Treatment of Arteriosclerosis

Written by Zeng Wei Jie
Cardiology
Updated on September 09, 2024
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The treatment of arteriosclerosis includes general preventative measures, pharmacological treatment, interventional procedures, and surgical operations.

General precautions involve a balanced diet, with some patients needing to lose weight, increasing the intake of fruits and vegetables, quitting smoking and limiting alcohol consumption, and adopting a low-fat diet. Additionally, it is advised that patients engage in appropriate physical labor and sports activities, while also maintaining an optimistic and calm mindset.

Pharmacological treatment is quite specialized, mainly including lipid-lowering and antiplatelet therapies.

Then, there are cases with clear symptoms, such as renal artery stenosis or coronary artery narrowing, where interventional treatments can be considered. For those unsuitable for interventional procedures, surgical treatments, such as bypass surgery, might be considered.

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How is coronary atherosclerosis treated?

Coronary atherosclerosis is treated generally through the following three aspects: The first aspect is general preventive measures, which include four sub-aspects. First is actively controlling risk factors related to the disease, such as hypertension, hyperglycemia, hyperlipidemia, and obesity. Second is a reasonable diet, controlling the total caloric intake in the diet to reach a normal weight range, which can be simply measured using BMI, or waist circumference, with over 80 cm in females and 85 cm in males being considered overweight. Third is appropriate physical labor and sports activity. Fifth, rational arrangement of work and life, advocating quitting smoking and limiting alcohol, regular work schedules, maintaining an optimistic and pleasant mood, avoiding emotional excitement and excessive fatigue, balancing work and rest, and ensuring adequate sleep. Medicinal treatment includes five items: one is adjusting blood lipids, commonly using statin drugs; second look at antiplatelet drugs, such as aspirin and clopidogrel; third involves thrombolysis or anticoagulation, for instance, warfarin and low molecular weight heparin; fourth involves using drugs that improve myocardial remodeling and prognosis, such as valsartan and ACE inhibitors; additionally, there is treatment for ischemic symptoms, and if angina occurs, nitrate drugs like nitroglycerin can be used, as well as others like metoprolol. Lastly, the third major category is interventional and surgical procedures. If there is significant coronary artery narrowing, greater than 90%, procedures like stent placement or coronary artery bypass surgery can be performed. These three major aspects comprise the treatment of coronary atherosclerosis.

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How to check for arteriosclerosis?

Arteriosclerosis is a relatively common disease in our daily life. After being diagnosed with arteriosclerosis, the following tests should be considered: Firstly, blood tests, such as lipid panels, are necessary to determine the levels of blood lipids. Based on the results, medication might be required for treatment. Secondly, arterial Doppler ultrasound is useful as it can effectively detect the presence and severity of arteriosclerosis. Thirdly, arterial angiography is recommended when there is a strong suspicion of arterial narrowing due to arteriosclerosis, leading to coronary heart disease or other conditions. This test helps in determining the severity of the arteriosclerosis and in deciding the treatment plan.

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Arteriosclerosis is divided into several stages.

Arterial atherosclerosis sequentially manifests as three major types: lipid spots and stripes, atheromatous and fibrous atheromatous plaques, and complex lesions. According to the process of its occurrence and development, it can be subdivided into six types. The first type is lipid spots, which are small yellow spots on the arterial intima that gradually develop into the second type, lipid stripes, where some yellow stripes appear on the arterial intima. Then there is the third type, pre-lesional plaque, where more lipid droplets appear extracellularly. The fourth type is the atheromatous plaque, where lipids accumulate excessively and form lipid pools, and the intimal structure will be damaged. The fifth type is the fibrous atheromatous plaque, which is the most characteristic lesion of arterial atherosclerosis. The sixth type is a complex lesion, representing a severe condition.

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Can arteriosclerosis be cured?

Atherosclerosis can only slow down its further progression and prevent the further occurrence of conditions such as coronary heart disease, cerebral infarction, and lower limb arterial occlusion. This is because it is influenced by many factors, including both modifiable and non-modifiable risk factors. For example, modifiable factors include abnormal blood lipids, hypertension, diabetes, smoking, and overweight obesity, which we can change. However, there are also non-modifiable factors such as age, genetics, and environmental factors. As age increases, the incidence of atherosclerosis significantly rises. Its pathological changes generally begin in childhood or adolescence, with symptoms becoming more apparent as age progresses.

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The earliest lesions of arteriosclerosis

The earliest lesion of atherosclerosis is the formation of lipid spots and streaks. The so-called lipid spots are small yellow dots that appear on the arterial intima. Under pathological observation, these are small areas of macrophages containing lipid droplets, forming a cluster of foam cells. As this small yellow dot develops, it gradually turns into a yellow streak made up of layers of macrophages containing lipids. The intima also comprises smooth muscle cells and lipids, as well as an infiltration of T cells, resembling a yellow streak on the intima.