Introduction Atherosclerosis is a common cardiovascular


Atherosclerosis is a common cardiovascular (heart) disease that involves complete or partial blockage of arteries by the heaping of plaque in their passages. Arteries are lined up with Endothelial cells to keep them smooth and allow blood to flow easily. When the arteries are damaged, the cholesterol builds up causing a plaque. Cardiac muscle cells play an important role in the cardiac circulation and they need constant supply of oxygen and nutrients, so any reduction in blood flow to the heart will lead to lack of cardiac performance.

Atherosclerosis Symptoms
The symptoms depend on which artery is affected Most symptoms do not show until a blockage occurs. Most common symptoms are:
• Chest pain and angina (gets worse with activity and go away with rest)
• Pains in your legs, arms and anywhere else where there is a blockage
• Shortness of breath
• Fatigue
• Confusion, which occurs if the blockage is affecting the blood circulation of the brain
• Muscle weakness in your legs from the lack of blood circulation

It is also highly essential to take note of symptoms for heart attack and stroke as they are also caused by atherosclerosis
• Discomfort on your chest
• Severe abdominal pain
• Perspiration
• Nausea and vomiting
• Sense of impending doom
• Loss of balance
• Trouble speaking
• Sudden and severe headache
• Vision problems mostly trouble seeing with both eyes
• Weakness or numbness in the face or limbs
• Loss of consciousness
Renal arteries supply oxygen rich blood to your kidneys, blockage in these arteries specifically can cause problems as well which has the following symptoms:
• Loss of appetite
• Change in how you urinate
• Swelling in the hands and feet, itchiness or numbness
• Trouble concentrating Causes of Atherosclerosis

Causes of Atherosclerosis

Atherosclerosis is a disease that results as a direct response to endothelium (inner lining arteries tissue) damage. Bloodstream lymphocytes and monocytes spread through the walls of arteries and become captured at the arteries walls. As a result, a plaque build-up will occur which subsequently will block the passages of the walls of arteries.

Atherosclerosis is caused by bad eating habits, high cholesterol level, high blood pressure, smoking and diabetes. When the blood vessels are malfunctioning due to the presence of fatty substances that invade the lumen of the artery, atherosclerosis is likely to occur. Lack of exercise, family history of heart disease can elevate the risk factor of atherosclerosis. It is suggested that more males than females get affected by atherosclerosis, mostly men above the age of 45 and women above 55 years.
As people age, the heart and blood vessels pumps blood harder which may cause weak arteries and cause it to be more elastic which may be susceptible to plaque build-up. A study done in a teaching hospital in South-western Nigeria showed that the following risk factors were associated with Atherosclerosis:
• Old age
• Obesity
• Hypertension
• Dyslipidaemia
• Alcohol consumption
• Chronic kidney disease

Diagnosis of Atherosclerosis
Atherosclerosis is a chronic disease that is greatly influenced by how people leave their lives. However, the plaque begins to accumulate at birth. there are several types of methods used to detect the disease, when a patient has the above-mentioned symptoms, the doctors may do the following procedures to make a confirmation. Below is a list of some methods employed to access carotid wounds.
? Digital Subtraction Angiography
This technique gives the most definite scrutiny and they can determine the length of the luminal diameter along a 2D plane artery. As good as thus technique maybe, it does not detect small plaque (Fibrous Cap Atheroma), plus it takes a lot of time and hard work and very expensive. (BL, 1991)
? Doppler Ultrasound
This one is very efficient, not expensive and does not intrude your personal space, no machinery is put inside your body in attempt to dictate the plaque. It shows information in gradients per contra. The accuracy of it is questionable as it is subject to the operator and Doppler angles. ({Dr Sarah Jane George, 2010)
When the disease is dictated it could be in one of the five stages below and the methods above help us to do that
• Intimal thickening and intimal Xanthoma – this is the first stage of the disease where there is a horde cells (macrophages) loaded with fat. At this point the patient has very high chances of beating the disease
• Pathological Intimal Thickening-second stage of disease where they are acellular areas in the deeper layers of the intima (swelling in the first stage) and the inflammatory cells start to appear.
• Fibrous Cap Atheroma-the third stage, the horbid of cells below now have many different extracellular lipids, necrotic debris and cholesterol crystals. At this point their condition is worsening but if medical attention is given they might just beat it.
• Intraplaque Haemorrhage-caused by the creation of a thick plaque along the walls of micro vessels making it more difficult for blood to move within the vessels because now it has cholesterol crystals forming as well.
• Thin Cap Fibrous Atheroma (Vulnerable Plaque)-at this point this is now a full-blown Atherosclerosis, it has formed a cap on top of the plaque and the cap has no extra cellular matrix and smooth muscle and calcification may occur. This cap (Fibrothema cap) may cause ruptures and fissures which may expose highly Thrombogenic (clots attached to a blood vessel) composites. This may cause premature sudden death. (Jasjit S. Suri, 2011)

Atherosclerosis Management
Martin (2007) reported that the most effective management of cardiovascular disease caused by atherosclerosis is risk factor control. This is true in both stages before the disease is recognisable and during the symptomatic early periods. As symptoms develop, physical interventions (surgical or endovascular) are currently the only effective means by which these manifestations can be informed.
Thrombolysis is an adjunctive intervention that is producing effective strides. Normally vascular, surgical and endovascular procedures are used during late manifestations of Atherosclerosis.
Prof James (2018) listed at least three management strategies that have possibly resulted in the decline of Atherosclerosis:
• Improved primary prevention measure such as better blood pressure, better cholesterol controls, decrease in smoking and health lifestyle such as better diet and accelerated physical activities
• There is more use of invasive strategies of vascular revascularisation. The implantation of more potent anti-platelet drugs and improved drug-eluting stent technology has improved the outcomes.
• The use of effective therapies is the following- statin therapy, anti-platelet therapy and renin angiotensin system (RAS) blockers.
Loscalzo (2010) claimed that a wealth epidemiological data shows evidence of a relationship between hypertension and atherosclerosis risk, and extensive clinical trial support has established that pharmacologic treatment can reduce the risk of atherosclerosis and manage it.

This is a very deadly disease because it is very silent, however it’s progress can be derailed by living a healthy lifestyle even before the sufferer has been made aware of its presence in their body. Most people think that this is a very uncommon disease, which is not true and very dangerous, and it also indicates that there is not enough teaching about this disease and it is highly neglected, which can then result to premature mortality. Regular check-ups for cardiovascular disease are important as atherosclerosis can also be inherited from birth. The management of atherosclerosis thus can begin in early ages of life to decrease the rate of premature death it causes.
{Dr Sarah Jane George, D. J., 2010. Atherosclerosis.
BL, G., 1991. Atherosclerosis. Volume 1.
Jasjit S. Suri, C. K. F. M., 2011. Astherosclerosis Disease Management.

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Levin, Richard I. Laboratory for Cardiovascular Research, and Training Program in Cardiology, New York University School of Medicine, New York, New York.

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Author Adeleye Dorcas Omisore1 , Olusola Comfort Famurewa1 , Morenikeji Adeyoyin Komolafe1 , Christiana Mopelola Asaleye1 , Michael Bimbola Fawale1 and Babalola Ishmael Afolabi1
Affiliations : 1 Obafemi Awolowo University, Nigeria
Source : Cardiovascular Journal of Africa, Volume 29 Number 3, May / June 2018, p. 183 – 188