Cholesterol treatment and atherosclerosis

Cholesterol treatment and atherosclerosis (Best Cardiologist in Bhopal ) 

The problem with cholesterol treatment and atherosclerosis:

Over the last decade, cholesterol treatment and atherosclerosis has evolved significantly. Atherosclerosis is a common term for hardening and thickening of the arteries. In its most ordinary form, atherosclerosis is a slow progressive disease that generally starts in early adulthood and becomes dangerous later in life. Atherosclerosis is a complex process that generally starts with damage of the inner layer of the artery called endothelium. It happens as a result of smoking, high blood pressure and elevated levels of cholesterol and triglycerides in the blood. Because of the injure, fat or lipids, platelets and calcium accumulate in the wall of the artery and contribute to plaque buildup and narrowing of the artery.

Among clinical presentation of atherosclerosis, coronary artery illness is the most prevalent and is associated with high morbidity and mortality when presenting as acute coronary syndrome, including unstable angina and acute myocardial infarction. Scientific observations have demonstrated that plaque rupture or erosion with different degrees of superimposed thrombus or clot resulting in a decrease blood flow to the heart muscle represent the basic mechanism for acute coronary syndrome.

The upper panel labeled A and B demonstrated the presence to thrombus in the proximal left anterior descending coronary artery (LAD)on the angiogram and on the intravascular ultrasound, IVUS (upper C) white arrow while the black arrow indicate the possible site of plaque rupture. Repeat angiogram after treatment with an antiplatelet therapy (eptifibatide) demonstrated dissolution of the LAD lesion and Optical coherence tomography (OCT) revealed thrombus resolution and the site of prior rupture of thin cap fibroatheroma.

Cholesterol is an obviously established culprit in atherosclerosis and is a principal component of the vulnerable atherosclerotic plaque comprising almost 50% of the plaque mass.

Treatment of acute coronary syndrome

The instant treatment goals are to recover blood flow and preserve heart function. This can be accomplished most efficiently by angioplasty and stenting which reopens the artery by compressing the atherosclerotic plaque against the wall of the artery. In addition, anticoagulants, antiplatelets are used to stop thrombus to propagate. Medical therapy that includes beta-blockers, Ace inhibitors, or angiotensin receptor blockers helps control heart rate and blood pressure and decrease demand on the heart. In doing so, they are preserving or improving heart function. Statin therapy lowers the amount of LDL cholesterol circulating in the blood and stabilizes plaque deposits. This makes the plaque less probable to rupture and can even lead to regression in some cases. The current treatment of acute coronary syndrome has produced significant improvement in survival, but the residual danger of recurrent myocardial infarction and mortality still remains high. Some of these cardiac events happen even weeks after hospital discharge for acute coronary syndrome.

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