Atherosclerosis

Atherosclerosis
Single most important disease process in developed world
Ischaemic heart disease (Angina, heart attacks, arrythmias and heart failure) Peripheral vascular disease Strokes

Atherosclerosis
Basic pathology
Accumulation of lipid rich plaques in arterial walls Disease results from
Progressive narrowing reduction of blood supply Plaque rupture thrombus formation and occlusion of blood supply

Atherosclerosis

Atherosclerosis

Atherosclerosis

Atherosclerosis

Risk Factors

Big 5 risk factors for atherosclerosis

Smoking High cholesterol High blood pressure Diabetes Genes

Risk Factors
Smoking

Risk Factors
Smoking
Expensive Makes you smell More and more socially unacceptable Kills and disables you (and people around you) in a variety of interesting ways

Risk Factors

Smoking prevention
Dont start

Risk Factors

Smoking management
Have a major complication i.e. heart attack

Risk Factors

Smoking management
Medication
Nicotine replacement Pharmacological Buproprion (Zyabn)

Acupuncture Hypnotism

Risk Factors

Smoking management
Advice from health professional

Risk Factors
High cholesterol
Lifestyle Familial contribution

Risk Factors

High cholesterol
Dietary modification Drugs
Statins

Risk factors
High blood pressure / Hypertension
Stated as Systolic / Diastolic i.e. 130/80
Systolic Heart pumping Diastolic Heart relaxing

High blood pressure present if

Systolic > 140 Diastolic > 90

Risk factors
High blood pressure / Hypertension
Importance

Risk factors

High blood pressure / Hypertension

Usually essential no single underlying cause
Important factors
Obesity Alcohol High salt diet Familial

Risk factors

High blood pressure / Hypertension

Minority of cases secondary
Endocrine
Hormone excess

Renal
Kidneys not working

Risk factors

High blood pressure / Hypertension

Incidence
15-20% in western society Increases with age

Risk factors
High blood pressure / Hypertension
Unless very high asymptomatic If very high i.e. 240/130 can be symptomatic
Fits Confusion Headache Breathlessness Chest pain

Risk factors

High blood pressure / Hypertension

Management
Rule out underlying cause Lifestyle changes
Obesity, alcohol, high salt diet, exercise

Risk factors
High blood pressure / Hypertension
Management
Drugs
Different thresholds for treatment depending on co-existing disease Stroke Diabetes

Risk factors
High blood pressure / Hypertension
Management
Drugs
-blockers Diuretics ACE inhibitors Angiotensin II antagonists Calcium-channel blockers

Risk factors

Diabetes
Elevated blood sugar Control is an essential part of management of cardiovascular disease

Risk factors

Genes
Strong familial component Cant do anything about this!

Risk factors
Other risk factors
Less clear cut
Obesity Lack of exercise Stress and depression Elevated homocysteine

Risk factors
Often more than one risk factor present
The more risk factors the greater the risk

Primary prevention

Primary prevention
Treatment of risk factors for atherosclerosis to prevent disease happening

Primary prevention
Lifestyle
Smoking cessation and avoidance Diet
Low cholesterol Avoid excess

Exercise

Primary prevention

Control of underlying disease processes

High cholesterol High blood pressure Diabetes

Primary prevention
Statins and aspirin
Consider in high risk groups (even without high cholesterol)
Smokers Family history Diabetes Hypertensives