Arteriosclerotic Cardiovascular Disease
Disease Details
Family Health Simplified
- Description
- Arteriosclerotic cardiovascular disease (ASCVD) is a condition characterized by the thickening and hardening of the arterial walls due to the buildup of plaque, which can lead to reduced blood flow and an increased risk of heart attack and stroke.
- Type
- Arteriosclerotic cardiovascular disease (ASCVD) is not primarily a single-gene genetic disorder. Instead, it is a multifactorial disease influenced by a combination of genetic predisposition and environmental factors such as diet, exercise, smoking, and other lifestyle choices. Certain genetic variants can increase susceptibility, but the condition itself does not follow a simple pattern of genetic transmission like Mendelian inheritance.
- Signs And Symptoms
- Atherosclerosis is asymptomatic for decades because the arteries enlarge at all plaque locations, thus there is no effect on blood flow. Even most plaque ruptures do not produce symptoms until enough narrowing or closure of an artery, due to clots, occurs. Signs and symptoms only occur after severe narrowing or closure impedes blood flow to different organs enough to induce symptoms. Most of the time, patients realize that they have the disease only when they experience other cardiovascular disorders such as stroke or heart attack. These symptoms, however, still vary depending on which artery or organ is affected.Early atherosclerotic processes likely begin in childhood. Fibrous and gelatinous lesions have been observed in the coronary arteries of children. Fatty streaks have been observed in the coronary arteries of juveniles.While coronary artery disease is more prevalent in men than women, atherosclerosis of the cerebral arteries and strokes equally affect both sexes.Marked narrowing in the coronary arteries, which are responsible for bringing oxygenated blood to the heart, can produce symptoms such as chest pain of angina and shortness of breath, sweating, nausea, dizziness or lightheadedness, breathlessness or palpitations. Abnormal heart rhythms called arrhythmias—the heart beating either too slowly or too quickly—are another consequence of ischemia.Carotid arteries supply blood to the brain and neck. Marked narrowing of the carotid arteries can present with symptoms such as: a feeling of weakness; being unable to think straight; difficulty speaking; dizziness; difficulty in walking or standing up straight; blurred vision; numbness of the face, arms and legs; severe headache; and loss of consciousness. These symptoms are also related to stroke (death of brain cells). Stroke is caused by marked narrowing or closure of arteries going to the brain; lack of adequate blood supply leads to the death of the cells of the affected tissue.Peripheral arteries, which supply blood to the legs, arms and pelvis, also experience marked narrowing due to plaque rupture and clots. Symptoms of the narrowing are numbness within the arms or legs, as well as pain. Another significant location for plaque formation is the renal arteries, which supply blood to the kidneys. Plaque occurrence and accumulation lead to decreased kidney blood flow and chronic kidney disease, which, like in all other areas, is typically asymptomatic until late stages.In 2004, US data indicated that in ~66% of men and ~47% of women, the first symptom of atherosclerotic cardiovascular disease was a heart attack or sudden cardiac death (defined as death within one hour of onset of the symptom).Case studies have included autopsies of U.S. soldiers killed in World War II and the Korean War. A much-cited report involved the autopsies of 300 U.S. soldiers killed in Korea. Although the average age of the men was 22.1 years, 77.3 percent had "gross evidence of coronary arteriosclerosis".
- Prognosis
- Arteriosclerotic cardiovascular disease (ASCVD) prognosis varies depending on several factors, including the extent of arterial blockages, the presence of risk factors like hypertension, diabetes, smoking, and lifestyle choices. Early diagnosis and effective management, including medications, lifestyle changes, and possibly surgical interventions, can improve outcomes. However, severe cases with significant arterial damage may have a poorer prognosis, potentially leading to complications such as heart attacks, strokes, or cardiovascular mortality. Regular follow-up and adherence to treatment plans are crucial for improving long-term prognosis.
- Onset
- Arteriosclerotic cardiovascular disease (ASCVD) typically develops gradually over many years. The onset can be influenced by multiple factors, including age, genetics, lifestyle, and the presence of other conditions like hypertension, diabetes, and high cholesterol. The disease may remain asymptomatic for a long time before symptoms such as chest pain, shortness of breath, or other cardiovascular events occur.
- Prevalence
- Arteriosclerotic cardiovascular disease (ASCVD), also known as atherosclerotic cardiovascular disease, involves the thickening and hardening of the arterial walls due to plaque buildup. The prevalence of ASCVD varies by region and population but is a leading cause of death worldwide, particularly in developed countries. In the United States, approximately 50% of adults have some form of cardiovascular disease, with a significant portion attributable to ASCVD.
- Epidemiology
- Cardiovascular disease, which is predominantly the clinical manifestation of atherosclerosis, is one of the leading causes of death worldwide.Almost all children older than age 10 in developed countries have aortic fatty streaks, with coronary fatty streaks beginning in adolescence.In 1953, a study was published which examined the results of 300 autopsies performed on U.S. soldiers who had died in the Korean War. Despite the average age of the soldiers being just 22 years old, 77% of them had visible signs of coronary atherosclerosis. This study showed that heart disease could affect people at a younger age and was not just a problem for older individuals.In 1992, a report had shown that microscopic fatty streaks were seen in the left anterior descending artery in over 50% of children aged 10–14 and 8% had even more advanced lesions with more accumulations of extracellular lipid.In a 2005 report of a study done between 1985 and 1995, it was found that around 87% of aortas and 30% of coronary arteries in age group 5–14 years had fatty streaks which increased with age.
- Intractability
- Arteriosclerotic cardiovascular disease (ASCVD) is not inherently intractable, but it is a chronic condition that requires long-term management. While it cannot be completely cured, its progression can often be slowed or stabilized through lifestyle changes, medications, and, in some cases, surgical interventions. Effective management includes controlling risk factors such as hypertension, high cholesterol, and diabetes, as well as adopting a healthy diet, regular exercise, and smoking cessation.
- Disease Severity
- Arteriosclerotic cardiovascular disease (ASCVD) refers to the thickening and hardening of the arterial walls due to the accumulation of cholesterol and fatty deposits, which can lead to reduced blood flow. The severity of ASCVD can vary widely, ranging from asymptomatic in the early stages to severe complications such as heart attacks, stroke, and peripheral artery disease in advanced stages. The disease severity is influenced by factors such as the extent of arterial blockage, the number of affected arteries, and the presence of other risk factors like high blood pressure, diabetes, and smoking.
- Healthcare Professionals
- Disease Ontology ID - DOID:2348
- Pathophysiology
- Atherogenesis is the developmental process of atheromatous plaques. It is characterized by a remodeling of arteries leading to subendothelial accumulation of fatty substances called plaques. The buildup of an atheromatous plaque is a slow process, developed over a period of several years through a complex series of cellular events occurring within the arterial wall and in response to a variety of local vascular circulating factors. One recent hypothesis suggests that, for unknown reasons, leukocytes, such as monocytes or basophils, begin to attack the endothelium of the artery lumen in cardiac muscle. The ensuing inflammation leads to the formation of atheromatous plaques in the arterial tunica intima, a region of the vessel wall located between the endothelium and the tunica media. The bulk of these lesions is made of excess fat, collagen, and elastin. At first, as the plaques grow, only wall thickening occurs without any narrowing. Stenosis is a late event, which may never occur and is often the result of repeated plaque rupture and healing responses, not just the atherosclerotic process by itself.
- Carrier Status
- Arteriosclerotic cardiovascular disease (ASCVD) does not have a "carrier status" as it is not a genetic disorder. Instead, ASCVD develops due to a combination of factors including lifestyle choices, age, and other health conditions. It's characterized by the hardening and narrowing of the arteries from plaque buildup.
- Mechanism
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Arteriosclerotic cardiovascular disease (ASCVD) refers to conditions characterized by the thickening and hardening of arterial walls due to the buildup of atherosclerotic plaques.
***Mechanism:***
1. **Endothelial Injury**: Damage to the endothelial layer of arteries, caused by factors like hypertension, smoking, or high cholesterol.
2. **Lipid Accumulation**: Low-density lipoprotein (LDL) cholesterol infiltrates the damaged endothelium and accumulates in the arterial wall.
3. **Inflammatory Response**: The immune system responds to the lipid accumulation by sending macrophages to engulf LDL particles, forming foam cells.
4. **Plaque Formation**: Persistent lipid and inflammatory cell accumulation form atherosclerotic plaques.
5. **Fibrous Cap**: Over time, smooth muscle cells proliferate and form a fibrous cap over plaques.
6. **Plaque Rupture and Thrombosis**: Plaque can rupture, causing thrombus (blood clot) formation, which can obstruct blood flow.
***Molecular Mechanisms:***
1. **Oxidative Stress**: Reactive oxygen species (ROS) oxidize LDL, making it more likely to be taken up by macrophages.
2. **Inflammatory Signaling Pathways**: Activation of nuclear factor-kappa B (NF-κB) and other pathways leads to the release of pro-inflammatory cytokines and recruitment of more immune cells.
3. **Endothelial Dysfunction**: Reduced nitric oxide (NO) production impairs vasodilation and increases vascular permeability.
4. **Macrophage Activation**: Macrophages internalize oxidized LDL through scavenger receptors, transforming into foam cells.
5. **Smooth Muscle Cell Migration and Proliferation**: Mediated by growth factors like platelet-derived growth factor (PDGF), contributing to plaque stability.
6. **Apoptosis and Necrosis**: Cell death within plaques can create a necrotic core, increasing plaque vulnerability to rupture.
7. **Extracellular Matrix Remodeling**: Matrix metalloproteinases (MMPs) degrade collagen, weakening the fibrous cap and contributing to plaque rupture.
Understanding these mechanisms is critical for developing strategies to prevent and treat ASCVD. - Treatment
- Treatment of established disease may include medications to lower cholesterol such as statins, blood pressure medication, or medications that decrease clotting, such as aspirin. A number of procedures may also be carried out such as percutaneous coronary intervention, coronary artery bypass graft, or carotid endarterectomy.Medical treatments often focus on alleviating symptoms. However measures which focus on decreasing underlying atherosclerosis—as opposed to simply treating symptoms—are more effective. Non-pharmaceutical means are usually the first method of treatment, such as stopping smoking and practicing regular exercise. If these methods do not work, medicines are usually the next step in treating cardiovascular diseases and, with improvements, have increasingly become the most effective method over the long term.The key to the more effective approaches is to combine multiple different treatment strategies. In addition, for those approaches, such as lipoprotein transport behaviors, which have been shown to produce the most success, adopting more aggressive combination treatment strategies taken on a daily basis and indefinitely has generally produced better results, both before and especially after people are symptomatic.
- Compassionate Use Treatment
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Arteriosclerotic cardiovascular disease (ASCVD) primarily involves the narrowing and hardening of the arteries due to plaque buildup. Compassionate use treatment, off-label, or experimental treatments for ASCVD may include:
1. **PCSK9 Inhibitors**: Originally approved for lowering LDL cholesterol, these drugs can be used in cases where traditional treatments are ineffective.
2. **Bempedoic Acid**: Recently approved for cholesterol management in patients who are unable to tolerate statins. Off-label use in ASCVD under compassionate grounds may be considered.
3. **Gene Therapy**: Experimental gene editing techniques, such as CRISPR, are being explored to directly target and rectify genetic factors contributing to ASCVD.
4. **Stem Cell Therapy**: Experimental approaches using stem cells aim to repair damaged heart tissues and improve heart function in patients with advanced disease.
5. **Anti-Inflammatory Therapies**: Investigational drugs targeting inflammation, which plays a role in plaque formation, are being explored in clinical trials.
6. **Antisense Oligonucleotides**: These experimental treatments aim to interfere with specific RNA molecules involved in plaque formation and cholesterol metabolism.
It's essential for patients to consult with a healthcare provider to weigh the potential risks and benefits of such treatments. - Lifestyle Recommendations
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For arteriosclerotic cardiovascular disease (ASCVD), lifestyle recommendations include:
1. **Healthy Diet**:
- Emphasize fruits, vegetables, whole grains, lean proteins, and healthy fats.
- Limit saturated fats, trans fats, cholesterol, sodium, and added sugars.
2. **Regular Physical Activity**:
- Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.
- Include muscle-strengthening activities on 2 or more days per week.
3. **Weight Management**:
- Maintain a healthy weight or work towards a 5-10% reduction in body weight if overweight or obese.
4. **Smoking Cessation**:
- Avoid tobacco products and seek programs or medications to support quitting if necessary.
5. **Limit Alcohol Intake**:
- Consume alcohol in moderation (up to one drink per day for women, up to two drinks per day for men).
6. **Stress Management**:
- Practice stress-relieving techniques such as mindfulness, meditation, or yoga.
7. **Regular Health Check-Ups**:
- Monitor blood pressure, cholesterol levels, blood glucose, and other relevant health metrics regularly.
8. **Medication Adherence**:
- Take prescribed medications consistently and as directed by healthcare providers.
These lifestyle changes can significantly reduce the risk and progression of ASCVD. - Medication
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The primary medications for managing arteriosclerotic cardiovascular disease (ASCVD) often include:
1. **Statins**: Used to lower cholesterol levels and reduce the risk of plaque buildup in arteries.
2. **Antiplatelet agents**: Such as aspirin or clopidogrel to prevent blood clots.
3. **Beta-blockers**: To manage blood pressure and reduce the heart's workload.
4. **ACE inhibitors or ARBs**: To lower blood pressure and reduce strain on the heart.
5. **Calcium channel blockers**: To relax and widen blood vessels, improving blood flow.
6. **Diuretics**: To decrease fluid retention and lower blood pressure.
These medications are often tailored to the individual's specific condition and risk factors. Always consult a healthcare provider for personalized treatment plans. - Repurposable Drugs
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Arteriosclerotic cardiovascular disease (ASCVD) refers to the thickening and hardening of arterial walls due to the accumulation of plaque, leading to narrowed and stiffened arteries. Potential repurposable drugs for ASCVD include:
1. **Statins (e.g., atorvastatin, simvastatin):** Originally developed to lower cholesterol levels, they have anti-inflammatory effects that can stabilize atherosclerotic plaques.
2. **Metformin:** Commonly used for type 2 diabetes, it may reduce cardiovascular events and improve endothelial function.
3. **Aspirin:** Traditionally an anti-inflammatory and analgesic, low doses are used for their antiplatelet effects to prevent blood clots.
4. **ACE Inhibitors (e.g., lisinopril, enalapril):** Initially for hypertension and heart failure, they can also improve arterial flexibility and reduce strain on the heart.
5. **Aldosterone Antagonists (e.g., spironolactone, eplerenone):** Primarily for heart failure, they may benefit ASCVD by reducing inflammation and fibrosis.
These drugs are under investigation or have shown potential benefits in managing ASCVD beyond their original indications. However, clinical consultation is necessary to tailor treatment to individual patient needs. - Metabolites
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Arteriosclerotic cardiovascular disease (ASCVD) involves the build-up of fatty deposits and the thickening of artery walls, leading to reduced blood flow. Metabolites associated with ASCVD include:
1. **Cholesterol Metabolites**: Elevated levels of low-density lipoprotein (LDL) cholesterol and reduced levels of high-density lipoprotein (HDL) cholesterol are significant risk factors.
2. **Triglycerides**: High levels in the blood increase the risk of ASCVD.
3. **Glucose**: Impaired glucose metabolism, such as in diabetes, is a notable risk factor.
4. **Homocysteine**: Elevated levels can damage blood vessels and promote ASCVD.
5. **Inflammatory Markers**: C-reactive protein (CRP) and interleukin-6 (IL-6) are markers of inflammation that correlate with ASCVD.
These metabolites and markers are crucial in understanding the predisposition and progression of arteriosclerotic cardiovascular disease. - Nutraceuticals
- Nutraceuticals, which are food-derived products with potential health benefits, can support cardiovascular health in individuals with arteriosclerotic cardiovascular disease. Examples include omega-3 fatty acids (found in fish oil), which may reduce inflammation and lower cholesterol levels, and plant sterols or stanols, which can help reduce LDL cholesterol. Antioxidants such as vitamins C and E, polyphenols (found in green tea and dark chocolate), and fiber supplements can also support cardiovascular health. However, it is important to consult a healthcare provider before starting any new supplement regimen.
- Peptides
- Arteriosclerotic cardiovascular disease (ASCVD) involves the buildup of plaques in the arterial walls, leading to narrowing and hardening of the arteries. Peptides, such as natriuretic peptides, can play roles in diagnosing and managing ASCVD. Natriuretic peptides, like B-type natriuretic peptide (BNP), can be biomarkers for heart failure, often associated with ASCVD. Nanotechnology is emerging in the diagnosis and treatment of ASCVD, with nanoparticles being explored for targeted drug delivery, imaging, and plaque stabilization.