Advanced Health Tune Up

Atherosclerosis is a disease of large and medium-sized muscular arteries and is characterised by endothelial dysfunction, vascular inflammation, and the build-up of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall. These build-up results in plaque formation, vascular remodelling, acute and chronic luminal obstruction, abnormalities of blood flow and diminished oxygen supply to target organs. The location of atherosclerotic lesions predicts the clinical manifestation. Atherosclerotic coronary arteries can precipitate angina pectoris and myocardial infarction (MI); atherosclerosis of the central nervous system (CNS) arteries is antecedent to transient cerebral ischaemia and stroke. Other potential complications of atherosclerosis include kidney damage, e.g., from renal artery stenosis; claudication and even gangrene from peripheral arterial occlusion; and mesenteric ischaemia or bowel infarction from involvement of the splanchnic circulation. Atherosclerosis in the aorta tends to lead to aneurysm formation and predilection to dissection and/or rupture rather than stenosis and occlusion (Libby 1998). Atherosclerosis is the leading cause of illness and death in the United States and most other Western countries: close to one million deaths per year in the United States are attributable to heart disease alone, double the number of deaths from cancer.

Aetiology / Risk Factors

Lowered oestrogen levels—e.g., postmenopausal women

Hypercholesterolaemia, particularly elevated LDL as well as increased triglycerides and high levels of apolipoprotein (a)

Low levels of HDL cholesterol

Family history—since identified genetic markers only account for a small fraction of familial-related atherosclerosis, either learned behaviour or other unidentified genetic markers must be involved

Cigarette smoking and regular exposure to second-hand smoke

Obesity, particularly abdominal

High intake of saturated fat and trans-fatty acids

Hyperhomocysteinaemia

Hyperfibrinogenaemia

Stress—for example, psychosocial, which may be related to work, attitude (e.g., hostility and cynical distrust), social isolation, sleep deficiency, or suppressed anger

High ratio of free radical markers to antioxidants

Chest pain, classically described as heavy, squeezing, or crushing, but may also be described as burning or stabbing. In the case of stable angina, but not MI, pain generally subsides with rest.

Transient ischemic attack (TIA) and stroke. A TIA is distinguished from a complete stroke by the fact that the neurologic deficits last less than 24 hours.

Peripheral artery disease causes intermittent claudication—experienced as pain, aching, cramps, numbness, or a sense of fatigue in the muscles of the lower extremities, aggravated by exertion and relieved by rest.

Diminished or absent distal pulses

Smooth, shiny skin surface

Skin cold to the touch

Xanthelasma, tendon xanthomata

Abdominal aortic aneurysm—pulsatile abdominal mass