Atherosclerosis

Atherosclerosis, also known as arteriosclerotic vascular disease (ASVD), is a form of arteriosclerosis characterised by the development of lesions in the arterial walls. These lesions, composed of fat, cholesterol, calcium, and other substances, lead to the narrowing of arteries, restricting blood flow and potentially causing severe complications such as coronary artery disease, stroke, peripheral artery disease, and kidney problems. The disease typically starts in youth and worsens with age, with nearly all individuals over 65 affected to some degree.

Signs and Symptoms

Atherosclerosis is often asymptomatic for decades. Symptoms arise only when the narrowing or closure of arteries becomes severe enough to impede blood flow. Common manifestations include chest pain (angina), shortness of breath, abnormal heart rhythms, and stroke symptoms such as dizziness, difficulty speaking, and numbness. Peripheral artery disease may present with numbness or pain in the limbs, while renal artery involvement can lead to chronic kidney disease.

Risk Factors and Causes

The exact cause of atherosclerosis is multifactorial, with several risk factors contributing to its development:

Modifiable Risk Factors:

• Western pattern diet
• Abdominal obesity
• Insulin resistance and diabetes
• Dyslipidaemia
• Hypertension
• Tobacco smoking
• Certain bacterial infections and HIV/AIDS

Nonmodifiable Risk Factors:

• South Asian descent
• Advanced age
• Genetic abnormalities
• Family history

Lesser or Uncertain Risk Factors:

• Thrombophilia, systemic inflammation, sedentary lifestyle, air pollution, chronic stress, and others.

Pathophysiology

Atherogenesis, the development of atheromatous plaques, involves a complex series of cellular events within the arterial wall. This process begins with the adherence of monocytes to the endothelium, their migration into the sub-endothelial space, and their differentiation into macrophages that ingest oxidised LDL, forming foam cells. Over time, smooth muscle cells proliferate and migrate to the intima, forming a fibrous capsule over the fatty streak. Calcification occurs within the plaques, leading to arterial stiffening and potential rupture.

Diagnosis

Diagnosis of atherosclerosis involves physical exams, electrocardiograms, exercise stress tests, and imaging techniques such as coronary calcium scoring by CT, carotid intimal media thickness measurement by ultrasound, and intravascular ultrasound (IVUS). Advanced diagnostic methods focus on detecting vulnerable plaques and physiological measurements like lipoprotein subclass analysis, hs-CRP, and homocysteine levels.

Prevention

Preventing atherosclerosis involves lifestyle modifications such as maintaining a healthy diet, exercising, not smoking, and managing weight. Evidence supports the benefits of a diet high in fruits and vegetables, and the Mediterranean diet has shown promising results in reducing cardiovascular risks.

Treatment

Treatment strategies include lifestyle changes, medications, and surgical interventions. Statins are widely prescribed to lower cholesterol levels, while blood pressure medications and anticoagulants like aspirin help manage symptoms and reduce risks. In severe cases, surgical procedures such as percutaneous coronary intervention, coronary artery bypass grafting, or carotid endarterectomy may be necessary.

Understanding the pathophysiology, risk factors, and treatment options for atherosclerosis is very important for dental professionals, as they may encounter patients with this condition and need to consider its implications during dental treatments.

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Self-assessment MCQs (single best answer)

What is atherosclerosis also known as?

What is a common symptom of severe atherosclerosis?

Which of the following is a modifiable risk factor for atherosclerosis?

What cells ingest oxidised LDL to form foam cells during atherogenesis?

Which diagnostic method involves imaging to detect coronary calcium?

Which lifestyle change is recommended to prevent atherosclerosis?

Which medication is commonly prescribed to lower cholesterol levels in atherosclerosis patients?

What is a nonmodifiable risk factor for atherosclerosis?

Which surgical procedure might be necessary for severe cases of atherosclerosis?

What is the main characteristic of atherosclerosis?