Atherosclerotic Cardiovascular Disease: Description, Causes and Risk Factors:
Abbreviation: ASCVD.
ICD-9: 429.2 – Cardiovascular disease, unspecified, Arteriosclerotic cardiovascular disease [ASCVD].
The Arteriosclerotic Cardiovascular Disease (ASCVD), Coronary Artery Disease (CAD), Coronary Heart Disease (CHD), Ischemic Heart Disease (IHD) are all different names for the same disease. This disease is caused by atherosclerosis, which is a buildup of fatty deposits (atheroma or plaque) in the coronary arteries. ASCVD is atherosclerotic cardiovascular disease, which could be atherosclerosis in any artery in the body. If it is in the arteries that supply the heart, then it is coronary artery disease (CAD). If it occurs in the arteries that supply the brain it is cerebrovascular disease (CVD or CD). If it occurs in the arteries in the legs it is peripheral vascular disease (PVD).
Athersclerotic cardiovascular disease is attributed to the build up of fat deposits, which essentially clog up the heart’s arteries. These deposits are called atheroma or plaque. Plaque is built up over time in the inner lining of the arteries, which limits the blood and oxygen flow and supply to the heart.
Atherosclerotic Cardiovascular Diseasecan occur in any artery. Most commonly it occurs in the aorta, the artery that receives blood directly from the heart. Since the aorta is the largest artery in the body, it is rarely critically narrowed by atheromas. An estimated 70% of North Americans have coronary atherosclerosis, although the overt symptoms may not be evident until the arteries are three-quarters occluded. Coronary artery atherosclerosis leads to angina pectoris, heart attack and cardiac arrest. Although atherosclerosis is by far the most common cause of heart attack & cardiac arrest, other causes include coronary artery spasm, electrical irregularities, and congenital defects.
Everything else being equal, the risk of heart attack is doubled for a diabetic man and increased 5 times for a diabetic woman. Diabetes also doubles the risk of stroke independently from effects of heart disease and high blood pressure — although good control of blood glucose can reduce the risk.
Risk Factors:
Major Risk Factors of atherosclerotic Cardiovascular Disease:
- Age (males 45 years or older or females 55 years or older).
- Smoking.
- Insulin resistance.
- Hypercholestrolemia.
- Hypertension.
- C. pneumoniae.
- H. pylori.
- Cytomegalovirus (CMV).
Qualified Risk Factors:
- High CRP (C-reactive protein).
- Low risk: less than 1.0 mg/L.
- Average risk: 1.0 to 3.0 mg/L.
- High risk: above 3.0 mg/L.
- Lipoprotein (a) Lp(a). Elevation of plasma lipoprotein (a) above 30 mg/dL is a strong independent risk factor for coronary artery disease and possibly for stroke.
- Homocysteine. Elevation of the level of homocysteine in the plasma is an independent risk factor for cardiovascular disease (including myocardial infarction, stroke, thromboembolic disease, and intermittent claudication).
- Fibrinogen: Although fibrinogen is needed for normal blood clotting, its excess may promote excessive clumping of platelets and can result in thrombosis in an artery, leading to a heart attack or stroke.
- Low HDL-C (High-density lipoprotein cholesterol).
- Elevated triglycerides
Symptoms:
Atherosclerotic Cardiovascular Disease often produces no signs or symptoms until blood flow becomes blocked and results in a medical emergency. However, in cases of reduced blood flow to the heart, the person experience chest pain known as stable angina. Other symptoms include shortness of breath and/or irregular heartbeats, and even a heart attack. A typical chest pain which is sudden and sharp is prevalent in women.
Other Symptoms of atherosclerotic Cardiovascular Disease: Since atherosclerosis can affect all body parts, the symptoms will vary. Symptoms from the affected body parts are:
- Decreased performance, easy to tire out.
- Pain by physical activity, so called anoxic pain.
- By severe impairment of blood flow, tissue damage or sores can occur.
If the situation is more serious some other conditions include:
- Coronary artery disease.
- Kidney disease.
- Mesenteric artery ischemia.
- Peripheral artery disease.
- Abdominal aortic aneurysm.
- Renal artery stenosis.
- Hypertension.
- Stroke.
- Thoracic aortic aneurysm.
Diagnosis:
A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerotic Cardiovascular Disease can create a whooshing or blowing sound (“bruit”) over an artery. Some tests such as electrocardiogram, echocardiogram, exercise stress test, nuclear scan, and coronary angiography are conducted to make a definite diagnosis. Other tests include electron beam computed tomography which is done to determine the extent of calcium within the lining of the arteries. Coronary CT angiography and Magnetic resonance angiography may also be done as per the decision of the physician/cardiologist.
Treatment:
Depending upon the symptoms and the severity of each individual case, the line of treatment may be determined. Where the disease is relatively symptom free, the patient may be treated with medication or with an angioplasty along with stenting. Some of the medication prescribed in this cardiovascular disease includes ACE inhibitors, nitrates (for chest pain), statins (for cholesterol), blood thinners (for clots), calcium channel blockers and diuretics (blood pressure).
Some of the other treatment options include heart surgery that is minimally invasive and bypass surgery of the coronary artery.
Preventive measures:
Making healthy food choice is an integral part of total risk management. Food should be varied, and energy intake must be adjusted to maintain ideal body weight.
The consumptions of the following foods should be encouraged: Fruits and vegetables, whole grain cereals and bread, low fat dairy products, fish and lean meat. Oily fish and omega-3 fatty acids have particular protective properties.
- Total fat intake should account for no more than 30% of energy intake, and intake of saturated fats should not exceed a third of total fat intake. The intake of cholesterol should be less than 300 mg/day.
- In an isocaloric diet, saturated fat can be replaced partly by complex carbohydrates, partly by monounsaturated and polyunsaturated fats from vegetables and marine animals.
Studies have consistently found that individuals with three or more servings of whole grain food per day have a 20 to 30 per cent lower risk for atherosclerotic cardiovascular disease, compared to individuals with a lower intake of whole grains.
Some ayurvedic herbs which will be helpful include:
- Allium sativum (garlic).
- Emblica officinalis (Indian gooseberry).
- Nardostachys jatamansi (jatamansi).
- Centella asiatica (manduka parni).
- Terminalia chebula (herde).
- Tinospora cordifolia (guduchi).
- Ocimum sanctum (basil).
- Myristica fragrans (nutmeg).
- Commiphora mukul (guggulu).
- Convolvulus pluricaulis (shankhpushpi).
- Terminalia arjuna (arjuna).
- Trigonella foenum-graecum (fenugreek).
- Withania somnifera (ashvagandha).
- Zingiber officinale (ginger).
Disclaimer: The following tests, drugs and medications, surgical procedures are in some way related to, or used in the treatment. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.