ATHEROSCLEROSIS: RESEARCH REVIEW

 

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ABOUT AUTHOR:
Shambhavi Singh
Department of Pharmacology, Singhania University,
Jhunjhunu, Rajasthan
shambhavisingh6777@gmail.com

ABSTRACT
Atherosclerosis a disease of the larger arteries is the major cause of heart disease and stroke.  Nowadays, serve as leading reason of death not only in senility peoples but in youth also worldwide. Researches in the atherosclerosis disease have led to many persuasive hypotheses about the pathophysiology of atherosclerotic lesion development and of tricky situation such as myocardial infarction and stroke. It is now unambiguous that atherosclerosis is not simply an unavoidable degenerative consequence of ageing, but somewhat a chronic inflammatory situation that can be transformed into an acute clinical occasion by plaque rupture and thrombosis. Evidently, crystallization of information concerning atherosclerosis will approach only by the appropriate free interplay and satisfactory fusion of the three foremost looms to the trouble, epidemiologic, clinical and investigational.

REFERENCE ID: PHARMATUTOR-ART-2229

PharmaTutor (ISSN: 2347 - 7881)

Volume 2, Issue 8

Received On: 13/06/2014; Accepted On: 19/06/2014; Published On: 01/08/2014

How to cite this article: S Singh; Atherosclerosis: Research review; PharmaTutor; 2014; 2(8); 162-169

INTRODUCTION
Atherosclerosis or arteriosclerosis is a sluggish and progressive building up of fatty substances, plaque, cholesterol, cellular waste products, fibrin and calcium in the inner lining of an artery. The deposition of plaque in arteries, may subsequently leads to partially or fully blockage of artery.

Atherosclerosis can not only affect arteries in the heart but also brain, arms, legs pelvis and intestines leading to disease of those organs.

There are 4 types of atherosclerosis which include as follows:
a. Coronary artery disease (CAD):
When deposition of fat take place, and plaque formation results, in the coronary arteries, supply of oxy-rich blood to heart is reduced or completely prohibited leading to chest pain and ultimately heart attack.

b. Cerebrovascular disease:
If plaque formation takes place in carotid arteries, it will result in partial or complete supply prohibition of oxy-rice blood to brain and thus cause stroke.[1]

c. Peripheral Arterial Disease (PAD):
Plaque formation in the arteries of legs causes narrowing of arteries. And thus inhibition in supply of blood to leg, arms and pelvis leads to numbness, pain and vital infections.[1]

d. Abdominal Angina and a Bowel Infraction:
Atherosclerosis leads to narrowing of arteries supplying blood to the intestines causing abdominal pain and is called abdominal angina. Complete or sudden blockage of blood supply to intestines leads to bowel infection.

Although, the atherosclerotic causing process is not has been completely understood till now. Atherosclerosis is intimated by inflammation in the endothelial cells of the arteries walls when it retains low density lipoprotein molecules. Some researches signify that atherosclerosis could be caused by an infection of the vascular smooth muscle cells.

In Chickens, atherosclerosis develops when infected with the Marek’s disease herpes virus. Herpes virus infection in arterial smooth muscle cells found as causative agent of cholesterol ester accumulation, that is related atherosclerosis[1,7,9]

CAUSES OF ATHEROSCLEROSIS:
Following is a catalog of causes of atherosclerosis

  • High cholesterol
  • Atheroma
  • Primary-atherosclerosis
  • Verners syndrome-atherosclerosis
  • Xanthoma-atherosclerosis
  • Carbon disulfide induced cardio vascular diseases atherosclerosis
  • Progeria-atherosclerosis
  • Chemical induced cardiovascular diseases atherosclerosis
  • Pseudoxanthomaelasticum, forme frusta-atherosclerosis
  • Premature aging-atherosclerosis
  • Smoking
  • High blood pressure
  • Obesity
  • Soaring amounts of sugar in the blood because of insulin resistance of diabetes
  • Physical inactivity[1,7,8]

Symptoms of atherosclerosis
Regrettably, atherosclerosis produces no signs until the harm to arteries is severe enough to block blood flow. According to research studies data for the year 2004, about 66% of men and 48% of women, the first symptom of atherosclerosis is heart attack or sudden cardiac death.

Though some individuals have nuisance symptoms with short term flushing reactions, especially to begin with, cautious selections of brand, dosing strategy, etc. are usually serious to success.[6,7,8]

Pathophysiology of atherosclerosis
Atherogenesis is the progressive process of athermanous plaque. Accumulation of fatty and cholesterol substances in arteries called plaque. The buildup of plaque is steady process, it may start developing from childhood but mostly its effects are seen in with passes of time. In some recent hypothesis found that, for unidentified reasons, leukocytes, such as monocytes or basophiles, start attacking the endothelium wall of the artery lumen incardiac muscles. The resulting inflammation results to formation of artheromatous plaque in arterial tunica intima, located in between the endothelium and the tunica media. The expansion of these lesions is due to excess fat collagen and elastin. Thus, stenosis is a late process, which may never take place and is often the outcome of repeated plaque rupture and therapeutic responses, not just the atherosclerotic development by itself.[11]

Diagnosis of atherosclerosis
Severe plaque formation, stenosis, is easily detectable by angiography in arteries. To a lesser extent stress testing also has been in focus as diagnostic techniques for cardiovascular disease. However, these diagnostic methods can detect only chronic narrowing, not the starting point. As established by clinical studies, most severe incident occurs where, heavy plaque found. Plaque rupture can result to artery lumen occlusion within few seconds or minutes, and likely permanent weakness and sometime unexpected death.

Ruptured plaque is known as complicated plaques.  Cracks in extracellular matrix of lesion occur, typically at the shoulder of fibrous cap that disparate from arterial lumen, where the bare thrombogenic components of the plaque, primarily collagen always trigger thrombus formation. The thrombus move downstream towards the other blood vessels, and thus blood clotting can partially or completely obstruct blood flow.

Whether, the blood flow is absolutely blocked, due to lack of oxygen cell death take place resulting in necrosis. The blockage of can take place in any artery within the body. Complete blockage of arteries supply to heart muscle leads in a heart attack, while the hindrance of arteries procuring the brain result in a stroke.

Besides, the time-honored diagnostic methods named as angiography and stress-testing. Some other diagnostic techniques have been soaring in the past decades for former detection of atherosclerotic disease. Some of the revealing approaches take in anatomical detection and physiologic measurement.

Unveiled some techniques of anatomical detection consist of:
(a) Coronary calcium scoring by CT,
(b) Carotid IMT measurement by ultrasound, and
(c) Intravascular ultrasound (IVUS).

Examples of physiologic measurement methods comprise of:
(a) Lipoprotein subclass analysis,
(b) HbA1c,
(c) hs-CRP
(d) Homocysteine.

Both techniques consist of anatomical and physiological methods that allow early detection sooner than symptoms confirm disease staging and way of disease progression.  Anatomic methods are costly and some are invasive methods, example IVUS. Whereas, physiological methods are found less expensive moreover they are much safer also.[2,12]

Preventions processes
The lifestyle that cure and prevent from atherosclerosis, also prohibit it from soaring up and becoming a chronic disease. Some of them are mentioned below that patient should adopt for being cured from atherosclerosis.

Maintain suitable diet plan ardently comprises of fruits and vegetables. Along with whole grains, seafood, poultry without skin, lean meat and fat-free milk. Healthy diets secure low sodium, sugar, refined grains and solid fats.

In initiation, make sure that patient is not suffering from overweight or obese, make schedule with your doctor supervise fat or get rid of it.

Should be physically active as much patient can, physical activities can improve fitness and health. Try to consult doctor regarding type and amount of exercise.

Quit Smoking, can harm and tighten blood vessels and elevate risk for atherosclerosis. Consult with doctor regarding programs and medicines that can help to get rid of smoking. In addition, avoid secondhand smoke.

Awareness of own family history towards atherosclerosis is essential. In case somebody in patient’s family suffers from atherosclerosis, be sure to inform doctor.

If, lifestyle changes do not bring out any sufficient results. Evidently, consult doctor and consume properly prescribed medicine.[13]

TREATEMENT
a. Various medication procedures:
(i.) Cholesterol medication:
Aggravate lowering of low density lipoprotein (LDL) cholesterol, can slow, stop or reverse the makeup of fatty deposition in arteries. Enhancement of high density lipoprotein cholesterol can help out patient to cure atherosclerosis.[4]

(ii.) Beta-blocker medication:
Beta-blockers are mainly used for coronary artery diseases. These medicines help out to lower heart rate and blood pressure. Relief from chest pain as well as lower the chances of heart attack.[8]

(iii.) Anti-platelet medication:
They reduce the clumping in narrowed arteries from blood clot and any caused further blockage.[8]

(iv.) Angiotensin converting enzyme (ACE) inhibitors:
ACE inhibitors slow down the progression of atherosclerosis by lowering blood pressure and providing amity effects on the heart arteries. ACE inhibitors resist angiotensin converting enzyme, thereby declining the stress of blood vessels and blood volume, consequently lower blood pressure.[1,7]

(v.) Calcium channel blockers:
Input method of calcium channel blockers is lowering of blood pressure.[8]

(vi.) Diuretics
High blood pressure is a foremost risk factor of atherosclerosis.
Diuretic drug lowers blood pressure.[5]

B. Surgical procedures
When, the conditions become chronic, the drugs and precaution fail to cure patient atherosclerosis. In that condition doctors prefer patents to go through surgery. Numerous surgical treatments, make patient feel good for in short term only, take in minimally invasive angioplasty that might include stents to physically expansion of  narrowed arteries and foremost invasive surgery, as such bypass surgery, to generate additional blood supply links that go around the more chronic narrowed areas.[6]

(i.) Angioplasty
During this procedure, a long tube introduce (catheter) into the blocked or narrowed portion of artery. Flexible tube along with a balloon at its tip threaded throughout a blood vessel to the exaggerated artery. Just the once, in place balloon is inflated to reduce the plaque alongside the artery wall. Thus, restores blood flow through the artery.[4]

(ii.) Endarteretomy
In some cases, fat deposition ought to be surgically detached from the walls of narrowed artery. The same process is when resumed on arteries in neck known as carotid endarterctomy.[6]

(iii.) Thrombolytic therapy
If artery is found to be blocked by clots, clot dissolving medicines are inserted into artery at the spot of the clot to rupture it up.[3]

c. Herbal treatment:
Herbal treatments are safest & most reliable method of any disease treatment. Here are some best known herbal treatments of atherosclerosis.

(i.) Garlic
Include fresh garlic in diet, a great way to treat atherosclerosis. Garlic has been proved naturally good body cholesterol management. It lowers cholesterol and thus keeps the arteries unclogged and unhardened. Note that fresh garlic is superlative, raw if available.[4,5]

(ii.) Rutin
Engulf along with vitamin C Rutin persuade good cell heath and help out in keeping arties clear, unblocked and unhardened. Best result is seen when consumed 500mg of rutin daily along with 500 mg of vitamin C.[4]

(iii.) Onion
Produce same effect as garlic use to be (unbeatable cholesterol management). Include some fresh raw onion to daily diet for good results. Consumption of patenttea-spoon of pure onion juice found supplementary affective.[5]

(iv.) Grape seed extract
Grape seed extract, inhibit enzymes that damage tissues of arteries by removing things like collagens and elastage that are important in keeping arteries, supply to function accurately. Nowadays in market packed grapes seed extracts supplements are easily available.[4]

(v.) Pomegranate juice
Pomegranate juice well known for its anti-oxidant properties and thus it help in curing atherosclerosis. It produces effort by reducing oxidation of lipids as effective atherosclerosis treatment.[5]

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