Overview of the main risk factors for atherosclerosis

– a disease based on impaired metabolism

(fats) of the body. With this pathology, fat is deposited on the inner wall of medium and large caliber arteries. Atherosclerosis underlies many cardiovascular diseases and is also a risk factor.

He occupies a leading position in the list of the most common diseases in the world. Also, one of the first places this vascular disease is in the list of diseases leading to death. According to statistics, every 10 deaths on the planet comes from the consequences of atherosclerosis, which most often acts as myocardial infarction and hemorrhage in

The territories where this disease is most common are countries in Europe and North America with a high level of economic development. According to the United States Demographic Bureau, atherosclerosis is the cause of 30 percent of deaths. In the second half of the twentieth century, this metabolic disorder has become increasingly diagnosed in Japan and China.

Atherosclerosis2 - Overview of the main risk factors for atherosclerosis

Experts note that this contributes to the development of technology, which entails a sedentary lifestyle. In the Russian Federation, atherosclerosis is also a common pathology. Atherosclerotic vascular changes annually cause death among men in more than 60 percent of cases.

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Interesting Facts

The traditional causes of the development of atherosclerosis are considered improper diet

and sedentary lifestyle. According to these factors, atherosclerosis is a disease of our time, since in antiquity there was no fast food, tobacco products and at the same time ancestors led an active life. However, some studies refute this assumption. Employees of a medical center in California conducted an analysis of mummified bodies.

During the experiment, the remains of 76 people who lived on the territory of 5 continents many centuries ago were examined. As a result of the study, symptoms of atherosclerosis were found in 35 percent of the bodies. The head of the study emphasized that scientists could not find at least one ancient civilization, whose representatives did not have signs of this disease.

The lack of a direct link between atherosclerosis and diet is confirmed by studies conducted among residents of African countries. Some African tribes feed mainly on camel and goat milk, which is several times fatter than cow’s milk. Despite this, increased levels of cholesterol in the blood and atherosclerosis in these people are much less common than in other nations.

A large-scale study on atherosclerosis was conducted in India. The analysis showed evidence that mortality from the effects of atherosclerosis among residents of the southern part of the country is 7 times higher than among those living in the northwestern region. Noteworthy is the fact that residents of northwestern India consume significantly more tobacco products and fatty animal products.

The mechanism of development of atherosclerosis – what is the disease dangerous?

The first step in the degenerative process when the disease in question appears is the destruction of the inner wall of the artery. This phenomenon is favored by many different factors, which will be described in the next section.

ateroskleroz tipy ateroskleroza simptomy riski 2 - Overview of the main risk factors for atherosclerosis

The damaged area serves as a kind of window for low-density lipoproteins, which easily penetrate into the artery, and form a lipid spot here. Under the influence of a number of chemical processes, the already inflamed zone is under the constant influence of migrating inflammatory mediators.

All these phenomena contribute to the accumulation of cholesterol in the form of a plaque. It is converted to atherosclerotic as a result of the growth of connective tissue in it.

Over time, due to the progression of the pathological process, small blood clots appear, microcracks of the inner wall of the artery are noted. Similar conditions lead to the appearance of new atherosclerotic plaques.

This negatively affects the quality of the supply of the artery with useful substances, after which it loses its shape and elasticity, narrows and tightens. Blood cannot fully circulate throughout the body, which is displayed on the nutrition of internal organs.

Among the most common exacerbations of the disease in question are the following:

  • Ischemia.
  • Oxygen starvation.
  • Degenerative transformations of internal organs.
  • Small focal sclerosis. It is a consequence of the proliferation of connective tissue.
  • Acute vascular insufficiency. May occur when the lumen of the vessel is blocked by a thrombus. In this case, the infarction of the internal organ is a completely expected phenomenon.
  • Rupture of aneurysm. It ends with the death of the patient.

The bottom line is a violation of the integrity of the endothelium, where the main damaging factors are carbon monoxide entering the bloodstream when smoking, arterial hypertension and dyslipidemia.

1 period – a lipid spot and is a preclinical phase.

2 period – fibrous plaque, is a clinical phase (hemodynamically significant).

3 period – plaque rupture.

Clinical manifestations of atherosclerosis.

  • Dyslipidemia syndrome – is based on laboratory parameters of lipid parameters of blood plasma (the level of cholesterol, LDL, TG in the blood is estimated), they should be increased.

-optimal value – not more than 5 mmol/l;

-normal value – not more than 1 mmol/l;

-optimal value – not more than 2 mmol/l;

– if damage to the coronary arteries is coronary insufficiency, manifested by coronary artery disease;

ateroskleroz smysl - Overview of the main risk factors for atherosclerosis

– if damage to the cerebral arteries, then a stroke;

– damage to the vessels of the extremities – intermittent chromate;

– damage to the vessels of the mesentery – infarction of the intestine, etc.

We diagnose this syndrome clinically and instrumentally.

Clinically means direct examination of the patient by palpation of the accessible arteries: carotid, radial, brachial, etc. Palpate symmetrically, this is necessary for comparison. The detection of asymmetry can be in the form of a weakening or even disappearance of the ripple. If the vessel cannot be palpated (ascending aorta, renal arteries), then we listen to the phonendoscope – auscultation, there may be the appearance of systolic murmur.

Instrumental diagnostics: ultrasound, contrast study of blood vessels. At this time, it is possible to conduct quantitative intravascular ultrasound angiography, which allows you to accurately determine the location, size and condition of the fibrous plaque.

  • Syndrome of external manifestations of dyslipidemia. Xanthelasma of the eyelids, lipoid arc of the cornea, skin and tendon xanthomas on the extensor surfaces of the hands.

Causes and risk factors for atherosclerosis

Atherosclerosis is a polyetiological (multifactorial) disease, in the development of which more than a dozen factors are simultaneously involved.

2fbf923721c80fbc6018733dfe14ecd6 - Overview of the main risk factors for atherosclerosis

The causes and risk factors for atherosclerosis are:

  • dyslipidemia – a violation of lipid metabolism;
  • arterial hypertension – high blood pressure, which provokes the stratification of the epithelium of the vascular wall and the rapid penetration of lipids into it;
  • smoking – the integrity of the vascular wall is also violated;
  • obesity – accompanied by impaired metabolism and excessive concentration of lipids in the blood serum;
  • impaired metabolism – diabetes;
  • burdened heredity – plays a major role in familial dyslipidemia;
  • male gender – atherosclerosis is more common in men than in women;
  • age over 55 years – with age, the metabolism slows down;
  • sedentary lifestyle;
  • malnutrition – excess fat intake;
  • hormonal imbalance – androgens have an atherogenic effect.

All of the above risk factors must not be considered separately, but in combination. They play a role not so much in the occurrence of atherosclerosis, but in its further progression. The most significant factors, the highest risk of which was recognized by the World Health Organization (WHO), are the first five – dyslipidemia, arterial hypertension, smoking, obesity and diabetes.


Dyslipidemia is a violation of lipid metabolism. Lipids, they are fats, play an important role in the body. They are the building material for cell membranes, for nerve tissue and for synthesis.

. However, their increased content is accompanied by the development of atherosclerosis. There are several fractions of lipids, each of which plays a role.

In order to assess lipid metabolism disorders, you need to know what the normal lipid composition of the blood looks like.

The ratio of basic lipids is normal

Concentration is normal

It is the precursor of sex hormones, bile acids, vitamin D.

3,5 – 5,2 mmol per liter

(Low Density Lipoproteins)

Cholesterol is transferred from one cell to another. They are also called “bad lipids,” because they increase the risk of developing atherosclerosis.

up to 3,5 millimoles per liter

(High Density Lipoproteins)

Cholesterol is transferred to the liver. They are also called “good lipids,” since they reduce the risk of developing atherosclerosis.

0,9 – 1,9 mmol per liter

They are synthesized by adipose tissue cells and are the main source of energy for the cell.

0,5 – 2 mmol per liter

Klimov Atherogenic Index

Reflects the degree of risk of diseases of the heart and its vessels.

The concentration of cholesterol is the main factor reflecting the development of atherosclerosis. However, in order to correctly understand the relationship between the concentration of cholesterol in the blood and the diet, you must know that there is endogenous and exogenous cholesterol.

Endogenous cholesterol is one that is produced by the body itself. It is he that is deposited on the inner wall of blood vessels and contributes to the development of atherosclerosis. Exogenous cholesterol is one that is ingested with food. It has a lesser effect on the process of atherosclerosis. Therefore, completely eliminating cholesterol from your diet is not recommended.

The relationship between high blood pressure and atherosclerosis has been proven in a number of studies. According to these studies, arterial hypertension is accompanied by structural changes in the vascular wall and dysfunction of the epithelium itself. There is desquamation (delamination) of the epithelium of the vascular wall and a violation of its permeability.

This creates the ground for the rapid impregnation of the vascular wall with lipids and the formation of atherosclerotic plaques. Also, high blood pressure is accompanied by the production of substances that narrow the vessel wall (angiotensin II) by the epithelium. At the same time, the synthesis of substances that dilate blood vessels (nitric oxide) is reduced.

The same studies calculated the risk of coronary heart disease, with a combination of atherosclerosis and arterial hypertension. So, if the diastolic pressure exceeds 100 millimeters of mercury, then the risk of developing angina pectoris increases four times. Elevated systolic pressure has an effect more on the cerebral vessels than on the vessels of the heart. Therefore, increased systolic pressure in atherosclerosis is associated with an increased risk of stroke.

The risk of developing cardiovascular complications in smokers is 3 times higher than in non-smokers. This risk has been demonstrated by most modern studies. They proved that smoking leads to significant endothelial dysfunction, which is the trigger in the development of atherosclerosis. In addition, smoking stimulates blood clots and increases blood viscosity. This leads to frequent blood clots and vascular blockage, which complicates the course of atherosclerosis.

Today, most studies have shown a direct relationship between mortality from cardiovascular disease and body weight. The frequency of cardiovascular diseases is increasing simultaneously with weight in both women and men. It was found that with a body mass index of more than 25, the risk of coronary heart disease increases by 50 percent. This is because obesity is accompanied by high cholesterol,

and low HDL. At the same time, the activity of fat cells (adipocytes) increases, and they begin to secrete free

that increase the concentration of triglycerides.

Also, overweight people have a high risk of developing type diabetes. This factor is an additional risk factor for the development of atherosclerosis. The reason for the development of diabetes with excess weight is an increased concentration of the hormone insulin in the peripheral tissues and the development of insulin resistance. In this case, the sensitivity of tissues to insulin decreases and glucose (in the people – sugar) ceases to be absorbed.

In order to maximally reflect the causal relationship between obesity and atherosclerosis, the term “metabolic syndrome” or “syndrome X” was introduced by specialists. It combines an increased concentration of triglycerides, insulin resistance and high blood pressure. This syndrome is combined with obesity, which proves the relationship of obesity and atherosclerosis.

It should be noted that not only being overweight in itself is dangerous, but also the process of gaining it. This phenomenon was confirmed by the Framingham study, which showed a relationship between weight gain in women after 25 years and a high risk of cardiovascular disease.

Diabetes mellitus is combined not only with a high risk of atherosclerosis, but also with a severe degree of its course. It is known that the risk of developing cardiovascular complications in atherosclerosis in men with diabetes increases by 5 times, and in women – by 7 times. This risk increases several times if a man or woman smokes or is overweight. Type diabetes is characterized by a high concentration of lipids, cholesterol and the development of dyslipidemia.

Another mechanism that causes the rapid progression of atherosclerosis is the glycosylation process. It is characterized by deposition

in the vascular endothelium, which leads to damage. Through defects in the endothelium, lipids penetrate the vessel faster and impregnate it.

There is no specific reason for the occurrence of the disease. The risk of developing atherosclerosis is due to many factors. Among them, unmodified and modified are distinguished. The former cannot be partially or completely eliminated. These include:

  1. Age-related changes. In women, the disease often appears after fifty years, in men – after reaching forty-five.
  2. Hereditary predisposition. If the next of kin (for example, parents, siblings) suddenly died, suffered a stroke or heart attack up to sixty years, then the likelihood of developing the disease is quite high.

Factors that belong to the second category can be eliminated with proper treatment:

  1. Hypercholesterolemia is an increased level of cholesterol in the body.
  2. The presence of diabetes.
  3. Wrong way of life. Alcohol abuse, smoking, inactivity, poor poor-quality food with a high fat content.
  4. Overweight problems, obesity.
  5. High hell, the development of hypertension.

Other factors that influence the development of the disease are stress and sleep apnea. In the second case, breathing stops for short periods of time, as a result of which the blood pressure rises greatly. Scientists are sure that against the backdrop of worsening psycho-emotional and physical health in such circumstances, the risk of stroke or heart attack increases several times.

With atherosclerosis, accumulation of cholesterol deposits on the arterial walls is characteristic. The level of lipids is constantly increasing, which eventually leads to complete blockage of blood vessels. This is possible only with damage to the inner wall of the vessels. These processes are facilitated by:

  • diabetes;
  • constantly high blood pressure;
  • harmful activity of opportunistic microorganisms;
  • infectious diseases;
  • bad habits (especially smoking).

These risk factors for atherosclerosis are the main causes of damage to the protective layer of arterial walls. Through this, lipids are freely fixed inside the artery, forming cholesterol plaques. Increasing in size, these pathologies become one of the main reasons for the lack of blood supply to vital organs.

Etiology of atherosclerosis.

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Atherosclerosis is a multifactorial disease.

Risk factors can be divided into modifiable and non-modifiable. Non-modifiable risk factors – this is something we cannot influence.

Modifiable: 1) smoking is the most dangerous factor. When smoking, there is an increased synthesis of NO, causing vasoconstriction – spasm of the vessels of the GM, all this leads to a violation of microcirculation – in general, this leads to damage to the endothelium.

2) hyperlipoproteinemia – that is, an increased blood cholesterol content of more than 5 mmol/L, LDL (low density lipoproteins) more than 3 mmol/L. Their constant content in the blood leads to their deposition, and they are the basis of AS plaque.

3) arterial hypertension.

6) lack of exercise (sedentary lifestyle)

cool - Overview of the main risk factors for atherosclerosismalnutrition

9) hypothyroidism (in which there is a metabolic disorder, which is a favorable environment for AS)

10) alcohol abuse

-floor (men are more predisposed to AS, since women have estrogen, which has an anti-atherosclerotic effect, and male testosterone does not have this property. After 40 years, when women have menopause, they become more vulnerable due to a decrease in estrogen levels in the blood).

Many theories of the development of atherosclerosis are proposed, among which the following are most common:

  • Viral Theory (Herpes Virus)
  • Heredity
  • Coagulation Disorder
  • Immune System Disorders
  • Benign tumor
  • Disorders of lipid metabolism and damage to the endothelium – ENDOTHELIAL THEORY.

The last of these theories currently dominates.

Types of Atherosclerosis

Symptoms of atherosclerosis depend on its location. Most often, atherosclerosis affects the aorta, coronary vessels of the heart and blood vessels of the brain. But there are also other localizations.

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Types of atherosclerosis at the site of localization are:

  • atherosclerosis of the aorta;
  • atherosclerosis of the peripheral arteries (i.e. lower limbs);
  • cerebral arteriosclerosis;
  • renal arteriosclerosis;
  • atherosclerosis of brachiocephalic vessels.

Also, atherosclerosis can vary in the nature of the lesion.

Types of atherosclerosis by the nature of the lesion are:

  • stenosing atherosclerosis;
  • obliterating atherosclerosis.

ateroskleroz tipy ateroskleroza simptomy riski 2 - Overview of the main risk factors for atherosclerosis

In fact, these species are only stages in the development of the atherosclerotic process. With stenotic atherosclerosis, a narrowing of the lumen of the vessel occurs. Atherosclerotic plaque thickens the endothelium and reduces the volume of blood supply. But the patency of the blood vessel in this form is preserved.

Obliterating sclerosis is characterized by a significant narrowing of the lumen of the vessel up to its complete blockage. Obliteration means vascular obstruction, which characterizes the pathological process in this disease. The leading form of systemic atherosclerosis is its obliterating appearance.

Atherosclerosis obliterans is a pathology that affects peripheral blood vessels, that is, vessels of the lower extremities. This disease occurs in 5 percent of the population, mainly in men after 40 years. As a rule, arteries of medium and large caliber are affected.

Arteries that are affected by obliterating atherosclerosis are:

  • iliac arteries;
  • femoral arteries;
  • popliteal arteries.

For a long time, obliterating atherosclerosis is asymptomatic. In the initial stages, the patient may pay attention to increased sensitivity to cold and to the fact that the legs are always felt cold. Also, the patient may complain of constant chilliness and numbness. Much later, complaints of periodic pain in the calf muscles appear. Depending on the distance at which the pain appears, the stages of obliterating atherosclerosis are also distinguished.

The stages of atherosclerosis obliterans are:

  • stage I – pains appear after passing more than one kilometer or with very strong physical exertion;
  • stage IIa – the onset of pain is observed after covering a distance of up to 1000 meters;
  • stage IIb – painless walking is observed at a distance of up to 250 meters;
  • stage III – the distance of a painless walk is 50 meters, pain occurs at rest, often in a dream;
  • stage IV is the stage of trophic changes, which are characterized by ulcers and gangrene.

ateroskleroz tipy ateroskleroza simptomy riski - Overview of the main risk factors for atherosclerosis

In connection with impaired blood circulation, ischemia (insufficient blood supply) of tissues develops. It manifests itself in a change in skin color and temperature of the limbs, as well as in violation of the growth of nails and hair. In the initial stages, the skin of the legs acquires a pale bluish color. Sometimes, with severe obliterating sclerosis, the skin acquires the color of ivory.

Subcutaneous fat atrophies and practically disappears. This gives the skin the appearance of thin, parchment paper. Due to impaired blood supply, the hair on the legs stops growing and begins to fall out. Changes also apply to nails – hyperkeratosis is noted, nail plates thicken and begin to exfoliate.

The options for the course of obliterating sclerosis are:

  • Acute form – occurs in 15 percent of cases. In this case, a complete blockage of the vessels of the limbs is observed very quickly and requires emergency hospitalization. The acute form quickly turns into gangrene.
  • Subacute form – occurs in 45 percent of patients with atherosclerosis. This option is characterized by periodic remissions and exacerbations. Treatment can slow the progression of atherosclerosis.
  • Chronic form – occurs in 40 percent of patients. This is a relatively favorable form, which proceeds without pronounced exacerbations. Treatment gives a good effect.

There are two types of factors:

  • modifiable – you can try to remove;
  • unmodifiable – are beyond our influence.
  • smoking;
  • high cholesterol, LDL;
  • trans fats;
  • excess weight;
  • high pressure;
  • diabetes;
  • a diet based on meat, fried foods, fast food.
  • older age;
  • gender (men);
  • family predisposition;
  • genetic abnormalities.

An additional list of the causes of atherosclerosis includes factors that have a lesser effect on the development of the disease, as well as insufficiently studied:

  • thrombophilia – a tendency to thrombosis;
  • saturated fats;
  • excess carbohydrates;
  • high triglycer >03 Nepravilnoe pitanie - Overview of the main risk factors for atherosclerosis

Smoking is one of the main factors that increase the risk of cardiovascular complications associated with atherosclerosis. The tendency to develop atherosclerosis is inherent in both active and passive smokers. Every tenth death from a disease is associated with systematic poisoning of the body with tobacco smoke.

Components of tobacco smoke increase the level of bad LDL, lower the concentration of good high-density lipoproteins (HDL). This is the worst possible combination. The ability of nicotine, carbon monoxide to damage the vascular endothelium further increases the chances of developing atherosclerosis. The body has to “patch” damage with atherosclerotic plaques, the high level of LDL contributes to their further growth.


High levels of total cholesterol, LDL, triglycerides, low HDL are associated with a high risk of developing atherosclerosis. “Harmful” LDL is responsible for delivering cholesterol to body cells. This is a very important function, because all cell membranes need it. But an excess of LDL can damage the vessel wall.

“Useful” HDL – magnets for LDL. By circulating in the blood, they collect excess LDL and remove them from the body. The regulatory function of good cholesterol has a positive effect on reducing the risk of cholesterol plaque formation.

The probability of developing atherosclerosis is affected not only by the total amount of LDL, but also the size of lipoproteins. Small molecules are more dangerous than large ones. After all, they are easier to settle on the surface of the arteries.

Trans fats

Trans fats are formed during the industrial hydrogenation of unsaturated fats found in vegetable oils. Products prepared using this technology have a longer shelf life, more attractive taste, texture, and are resistant to rancidity. Trans fats can be found in a variety of foods: margarines, cookies, pastries, salad dressings, vegetable oils.

The mechanism of the effect of trans fats on the body is poorly understood. It is reliably known that regular consumption of even a small amount of harmful lipids increases the LDL content, reduces the concentration of HDL. Perhaps they also make the walls of arteries more susceptible to damage. All these changes lead to the development of atherosclerosis.

Excess weight

Doctors have long noticed that most patients with cardiovascular complications are overweight. The relationship between atherosclerosis and obesity in men is especially clearly visible. This phenomenon is explained by an increase in the concentration of blood cholesterol, triglycerides, as well as the increased pressure from which almost all dense people suffer.

You can roughly estimate the correspondence of body weight to your height with the help of the body mass index (BMI): weight (kg)/height2 (m). Healthy is considered an indicator of 17,5-25.


Diabetic women are 3-5 times more likely to develop atherosclerosis than healthy ones. In men, a similar indicator is 2-4 times. Diabetes mellitus significantly changes the metabolism. Blood accumulates inflammatory cytokines, free radicals that damage the vascular endothelium. To start the development of atherosclerosis, more is not required.

The situation is exacerbated by a violation of the fat metabolism that accompanies diabetes. In 69% of patients, the following changes are observed:

  • high triglycerides;
  • increasing the content of LDL in small sizes (VLDL);
  • lowering the level of HDL.

Fat imbalance contributes to the progression of atherosclerosis.

High pressure

The wall of healthy arteries is elastic, flexibly responds to changes in blood volume, and the physiological state of a person. Hypertension is called an increase in pressure above 140/90 mm Hg. Art. For patients with diabetes mellitus, chronic renal failure, the figure is slightly lower – 130/80 mm RT. Art.

High pressure causes the muscles of the vessels to remain in constant tension. Prolonged exposure to hypertension makes the walls of arteries inelastic. They lose the ability to quickly, easily stretch, narrow. There is a high probability of vessel trauma due to the action of any damaging factor.

The damage site is covered with LDL, blood cells, connective fibers. So the atherosclerotic plaque begins to form.

The incredible prevalence of atherosclerosis in developed countries is associated with malnutrition. A person consumes a huge amount of foods containing trans fats, saturated fats, and cholesterol. The average resident eats a much larger number of these components than physiology requires. On the contrary, people began to eat much less fruit vegetables, preferring more attractive snacks.

Early researchers called for completely abandoning food of animal origin, switch to low-fat dairy products. However, many modern scientists do not approve of this approach. A more thorough study of the issue showed that for the successful prevention of atherosclerosis, it is enough to reduce the intake of foods rich in saturated fats, cholesterol, add more sources of fiber to your diet. Only trans fats need to be excluded.

Older age

  1. Zero. Preclinical. Ischemic changes in blood vessels take place, which can be detected through certain diagnostic measures. This stage can last a long time.
  2. First. Ischemic. Pathological changes are noted in the internal organs whose blood vessels narrow in the lumen. Due to such transformations, the blood supply to these organs is impaired.
  3. Second. Thrombonecrotic. During the diagnosis, you can find small or large foci of necrosis on the walls of damaged vessels. This stage is often supplemented by vascular thrombosis.
  4. Third. Sclerotic, fibrous. The muscle tissue of the affected internal organs gradually atrophies. In addition, scars form on them.
  1. The formation of fat (lipid) stains. This stage may have a different duration. Inside the walls of blood vessels complex complexes of compounds are formed, which include lipids, as well as proteins. It is possible to visualize such deposits exclusively under a microscope.
  2. Liposclerosis Fat spots gradually germinate with connective tissue, which provokes the appearance of an atheromatous plaque. In its structure, it is unstable: this plaque can crack, and its pieces with blood flow can migrate into the fine vascular network and clog individual vessels.
  3. Atherocalcinosis. The plaque becomes more dense in its structure, which is associated with its calcination. It can increase in diameter, and cause occlusion of the arterial vessel. Such a phenomenon leads to serious circulatory disorders, the death of certain sections of the corresponding organ.
  • Stenosing. The symptomatic picture is bright enough, which is caused by an overlap of the lumen of the vessel by more than 50%. Patient complaints will be determined by the location of the atherosclerotic plaque.
  • Non-stenosing. Pathological phenomena do not lead to pronounced changes in blood flow. The disease manifests itself in people with low blood pressure. In other cases, the symptoms are absent or make themselves felt less pronounced. The lack of therapeutic measures leads to the development of stenosing atherosclerosis.
  • Obliterating. Total blockage of the vessel, which in some cases leads to gangrene.

The mechanism of development of atherosclerosis – what is the disease dangerous?

With atherosclerosis, the “impregnation” of the inner lining of the vessels with lipids and cholesterol occurs. As a result of this, atherosclerotic plaques form, which by their volume narrow the lumen of the vessel. Further, these plaques can ulcerate, come off, and blood clots can form in their place. All this will lead to a narrowing or complete blockage of the vessel, which will cause insufficient blood supply (ischemia).

04 Alkogolizm - Overview of the main risk factors for atherosclerosis

Two factors are involved in the development of all these processes – vascular and lipid.

Vascular factor Affects vascular-platelet changes that form the soil for the rapid development of atherosclerotic plaques. These changes include desquamation (exfoliation) of the epithelium of the vascular wall. It is known that several layers are distinguished in the vascular wall.

The layers of the vascular wall are:

  • the inner layer consisting of the endothelium and the elastic membrane;
  • the middle layer formed by muscle cells;
  • the outer layer formed by connective tissue.

With atherosclerosis, the inner layer of the vascular wall, consisting of endothelium, is affected. Its desquamation (exfoliation) can occur for various reasons. Most often, such a cause is high blood pressure. With this disease, the distance between the endothelial cells expands, and small windows form.

and, importantly, when smoking. In all these cases, damage to the inner layer of blood vessels of varying depth and extent is noted.

Lipid factor The lipid factor reflects lipid metabolism disorders (synonym – dyslipidemia). In this case, the content of basic lipids is disrupted in the blood plasma. Deviation of a parameter from the norm or violation of the ratio of several parameters is called dyslipidemia. Distinguish between primary (they are hereditary) and secondary (acquired) dyslipidemia.

Some types of dyslipidemia

The risk of developing atherosclerosis

With dyslipidemia, excess cholesterol accumulates in the body and is deposited on the vascular wall. Thus, two factors are necessary for the formation of atherosclerosis – a defective vascular wall and an impaired lipid composition.

Atherosclerotic plaques are deposits of cholesterol and lipoproteins inside the vascular wall. The danger of a plaque is that, as it grows, it closes the lumen of the vessel and disrupts blood circulation. In its development, the plaque goes through several stages.

The stages of the formation of atherosclerotic plaques are:

  • increased plasma lipids;
  • lipid impregnation of the vascular wall;
  • the formation of atherosclerotic spots and stripes ranging in size from 1 to 1,5 millimeters;
  • platelet adhesion to the stripes and the formation of a parietal thrombus;
  • hyperplasia of smooth muscle cells forming the vascular wall;
  • impregnation of a blood clot with macrophages and other cells and the formation of an atherosclerotic plaque.

Initially, the plaque does not disturb the blood flow, because it grows in the thickness of the vascular wall, that is, outside the lumen. However, then it begins to grow inside the lumen, gradually narrowing the vessel. As a result, blood flow in the vessels decreases until it stops completely (at the moment when the plaque completely fills the lumen of the vessel).

Reduced blood flow leads to the fact that the organ to which this vessel goes, stops supplying blood. The decrease or complete cessation of blood supply to the body is called ischemia. The most acute ischemia passes in the heart. The arteries of the heart are very small, so their blockage by an atherosclerotic plaque develops rapidly. Complete obstruction of the coronary arteries can lead to a heart attack.

In the structure of atherosclerotic plaque, the core and the tire are isolated. The core of the plaque consists of cholesterol crystals and its esters. The plaque tire is represented by muscle cells and connective tissue. Subsequently, calcium salts may be deposited in the plaque.

Further development of the atherosclerotic process can lead to the formation of a “complicated plaque”. At this stage, there is an increase in the volume of the plaque core (i.e. its fatty part) and destruction of the tire. Through the defect formed in the tire, the contents of the plaque fall into the lumen of the vessel. This can cause embolism and blockage of blood vessels.

Stage Atherosclerosis

The clinical and anatomical and pathological stages of atherosclerosis are distinguished. The clinical stages describe the stages of atherosclerosis in terms of the main symptoms.

The clinical stages of atherosclerosis are:

  • Asymptomatic stage – characterized by the absence of specific complaints from the patient and narrowing of the lumen of the vessel to 50 – 70 percent. Even when the lumen of the vessel is narrowed by half (50 percent), the patient may have no complaints. Despite the fact that there are already changes on the inner wall of the arteries, they do not give clinical manifestations. This stage lasts for many years, and its duration is determined by the presence of risk factors in the patient. It is possible to identify the asymptomatic stage only when conducting specialized studies, for example, dopplerography.
  • Stage of clinical manifestations – characterized by the appearance of specific complaints from the patient. This stage occurs when the lumen of the vessel narrows by 70 percent or more. At this stage, the atherosclerotic process becomes irreversible, and treatment is carried out to prevent the development of complications.

Anatomical and pathological stages evaluate atherosclerosis at the level of changes in the vascular wall.

Anatomical and pathological stages are:

  • dolipid stage – characterized by damage to the epithelium of the vascular wall;
  • stage of lipoidosis – characterized by the penetration of lipids into the vascular wall and the formation of lipid spots;
  • stage of atheromatosis – characterized by the formation of an atherosclerotic plaque that protrudes into the lumen of the vessel;
  • stage of complicated plaque – in which the plaque ruptures and its contents exit into the bloodstream, which often leads to blockage of the vessel;
  • stage of sclerosis (if it did not break) – in which there is an overgrowth of connective tissue in the plaque, as a result of which it becomes denser;
  • stage of calcification – deposition of calcium salts in the plaque.

To determine the likelihood of developing pathology, a special test with questions was developed. Each positive answer is equal to one point.

  1. You are female, over fifty years old.
  2. You are male, over the age of forty-five.
  3. You are overweight.
  4. Hereditary predisposition factor: Atherosclerosis was previously diagnosed in your close relatives.
  5. Constant exposure to stress for several months.
  6. Sedentary lifestyle.
  7. Smoking.
  8. Drinking alcohol more than twice a week.
  9. Diet: A regular meal that contains high levels of fat.
  10. The sudden leaps of hell.
  11. Hypertension.
  12. Trouble sleeping.
  13. The presence of diabetes.
  14. Frequent damage to the body by diseases of an infectious nature.
  15. Painful sensations in the lower extremities that occur after physical exertion.
  16. Fatigue of legs while walking, running.
  17. Blood pressure depends on weather conditions.
  18. Irregular food system: snacks, eating at places of public catering.
  19. Irregular work schedule: lack of days off, rest, defective sleep.
  20. Frequent consumption of food (from several times a week) with a high content of cholesterol.

Results calculator. All positive answers must be summarized. According to the table, a score of zero indicates that there is no risk of the disease in the next few years.

With a result of one to two points, there are average chances of getting sick. Three to five – they increase.

Also, the data obtained may indicate that the risk of developing heart disease is about thirty percent. If the answers exceed five points, the likelihood of an ailment is very high. In such cases, you should contact a specialist for examination.

The insidiousness of this disease, firstly, is that it develops asymptomatically for a long time and may not give a clinical picture for more than ten years, and secondly, it is practically not diagnosed in the early stages.

Clinical symptoms begin to appear only when overgrown atherosclerotic plaques overlap more than half of the lumen of the vessel and cause hypoxia. Diagnosis of early atherosclerosis is possible only with the help of special screening.

However, there is a fairly simple way to find out about the risks of developing this disease – determining the atherogenic coefficient (the higher it is, the greater the risk of developing the disease). The atherogenic coefficient is the ratio of the so-called “bad” cholesterol to “good”.

1. Disposable

These include factors that directly depend on the will of a person, therefore, they can be eliminated by abandoning bad habits:

  • Food with a lot of animal food: lard, pork, eggs, poultry skin, etc. Such a diet acts as a catalyst for the development of this vascular pathology.
  • Smoking The main enemies of arterial vessels in this situation are tar and nicotine. These substances can provoke jumps in blood pressure, hyperlipidemia, coronary heart disease.
  • Sedentary lifestyle. It leads to the formation of excess weight, the appearance of diabetes mellitus, vascular atherosclerosis.

2. Fatal

Initial signs and typical symptoms of atherosclerosis – do not miss the disease!

The symptoms of this ailment are determined by the localization of the atherosclerotic plaque.

The most common and dangerous type of atherosclerosis. The main object of damage is the vessels of the heart.

Among the most common symptoms, the following are distinguished:

  1. Sternal sudden pains that give to the left hand. They stop with nitroglycerin, which is placed under the tongue of the patient.
  2. Failures in the heart rhythm.
  3. Swelling of the skin.
  4. Increased blood pressure.
  5. Bouts of suffocation.

Complete blockage of the coronary artery can lead to myocardial infarction. In this case, the patient experiences severe chest pain, which extends to the left shoulder, lack of air, cold sweat.

Taking nitroglycerin does not give a positive effect.

The degenerative process is concentrated in the vessels that feed the brain and ensure its functioning. This group also includes carotid arteries.

Initial signs and typical symptoms of atherosclerosis – do not miss the disease!

Clinical manifestations may be different. It depends on the location of the affected areas, size and stage of formation. Symptoms are often absent due to the preservation of the integrity of the plaques. In many cases, they do not burst and remain in one place. Patients may indicate painful sensations of varying degrees of intensity, which intensify after physical exertion. This often indicates that the plaque is increasing in size, and it can reduce blood flow.

The likelihood of coronary heart disease increases against the background of decomposition of the growth. Its individual elements begin to migrate, and in the destroyed area, trobms form in the area of ​​the coronary and cerebral vessels.

This process can lead to negative irreversible consequences – a stroke or a heart attack (multifocal atherosclerosis often contributes to their development). Among the main symptoms indicating a devastating effect of pathology in the abdominal aorta, there are:

  • pain in the abdomen;
  • damage to the lower extremities. It is accompanied by a feeling of numbness, cold, redness, periodic lameness may be observed;
  • problems with appetite;
  • sharp weight loss;
  • puffiness

A common clinical picture is a violation of sexual functions. Male representatives have impotence, women have infertility.

When plaques occur in the vascular system of the lower extremities in the initial stages, there are no visible symptoms. Pain syndrome often manifests itself only against the background of serious disturbances in blood circulation. Its intensity increases during movement.

The muscle structure does not receive enough oxygen and nutrients, which often leads to such consequences:

  • the appearance of lameness;
  • the formation of trophic ulcers;
  • changes in skin tone (it becomes much paler, sometimes cyanotic);
  • the development of obliterating atherosclerosis.

Patients often lose hair on their legs, nails come in poor condition. As the disease progresses, the pulsation periodically disappears in the knees, hips, and other areas that are close to the arteries.

The growths in the carotid artery also for a long time do not show any signs of their existence. This condition, which causes serious complications, is extremely dangerous for the patient. It can only be prevented if you see a doctor in a timely manner. A person is periodically subjected to ischemic attacks, he has sudden problems with speech (for example, confusion), a feeling of numbness in one arm or leg, impaired visual function in the right or left eye.

If the plaques are localized in the thoracic region, the patient is concerned about severe pain of varying durations (often they last for several days). After some time, patients indicate signs characteristic of heart failure, shortness of breath. Upper blood pressure may also increase.

Such symptoms are accompanied by headaches, dizziness, memory problems, a feeling of constant fatigue, drowsiness. The skin becomes pale.

With the formation of atherosclerotic plaques in the vessels of the brain in a person, the psyche is disturbed. As the disease progresses, it can behave inappropriately even in ordinary situations, it becomes more nervous, irritable. His mood often changes.

At the initial stage, disability decreases markedly, memory worsens, depression may develop. The second stage is accompanied by more pronounced symptoms: anxiety, short temper, hypochondria. Then there are signs characteristic of dementia (due to exposure to both exogenous and endogenous factors). The connection with reality is lost, visual functions worsen, strokes can occur.


Modern diagnostic methods include conducting biochemistry, passing general blood tests, urine tests, instrumental examinations. The process of determining the disease can be very difficult. This is due to the fact that a number of symptoms are characteristic of the disease, which are often similar to signs of other pathologies.

The doctor conducts a full examination of the patient, examines his history to determine risk factors, sends him to a biochemical blood test to establish the exact level of cholesterol (according to the formula, the normal total cholesterol is from three to six mmol/l), a coagulogram is performed to assess coagulability.

Instrumental studies (for example, ultrasound) provide an opportunity to study the structural features of blood vessels, determine the location of growths. If aortic atherosclerosis is suspected, an X-ray examination is performed.

Atherosclerosis treatment.

It is necessary to begin treatment with smoking cessation, alcohol, start an active lifestyle, maintain psychological comfort, reduce body weight if there is obesity.

Compliance with a diet, which implies the rejection of products containing saturated fatty acids: solid fats, eggs, animal meat, chocolate, condensed milk, sausages, fried potatoes, ice cream. It is necessary to include in your food products that contain a large amount of polyunsaturated fatty acids: fish, seafood; and foods containing fiber and complex carbohydrates: vegetables, fruits, cereals, cereals.

-GMGKoAreductuzy inhibitors (statins)

– Inhibitors of cholesterol absorption in the intestine

– w-3 polyunsaturated fatty acids

– In vitro treatment methods.

  1. Statins are the most effective in the treatment of atherosclerosis.

This is largely due to the stabilization effect of the atherosclerotic plaque tire characteristic of statins only. In this regard, in the treatment of atherosclerosis, other drugs are used mainly when it is impossible to use statins or in combination with them.

statins inhibit -hydroxy–methylglutaryl-coenzyme-A-reductase, an enzyme directly involved in the synthesis of cholesterol in the liver cell. In addition, statins have pleiotropic properties, affecting a number of processes unrelated to their lipid-lowering activity.

In high doses, these drugs reduce the level of CRP, inhibit platelet aggregation and proliferative activity of smooth muscle cells of the vascular wall. As a result of this, when statins are used, a significant decrease in new damage to the vascular endothelium is recorded, the rate of development of stenosis and the number of complications due to rupture of the plaque are significantly reduced.

Simvastatin (Zokor, vasilip, simvastol) – 5-80 mg 1 time per day.

Fluvastatin (Leskol) – 20-80 mg 1 time per day.

Atorvastatin (lypimar, atoris) – 10-80 mg once a day.

Rosuvastatin (cross, mertenyl) – 10-40 mg 1 time per day.

As a rule, statins are prescribed once during the evening intake, since the synthesis of cholesterol occurs most intensively at night. It is recommended to start therapy with the minimum dose of the drug, gradually titrating it to the optimal one, which allows reaching the target level of LDL cholesterol (less than 3 mmol/l in the population and less than 2,5 mmol/l in patients with coronary artery disease). Statin therapy can reduce LDL cholesterol by 20-60%, TG – by 8-15% and increase HDL cholesterol by 5-15%.

  1. Ezithymibe (ezitrol) is a drug that inhibits the absorption of cholesterol in the intestine.

This drug in the villous epithelium of the small intestine combines with glucuronic acid, blocking the absorption of cholesterol. Ezithymibe monotherapy causes a decrease in plasma cholesterol by no more than 15-20%. However, its combination with statins significantly increases the hypocholesterolemic effect as a result of inhibition of two processes – cholesterol synthesis in the liver and cholesterol absorption in the intestine.

  1. Nicotinic acid (niaspan, enduracin) – reduces the synthesis of VLDL in the liver, due to the suppression of the synthesis of apoprotein B-100.

Niaspan is used in an initial dose of 250 mg 3 times a day, the maximum daily dose of 2 g.

gemfibrozil – 600 mg 2 times a day, fenofibrate 200 mg 1 time per day.

Causes and risk factors for atherosclerosis


The exact causes of atherosclerosis are still the subject of controversy among doctors. However, we can confidently name a number of factors that increase the risk of developing atherosclerosis. They are divided into three groups – biological, physiological and behavioral.


Biological factors are due to the characteristics of the body, which cannot be changed. These include:

  1. Genetic predisposition: it means not only a predisposition to atherosclerosis itself, but also to the diseases that provoke its development – diabetes mellitus, hypertension, hyperlipidemia (high blood lipids) and some others.
  2. Hormonal background. It has been proven that the “female” hormone estrogen significantly reduces the risk of developing atherosclerosis, as it increases the level of HDL that captures “bad” cholesterol. Therefore, the risk of developing atherosclerosis is especially high for men, as well as women in the postmenopausal period.
  3. Age. Age-related changes in the body (in particular, in the liver) increase the risk of atherosclerosis for people over 40 years of age.


Physiological factors include those that are caused by the characteristics of the body, but can be adjusted, and sometimes completely eliminated. These include:

All these conditions can be corrected with medication.

  • Obesity.
  • Violation of carbohydrate metabolism in the body. Such disorders include not only diabetes mellitus (which is an extreme form), but also chronic impaired glucose uptake by tissues. These conditions are corrected by medication, changes in eating habits, and regular monitoring of blood sugar levels.
  • A large number of stressful situations and an overly emotional reaction to them. This factor is classified as physiological, since the type of reaction to stress depends on the structure of the nervous system and some biochemical characteristics of the body.

    This risk factor can be reduced not only by the development of certain patterns of behavior, but also by special therapy aimed at strengthening the nervous system and stabilizing the hormonal background.


    Causes of atherosclerosis – all factors affecting the development of pathology, and atherosclerosis risk groups

    2. Fatal

    • Gender In the male part of the population, atherosclerosis makes itself felt ten years earlier and occurs 3-4 times more often than in women. In women, this disease begins to manifest itself actively after 50 years, which is associated with the onset of menopause. Menopause affects the amount of estrogen in the blood, and is also negatively displayed on the body’s defenses.
    • Age. According to statistics, this pathology is often diagnosed in people after 40 years of age.
    • Genetic history. According to medical practice, the early development of atherosclerosis is facilitated by the moment that one of the patient’s closest relatives had this disease in the history of the disease. If pathology first made itself felt after 50 years, then its development, as a rule, is not associated with hereditary factors.

    This category is represented by chronic disorders that can be corrected with the help of therapeutic measures:

    • Infection of the body, its poisoning. Toxic agents, as well as harmful microorganisms, cause atherosclerotic transformations in the vascular walls.
    • Diabetes. Malfunctions in lipid metabolism. In individuals with these pathological conditions, the risk of developing the vascular pathology in question increases 6 times. A fatal outcome from atherosclerosis in diabetics occurs 2 times more often than in those who do not suffer from diabetes. In addition, absolutely any group of vessels can undergo degenerative processes. But most often the arteries of the brain, heart, lower limbs suffer.
    • Excess body weight.
    • Arterial hypertension. This condition contributes to the enhanced promotion of cholesterol components in the intima, which may cause the formation of atherosclerotic plaque in the future. On the other hand, atherosclerosis affects blood pressure.
    • Increased cholesterol, lipoprotein, triglyceride in the blood. The underlying cause of the development of the disease in question.

    Knowledge of these factors will make it possible to minimize the risk of developing atherosclerosis.

    Prevention of disease

    Prevention measures are aimed at eliminating risk factors that contribute to the development of the disease. Doctors advise you to choose a balanced diet for yourself, refuse ready-made fast foods and other foods that contain high cholesterol, do regular physical exercises. Guiding these simple rules will help minimize the risks of developing pathology.

    Secondary prevention includes the treatment of ailments that can lead to the formation of the disease. For example, taking drugs that regulate blood pressure, drugs that prevent blood clotting.

    Atherosclerosis is a serious disease, which is very difficult and long to treat. Therefore, it is better to think about prevention in advance, especially since it is very simple. Its main tasks are to prevent an increase in the level of “bad” cholesterol, to maintain vascular tone and to correct conditions that can provoke atherosclerosis.

    It is very important to know the risk factors. To prevent the disease, you need to take measures to combat them. Prevention recommendations:

    1. Stop smoking! This will significantly reduce the risk of vessel problems.
    2. Eat more “white” meat (chicken, turkey). Veal and low-fat mutton will also be useful. But fatty beef and pork should be consumed sparingly.
    3. Include more vegetables, fruits, and fish in your diet. According to studies, in Japan and the Mediterranean countries, whose traditional cuisine is rich in seafood and herbs, the disease is practically not found.
    4. Try to fry dishes as little as possible in fat and butter – use vegetable.
    5. Get moving! Even minimal physical activity in the form of morning exercises will help you keep your vessels in good shape.
    6. If you are predisposed to type diabetes mellitus (insulin-dependent), check your blood sugar level regularly.

    Atherosclerosis, like any disease, is easier to prevent than to treat. Knowing the risk factors and following simple preventative measures will help you avoid problems, and if they already exist, reliably take them under control.

    Atherosclerosis is called the hidden killer. The formation of cholesterol plaques takes 30-40 years and is not accompanied by any symptoms. The first signs of atherosclerosis appear when the deposition reaches a large size. But at this stage, the disease can no longer be treated. Therefore, the main task of the doctor is to take timely measures to prevent the disease.

    Prevention of atherosclerosis is the exclusion of modifiable risk factors:

    • smoking cessation;
    • moderation in alcohol;
    • a healthy diet;
    • pressure level control;
    • treatment of the underlying disease: diabetes mellitus, dyslipidemia, hypothyroidism;
    • at least 30 minutes of daily physical activity.

    People, regardless of the presence of risk groups, should regularly check their cholesterol, LDL. The first blood test is taken at 9-11 years old, the second – 17-21 years, and then every 4-6 years. People with a tendency to develop atherosclerosis should be screened more often. The schedule for passing tests for them is compiled individually.

  • Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
    The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
    The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.