In recent years, with the increasing improvement of people’s living standards and lifestyle changes, the incidence of vascular diseases is increasing year by year. According to statistics, the current incidence rate of cardiovascular diseases in China is 0.38% to 10%. Recent statistics show that, unlike developed countries such as Europe and the United States, cardiovascular disease in our population is still rising year by year, with about 3 million people dying from cardiovascular disease each year. Among them, coronary heart disease caused by atherosclerosis, cerebral embolism, aortic coarctation, peripheral artery embolism and other diseases have gradually occupied the main cause of death. The current view on the prevention and treatment of atherosclerosis is that it should be prevented before it happens, with emphasis on lifestyle changes and daily health care, and active diagnosis and treatment of diseases related to atherosclerosis that have already occurred.
What are arteries and what are veins?
The human circulatory system (cardiovascular system) consists of arteries, small arteries, capillaries, small veins and venules, which are responsible for transporting blood and maintaining the blood supply to the organs of the body. In layman’s terms, the blood vessels in the body that supply blood to the heart and brain are called the central vasculature, while the rest of the blood vessels are called the peripheral vasculature. Because the extremities are located in the periphery of the body, some people simply call the blood vessels that supply blood to the extremities peripheral blood vessels. There are arteries and veins in the blood vessels. The arteries carry blood with higher oxygen content through the pulmonary circulation to the whole body and maintain the blood supply to the organs of the body. After the organs and tissues have used the oxygenated blood, it flows back into the veins through capillaries, so the blood in the veins is relatively less oxygenated, and the veins flow back into the heart, then through the pulmonary circulation, and pump again through the heart into the arteries to start a new cycle.
Arteries and veins differ in their anatomical structure, location and shape because of their different functions. The arteries have thicker walls, more developed smooth muscle, more elastic fibers, rounded lumen sections, diastolic and somewhat elastic, and can beat significantly with the contraction of the heart and the high and low blood pressure. Therefore, the pulse is usually spoken of, i.e., obtained by touching the fluctuating arteries in the forearm, dorsum of the foot, thigh, N fossa, and neck, etc. We can also assess the frequency of the heartbeat by the number of arterial beats. Veins have thin walls, few smooth muscle and elastic fibers, lack of contractility and elasticity, and flat lumen sections. Superficial veins can be visually observed, such as the saphenous vein and jugular vein. Normally, the veins are usually used for infusion of fluids and medication.
What is atherosclerosis?
Atherosclerosis, also known as atherosclerosis, is one of the most common types of vascular disease. As the name implies, atherosclerosis has the following characteristics: 1. It occurs in arteries but not in veins, which is related to the different tissue structure of arteries and veins; 2. This leads to ischemia and necrosis in the tissues and organs fed by the diseased vessels.
Atherosclerosis can occur in all blood vessels of the body, from large blood vessels to peripheral blood vessels, from coronary arteries that feed the heart to corresponding arteries that feed the brain, kidneys and other organs. The incidence of atherosclerosis is now increasing year by year, and the age of onset is gradually getting younger, and there are data showing that 77% of people aged 50 to 60 have varying degrees of atherosclerosis, and the proportion of elderly people aged 60 to 70 has increased to 87%, while the incidence of atherosclerosis among elderly people aged 70 and above has actually reached 100%.
The occurrence of atherosclerosis is related to many factors, and studies now show that an unhealthy lifestyle is a very important cause of atherosclerosis. Smoking, alcohol consumption, advanced age, obesity, men and post-menopausal women, uncontrolled hypertension, stressful and high stress life rhythm, diabetes, high salt and high fat diet, and lack of exercise are the main manifestations of an unhealthy lifestyle and have been proven to be the main factors leading to atherosclerosis. These factors all lead to damage to the arterial lining, which activates a series of inflammatory reactions in the body, causing lipid-rich substances to accumulate at the site of the damaged lining and gradually build up, becoming irreversible “atheromatous” plaques and causing luminal narrowing.
What are the risks of atherosclerosis?
When atherosclerosis develops, it will affect the tissues and organs fed by the diseased vessels and cause certain clinical symptoms. If the coronary arteries that feed the heart become sclerotic, it leads to the common coronary heart disease, which causes symptoms of pain in the precordial region. The severity of symptoms is related to the degree of stenosis of the lumen. If the stenosis reaches 75% or more, angina pectoris, myocardial infarction, arrhythmia, and even sudden death can occur. The clinical onset is aggressive and severe myocardial infarction is often the first diagnosed symptom.
Currently, there are two types of treatment for coronary artery disease: medical intervention and surgical bypass surgery. Interventional treatment involves delivering a stent through a peripheral artery to the narrowed coronary artery to open it up and restore unobstructed blood flow. Interventional treatment is less invasive, less risky, and currently has a higher success rate. However, interventional treatment is limited by the location and number of diseased vessels, and stenting is not effective if the diseased vessels are difficult to open with stents, or if the diseased vessels are numerous and show diffuse lesions.
Surgical bypass therapy is figuratively understood as building a vascular bridge from the site of good blood supply to the distal end of the blocked vessel flow. Although surgical procedures are more invasive and have certain postoperative complications, surgical treatment can achieve better results than medical interventions, and the long-term rate of vessel reocclusion is lower than that after stent implantation. Currently, coronary artery bypass grafting (i.e., bypass surgery) is routinely performed in our department, and the success rate of the procedure has reached international standards, and we can successfully treat critical cases such as ventricular septal perforation after heart attack.
If atherosclerosis occurs in a large vessel, i.e., the aorta, in the long run, ulceration or even tearing of the atherosclerotic site can cause aortic coarctation, a critical and serious disease. In patients with aortic coarctation, the blood flow in the artery is shunted into the torn endothelial rupture, resulting in an obvious true and false lumen in the aorta, and the increase in the inner diameter of the false lumen leads to a significant decrease in blood flow in the true lumen, further leading to a lack of blood supply to the organs of the body. Once the vessel ruptures or is on the verge of rupture, the condition is very critical and can only be treated by emergency surgery. However, aortic coarctation surgery is also known as the most complicated, difficult and risky surgery in cardiothoracic surgery, which not only has high mortality rate and low success rate, but also only a few cardiac centers in China can carry out such surgery.
In recent years, the Cardiothoracic Surgery Department of Gulou Hospital has accumulated rich clinical experience in the treatment of aortic coarctation, and has formed an excellent cardiac surgery team including surgery, anesthesia, extracorporeal circulation perfusion and postoperative monitoring, and has successfully performed surgical procedures for more than 200 patients with aortic coarctation, with a success rate far exceeding international standards.
If atherosclerosis occurs in the blood vessels supplying the brain, the dislodged plaque and narrowed lumen can cause cerebrovascular embolism, which can further develop into cerebral ischemia and cerebral infarction, which is also a common clinical emergency. If atherosclerosis occurs in the arteries that feed the liver, kidneys and other organs, it will cause insufficient blood supply to the liver, kidneys and other organs, or even necrosis. The same is true for peripheral arteries, such as the common lower limb ulcers caused by lower limb atherosclerosis and retinal atherosclerosis.
How to prevent and treat atherosclerosis?
At present, the prevention and treatment of atherosclerosis mainly lies in “tertiary prevention”. First of all, we should actively prevent the occurrence of atherosclerosis (primary prevention), that is, good lifestyle, such as low salt and low fat diet, quit smoking and limit alcohol, weight control, exercise, etc. Lifestyle changes are the most critical step in the prevention of atherosclerosis, which is also the most easily achieved prevention means in people’s daily life. In addition, patients suffering from chronic diseases such as hypertension and diabetes should strictly control blood pressure and blood sugar under the guidance of doctors, and people with high blood lipid levels detected in physical examinations should also actively adjust their diets and take oral lipid-lowering medication if necessary.
If you already have atherosclerotic diseases such as coronary heart disease, you should prevent the development of the disease and strive for its reversal (secondary prevention). The most common daily medications for patients with coronary artery disease, such as aspirin, Lipitor, and Poliovel, are anti-platelet and lipid-regulating treatments for atherosclerosis. Current studies have shown that elderly people at high risk of atherosclerosis can take small doses of aspirin daily for preventive anticoagulation in the absence of digestive discomfort; at the same time, the effects of lipid-regulating drugs such as Lipitor are not only lipid-regulating, but their cardiovascular protective and regulating effects have also been widely confirmed. However, drugs are toxic in three parts, and in the process of taking drugs for control, one should listen to the doctor’s advice and regularly observe the blood biochemistry and other indicators after taking the drugs to prevent the toxic effects of the drugs.
Those who have developed complications (i.e., patients with heart, kidney, and cerebrovascular diseases) should be treated promptly to prevent their deterioration and prolong the patient’s life (tertiary prevention). Currently, the role and place of rehabilitation and health care in medical activities is being further strengthened, precisely thanks to the attention paid to the patient’s state of life after disease treatment. Appropriate health care physical therapy and exercise can effectively restore the mobility of patients with complications and effectively improve the quality of life.
In general, the prevention and treatment of atherosclerosis should focus on lifestyle changes, strengthening health awareness and actively preventing and treating the disease before it occurs.