel walls more easily. Glucose (a type of sugar) attaches to your lipoproteins, which are particles that carry cholesterol and triglycerdies to your cells. Sugarcoated LDL remains in the bloodstream longer and may help plaque form. People with diabetes, especially type 2 diabetes, can have low HDL and high triglyceride levels. Both of these boost the risk of heart and artery diseases.
If you have diabetes and have low levels of good cholesterol but high levels of bad cholesterol and high triglycerides, you have a condition called diabetic dyslipidemia. Up to 70% of people with type 2 diabetes have diabetic dyslipidemia.
People with type 1 diabetes who have their blood sugar under control usually have normal levels of cholesterol. If they're overweight or have obesity, though, they're more likely to have high cholesterol. But that's true for people without type 1 diabetes, too.
There's a link between high cholesterol and high blood pressure, or hypertension. High cholesterol seems to trigger inflammation and the release of certain hormones that causes blood vessels to tighten up. When that happens, it's called "endothelial dysfunction." Your blood pressure goes up because your heart has to work harder to pump blood through it.
High blood pressure is also linked to heart disease.
Erectile dysfunction is when a person can't achieve or maintain an erection during sex. Over the long term, high cholesterol seems to trigger a narrowing of the smaller blood vessels of the penis when they should be stretching to allow more blood for an erection. In addition, when you have too much LDL cholesterol, it can build up in arteries and then join with other substances to form plaque that hardens and narrows the blood vessels even more (atherosclerosis). The result can be less blood flow to both the heart and the penis, which can lead to erectile dysfunction.
A few simple changes can lower your cholesterol and cut your risk for conditions linked to high cholesterol.
Ask for expert advice on lifestyle changes. Your doctor can help you come up with a plan for healthy eating and exercise.
Give your diet a makeover. Go for foods like oatmeal, walnuts, tuna, salmon, sardines, and tofu. Stay away from things that are high in trans fats, saturated fats, and simple sugars.
Quit smoking. Smoking lowers your "good" (HDL) cholesterol. If you quit, you'll have more of it. There are lots of other benefits for your whole body.
Get moving. Even modest amounts of exercise, like half an hour a day of brisk walking, help you control weight. It's also good for other things that put you at risk for heart disease, like diabetes and high blood pressure. Exercise can lower your triglyceride levels and raise your HDL cholesterol. Both are good for your heart.
Take your medications. Your doctor will probably prescribe a medication called a statin to help lower your cholesterol, but some people have negative side effects when they take this type of drug. If that's the case for you, talk with your doctor about other treatment options. They may recommend an adenosine triphosphate-citrate lyase (ACL) inhibitor like Nexletol (bempedoic acid) or Nexlizet (bempedoic acid and ezetimibe). Both limit how much cholesterol your liver makes, but Nexlizet also lowers how much cholesterol your small intestine absorbs. Always take your medicines as prescribed, and if you have questions, talk with your doctor or pharmacist.
These groups offer more information about treating and preventing cardiovascular disease and other conditions linked to high cholesterol.
American Heart Association. This organization is dedicated to advocacy and education about heart disease.
American Stroke Association. This agency teaches you to reduce your risk of stroke and make positive lifestyle changes.
InterAmerican Heart Foundation. This group works in Latin America and the Caribbean to lower disability and death from heart disease, stroke, diabetes, and other related conditions.
National Heart, Lung, and Blood Institute. This government agency supports research on the causes, prevention, and treatment of cardiovascular, lung, and blood diseases.
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