Arteriosclerosis

Arteriosclerosis / atherosclerorsis is the narrowing and hardening of the arteries. In arteriosclerosis the narrowing is caused mainly by calcium deposits.  In atherosclerosis the narrowing is caused mainly by chronic lipid deposition, cell proliferation and reactive inflammation in the artery wall.

Atherosclerosis can start in childhood with early lipid deposits evolving into the lesions characteristic of atherosclerosis. The lesions begin as a grey to pearly white, elevated thickening of the internal part of the vessel with a core of extracellular lipid (mainly cholesterol, which usually is bound to proteins) covered by a fibrous cap of connective tissue and smooth muscle.
Atherosclerotic lesions can protrude into the artery lumen and impede blood flow. Due to a reduction in blood flow, the function of downstream tissues is impaired through insufficient oxygenation and less efficient metabolite exchange.

Atherosclerosis generally does not produce any symptoms until atheroma
encroaches significantly on the vessel lumen. However, if there is an acute
occlusion of a major artery by thrombosis, embolism or dissecting aneurysm the symptoms and signs can be dramatic. The signs and symptoms of atherosclerosis depend on the degree of blockage and also depend on which arteries are involved.

Atherosclerotic lesions occurring in the coronary arteries lead to coronary
heart disease (CHD). Symptoms of CHD may present acutely as ischaemic chest pain (i.e. angina pectoris) or myocardial infarction.
Lesions occurring in the cerebral arteries lead to cerebrovascular disease, which may lead to stroke.
Lesions in the iliac and femoral arteries lead to peripheral arterial disease, which may present as ischaemic pain in the extremities (e.g. intermittent claudication), gangrene, or aneurysm.

Risk factors:
Elevated blood cholesterol levels
High blood pressure
Smoking
Diabetes
Physical inactivity
Low antioxidant status
Low levels of essential fatty acids
Low levels of magnesium and potassium
Increased platelet aggregation
Increased fibrinogen formation
Elevated levels of homocysteine

Homocysteine
Evidence suggests that an elevated homocysteine level is a risk factor for heart disease independent of other known risk factors such as elevated cholesterol, and hypertension. Homocysteine appears to be capable of promoting the development of atherosclerosis. Cigarette smoking and coffee consumption are associated with increased levels of homocysteine.
Vitamin B6, Folic acid, and Vitamin B12 all function as cofactors for enzymes that can lower homocysteine levels.

Natural treatment regimes
Since the development of atherosclerosis begins in childhood, risk factor modification (including diet, physical activity and weight control) should begin early in life, at least in the late teens.

Preventing the development of coronary heart disease could
be assisted by following:

Prevention of childhood and adolescent smoking.
Systematically checking for serum hyperchlesterolaemia and for low HDL levels.
Prevention and treatment of obesity.
Identification and control of hypertension and glucose intolerance in young people.
Consumption of a plant-based diet rich in fruit and vegetables, nuts, natural vegetable oils, and whole grains.

Avoid trans-fatty acids and Increase Omega-3 fatty acids
Trans-fatty acids (TFAs) are found in many processed foods containing hydrogenated oils. The highest levels of TFAs occur in some margarines.
Margarine consumption has been linked to increased risk of heart disease. Eating
TFAs increases the ratio of LDL to HDL. Margarine and other processed foods
containing partially hydrogenated oils should be avoided.

Substituting saturated fats with omega-3 and omega-6 fatty acids found in
fish and certain plants such as Flaxseed has been shown to have a direct
effect on myocardial contractility, blood pressure, platelet function,
coagulation factors, cell mediated immunity and markers of inflammation.

Studies also show that concentration omega-3 fatty acid preparations are valuable in preventing sudden death following myocardial infarction. Clinical trials also show that consumption of fatty fish and fish oil supplements can significantly reduce the risk of developing heart disease. The omega-3 fatty acids inhibit platelet aggregation lower both systolic and diastolic blood pressure in patients with hypertension reduce triglycerides and LDL-cholesterol and lower fibrinogen levels.

Avoid smoking
Tobacco smoke contains more than 4,000 chemicals, of which more than 50 substances have been identified as carcinogens. Smoking is positively associated with the prevalence of raised atherosclerotic lesions in the abdominal aorta and the coronary arteries.

Fruit and vegetables
Cruciferous vegetables such as green leafy vegetables and citrus fruits, including juice, contribute the most protection from ischaemic stroke.
Also the consumption of whole grains (at least three servings daily) has been shown to result in a 28% lower risk of coronary artery disease, compared to consuming one serving or less.

Eating legumes (beans, pulses) four or more times per week versus less than once per week has been associated with a 22% lower CHD risk.
Many studies show a positive association between increased dietary fibre intake and cardio vascular disease mortality. Reduction in cholesterol levels have been observed with diets rich in fibre from oats, beans and psyllium.

Increase Exercise
An active lifestyle is also an important step in preventing cardiovascular disease. Poor fitness in young adults is associated with the development of cardiovascular disease risk
factors, such as diabetes, hypercholesterolaemia, and hypertension.

Plant Sterols
The latest research on sterols provides an extremely effective natural approach to reducing LDL cholesterol and triglycerides, while increasing HDL cholesterol.
Chinese red yeast rice has been used in China for hundreds of years. Its consumption has been found to regulate cholesterol levels in the blood. Red yeast rice extract contains a substance (monacolin K) that inhibits HMG CoA reductase, and also contains
phytosterols that inhibit cholesterol reabsorption.

Sugar cane wax alcohols contain a natural substance derived from the waxy coating of the stem and leaves of sugar cane. It has been shown in a number of clinical trials to lower LDL-cholesterol to assist in managing normal cholesterol. As well as improving cholesterol
levels, sugar cane wax alcohols have an antioxidant effect on LDL-cholesterol.
It also inhibits platelet aggregation, thinning the blood.

Co enzyme Q10
As early as 1974 the Japanese government approved CoQ10 for the treatment of chronic heart failure (CHF). Coenzyme Q10 is present in all cells with high concentrations in the heart. CoQ10 decreases lipid peroxidation which can help to alleviate the oxidant stress inherent in CHF. The recommended dosage is around 120mg daily.
See page on ‘Co-enzyme Q10. 

Vitamin C
Vitamin C has been shown to be very effective in preventing LDL – cholesterol from being oxidised, even in smokers. Having a diet rich is vitamin C has been shown to significantly reduce the risk of death from heart attacks and strokes.

Grape seed extract
Grape seed contains one of the most beneficial groups of plant flavonoids called proanthocyanidins (OPCs). These are potent antioxidants that have shown to be of a benefit in the treatment of conditions such as varicose veins, capillary fragility etc. The antioxidant effect of grape seed can help prevent damage to cholesterol and the lining of
the artery. Animal studies on OPC extracts have demonstrated a lowering of blood
cholesterol levels and decrease the size of cholesterol deposits in the artery.

Magnesium and Potassium
Magnesium and potassium are absolutely essential to the proper functioning of the entire cardiovascular system. Their critical roles in preventing heart disease and strokes are now
widely accepted. In addition increased intake of potassium and magnesium is
inversely associated with blood pressure in observational studies and diets
particularly rich in potassium have been shown to reduce the risk of stroke.

Vitamin E
Several studies undertaken have shown that vitamin E levels may be more predictive of a heart attack or stroke than total cholesterol levels. Vitamin E has the ability to protect against heart disease and stroke by:
-reducing peroxidation of LDL-cholesterol and increasing breakdown of plasma LDL
-increasing HDL-cholesterol levels
-Inhibiting excessive platelet aggregation
-increasing fibrinolytic activity

Garlic

Garlic has been shown to be hypo-lipodaemic in humans. The consumption of one half to one clove of garlic per day lowers serum cholesterol by approximately 9%. Garlic (along with Hawthorn) is also an ACE inhibitor and can play a part in reducing blood pressure.

Medical treatments
Medical treatment and prevention may include procedures such as coronary bypass operations or balloon and stent procedures.

Up-dated April 2015