About Authors:
Kambham Venkateswarlu1*, N.Devanna2, C.Vanajakshi3, Kottamasi Vijaya Bhaskar4
1M.Pharm Scholar, Department Of Pharmaceutics,
2Director Of Jntua-Otri,
3M.Pharm Scholar, Department Of Pharmaceutics,
4M.Pharm Scholar, Department Of Pharmacology,
JNTUA-Oil Technological Research Institute,
Beside Collector Office, Anantapur, Anantapur District, Andhra Pradesh, India. Pin Code: 515001
k.v.reddy9441701016@gmail.com
Abstract:
This review gives the information about what are the causes, symptoms and treatment of atherosclerosis. Atherosclerosis or arteriosclerosis is a slow and progressive building up of plaque, fatty substances, cholesterol, cellular waste products, calcium and fibrin in the inner lining of an artery. This building up of plaque may lead to thickening of the arteries, subsequently blocking the blood flow either partially of totally in an artery.
REFERENCE ID: PHARMATUTOR-ART-2075
I. ATHEROSCLEROSIS:
Atherosclerosis can affect arteries in the heart, brain, arms, legs pelvis and intestines leading to disease of those organs. There are 4 types of atherosclerosis which include as follows:
1.1. Coronary artery disease (CAD):
When plaque build-up in the coronary arteries, supply of oxygen rich blood to heart is reduced leading to chest pain and ultimately heart attack.[1]
1.2. Carotid artery disease or cerebrovascular disease:
When plaque builds up in carotid arteries, the supply of oxygen rich blood to the brain is reduced leading to a stroke.[1]
1.3. Peripheral Arterial Disease (PAD):
When plaque builds up in arteries supplying blood to leg, arms and pelvis, the oxygen rich blood supply to these parts is restricted leading to numbness, pain and dangerous infections.[1]
1.4. 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.
In service cause, atherosclerosis could also lead to narrowing of arteries of kidney leading to renal artery stenosis. Millions of Americans are diagnosed to be suffering from atherosclerosis and millions more have the diseases but are unaware it. Atherosclerosis accounts for about 75 percent of all deaths from cardiovascular diseases. Men, African –Americans and all individuals over 65 years of age have the highest risk of developing advanced atherosclerosis.[1, 7]
II. CAUSES OF ATHEROSCLEROSIS:
Following is a list of causes of atherosclerosis
· High cholesterol
· Polycystic ovary syndrome (PCOS)
· Atheroma
· Atherosclerosis
· Primary- atherosclerosis
· Verners syndrome- atherosclerosis
· Familial hypercholesterolemia
· Xanthoma- atherosclerosis
· Chemical induced cardiovascular diseases atherosclerosis
· Carbon disulfide induced cardio vascular diseases atherosclerosis
· Hutuhinson Gilford syndrome-atherosclerosis
· Progeria-atherosclerosis
· Premature aging- atherosclerosis
· Pseudoxanthomaelasticum, forme frusta- atherosclerosis
· Binswanger’s disease – atherosclerosis
· Smoking
· High amounts of certain fats and cholesterol in the blood.
· High blood pressure
· High amounts of sugar in the blood due to insulin resistance of diabetes
· Obesity
· Physical inactivity[1, 7, 8]
III. SYMPTOMS OF ATHEROSCLEROSIS:
Unfortunately, atherosclerosis produces no symptoms until the damage to arteries is severe enough to restrict blood flow.
* Restriction of blood flow to the heart muscle due to atherosclerosis can cause angina pectoris or a myocardial infarction (heart attack).
* Narrowing of the arteries supplying blood to the brain may cause transient ischemia attacks (symptoms and signs of stroke listing less than 24 hrs) and episodes of dizziness, or ultimately, to a stroke itself.[6,7,8]
IV. TREATEMENT:
Lifestyle changes, such as eating a healthy diet and exercising, are often the best treatment for atherosclerosis. But sometimes, medication or surgical procedures may be recommended as well.[3]
4.1. Medication Procedures:
4.1.1. Cholesterol Medications:
Aggressively lowering your low-density lipoprotein (LDL) Cholesterol, the “bad” cholesterol, can slow, stop or even reverse the build up of fatty deposits in your arteries. Boosting your high-density lipoproteins (HDL) cholesterol, the “good” cholesterol, may help, too.[4]
4.1.2. Anti-platelet medication:
Anti-platelet medication, such as aspirin, to reduce the likelihood that platelets with clumping in narrowed arteries form a blood clot and cause further blockage.[8]
4.1.3. Beta-blocker medication:
These medications are commonly used for coronary artery diseases. They lower your health rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta-blockers reduce the risk of heart attacks and heart rhythm problems.[8]
4.1.4. Angiotensin converting enzyme (ACE) inhibitors:
These medications can help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries ACE inhibitors can also reduce the risk of recurrent heart attacks.[1, 7]
4.1.5. Calcium channel blockers:
These medications lower blood pressure and are sometimes used to treat angina.[8]
4.1.6. Water pills (diuretics):
High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.[5]
4.1.7. Surgical procedures:
Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle of skin tissue survival, you may be a candidate for one of the following surgical procedures. [6]
4.1.8. Angioplasty:
In this procedure, a long, thin tube is inserted (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated ballon on its tip is then passed through the catheter to the narrowed area. The ballon is then inflated, compressing the deposits against artery walls. A mesh tube (stent) usually left in the artery to help keep the artery open.[4]
4.1.9. Endarterectomy :
In some cases, fatty deposits must be surgically removed from the walls of narrowed artery. When the procedure is done on arteries in the neck (carotid arteries), it’s known as carotid endarterctomy.[6]
4.1.10. Thrombolytic therapy:
If an artery is blocked by a blood clot, clot dissolving drug is inserted into artery at the point of the clot to break it up.[3]
4.2.Herbal Treatment
Finding and herbal atherosclerosis treatment is the next step in treating the condition in the purest and safety way possible. Here is the list of some of the best known natural atherosclerosis treatment options.[5,7]
4.2.1. Garlic:
Adding fresh garlic to diet is a great way to treat atherosclerosis, because garlic has been proving to naturally lower the bad cholesterol and increase the good, which is a key in keeping your arteries unclogged and from hardening. Note the fresh garlic is best, raw if possible. Also, garlic oil supplements have not proving effective as an atherosclerosis is remedy.[4, 5]
4.2.2. Rutin:
Take in conjugation with vitamin C Rutin encourages good cell health and can help to keep the arteries clear, healthy and strong. It is recommended to take 500mg of Rutin daily along with 500mg of vitamin C for the best results.[4]
4.2.3. Onion:
This has been known to work well for the same reasons that garlic does. Add some raw onion to daily diet for great results. It has also proving effective to consume one tea spoon of juice from an onion daily.[5]
4.2.4. Grape seed extract:
This has been shown to improve the condition of arteries by inhibiting several of the enzymes that damage tissues by taking away things like collagens and elastase, which are crucial in keeping arteries, supply function properly. Grape seed extract supplements are usually available wherever vitamins are sold.[4]
4.2.5. Pomegranate juice:
Not just tasty but this juice has recently been shown to work as an effective atherosclerosis treatment because of its anti-oxidant properties, which reduce oxidation of lipids. It is recommended that to drink one glass of pure pomegranate juice daily for the best results.[5]
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V. ANTI-ATHEROSCLEROSIS:
5.1. Anti-atherosclerosis diet and life style:
- A good anti atherosclerosis diet can help not just with the prevention of the disease, but also in the reversal of the condition.
- Note that the tips and suggestions given in this regard are very much similar to dietary advice for preventing and healing many other chronic and degenerative ailments, as well as for overall promotion of good health Nutrition, after all, is one of the core foundations of good health and vitality.[7]
- In general, a good atherosclerosis diet should not make one overweight or obese, as that is a risk factor for the disease as well as a host of other dangerous health condition.
- Dietary fiber has been linked with a reduced risk of heart disease and issues. They also help control cholesterol levels. Besides whole grains, fruits and vegetables, good sources of fiber include psyllium as well as beans.[7]
- Garlic has further health benefits, such as its ability to kill bacteria, viruses, fungi and parasites, as well as its anti-cancer properties. For maximum effect, consume some raw and organic garlic daily- a minimum of three large cloves a day is a decent dose.[1]
5.2. Classification of Anti-atherosclerosis Drugs:-
· HMG-COA Reductase inhibitors (stains):
Example: - lovastatin, simvastatin, pravastatin, atorvastatin.
· Bile acidsequestrants(Resins):
Example: - cholestyramine, colestipol.
· Activate litoprotein lipase(fibricacidderivaties):
Example: - clofibrate, gemfibrozil, bezafibrate, fenofibrate.
· Inhibit triglyceride synthesis and lipolysis:
Example: - nicotinicacid.
· Other: Probucol, Gugulipid.[8]
5.3. Pharmocology of Anti-Hyperlipidemic drug:
Low-density lipoproteins (LDL) transport cholesterol to the peripheral cells. When the cells have all of the cholesterol, the excess cholesterol is discarded into the blood. This can result in an excess of cholesterol, which can penetrate the walls of the arteries, resulting in atherosclerotic. An increase in serum lipids is believed to contribute to or cause atherosclerosis, a disease characterized by deposits of fatty plaques on the inner walls of arteries.[7]
These deposits result in a narrowing of the lumen(inside diameter) of the artery and a decrease in blood supply to the area served by the artery. When these fatty deposits occur in the coronary arteries, the patient experiences coronary artery disease. Lowering blood cholesterol levels can arrest or reverse atherosclerosis in the vessels and can significantly decrease the incidence of heart disease. Hyperlipidemia, particularly elevated serum cholesterol and LDL levels, is a risk factoring in the development of atherosclerotic heart disease.[8]
5.3.1.Statins (HMG CoA reductase inhibitor):
5.3.1.1. Lovastatin (Mevacor, Rovacor):
Normally, about 70-75% of plasma LDL is removed by hepatocytes, by receptor- mediated endocytosis cholesterol esters from LDL molecules are hydrolysed in the liver to free cholesterol. The lever also produces cholesterol by de novo synthesis by a Path way involving formation of mevalonic acid by HMG-CoA reductase.[7,8]
Statins inhibit the enzyme hydroxymethylglutaryl co- enzyme Areductase (HMG-CoA Reductase), the rate limiting enzyme. The resulting decrease in hepatic cholesterol synthesis of high affinity LDL Receptors on the liver cells and increased clearance of plasma LDL with a marked reduction in plasma LDL cholesterol levels.[7,8]
The hypolipidemic effect is does dependent and is observed in 10 years.
Simvastatin and Atorvastatin, in addition, raise HDL level in some patients and lower the triglyceride levels.
Lovastatin is incompletely absorbed and has a sort biological half-life. It is a prodrug, which is rapidly converted in the liver to an active metabolite. It is primarily excreted by the intestinal tract.[7,8]
5.3.1.1.1 Adverse reactions:
Lorastain and other statins may cause reversible rise in hepatic amino transferase levels. Combination of a stain with fibricacid derivatives &Nicotinic acid or cyclosporine has potentiating effect on the rise in plasma CPK level; dose dependent myalgia, muscle weakness and rarely myopathy have been reported. Doses used to not seem to induce deficiency of other important steroids derived from cholesterol.[7,8]
Lovastatin and simvastatin undergo extensive first-pass metabolism and their toxicity can be increased by the concurrent use of hepatic microsomal enzyme inhibitors. Fluvastatin, however probably causes fewer drug interactions.[7,8]
Rarely, statins may cause impotence, gynaecomastia, peripheral neuropathy and memory loss. Statins are contraindicated in pregnancy, during breast- feeding, in children and in patients with severe liver disease.[7,8]
5.3.1.1.2. Therapeutic uses:
Statins are useful in lowering blood LDL cholesterol particularly in therapy. They have been shown to reduce.
a. Progression of atherosclerotic;
b. Occurrence of myocardial infarction;
Statins, used alone, can lower LDL by 40-60% addition of cholestyramine resin further lowers the LDL level. Addition of nicotinic acid lowers the LDL level by more than 70%. [7,8]
5.3.1.1.3. The statins may have several non-lipid beneficial effects they are:
· Decrease in platelet aggregation and in fibrinogen levels.
· Improvement in endothelial function and increase in local NO production.
· Decease in macrophage infiltration into the vessel wall.
· Decease in the arterial muscle proliferation.
· Decrease LDL oxidation in the vessel wall.[7, 8]
VI. CONCLUSION:
Statins have a much role in treating the Atherosclerosis. Diet control also has a much scope to treat the Atherosclerosis. Better option for Atherosclerosis treatment is use of Statins along with diet control.
VII. REFERENCES:
1. HumphreyLL, FuR, RogersK, FreemanM, HelfandM. Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis. Mayo ClinProc 2008;83(11):1203–12.
2. Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framinghamriskscoretopredict cardio vascular events and mortality: a meta-analysis. JAMA 2008;300(2):197–208.
3. FlemingC, WhitlockEP, BeilTL, LederleFA. Screening for abdominal aorticaneurysm:abest-evidence system atic review for the U.S. Preventive Services Task Force. Ann Intern Med 2005;142(3):203–11.
4. Lederle FA. Management of small abdominal aortic aneurysms. Ann Intern Med 1990;113(10):731–2.
5. Kent KC, Zwolak RM, Jaff MR, et al. screening for abdominal aortic aneurysm: a consensus statement. J VascSurg 2004;39(1):267–9.
6. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM. Preventive foot care in diabetes. Diabetes Care 2004;27(1S):S63–4.
7. Hardman, Limbard, Gilman: Goodman & Gilman’s pharmacological basis of therapeutics. McGraw Hill medical publishers, 10th edition, 977-986.
8. Rang, Dale, Ritter, Flower, and Henderson: A Text Book of Rang & Dale’s Pharmacology. Elsevier churchillivingstone publishers, 7th edition, 285-293, 604.
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