Concept of Arteriosclerosis – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Concept of Arteriosclerosis
Atherosclerosis is a pattern of vascular disease which is characterized by intimal lesions called atheromas or fibro-fatty plaques which protrude into and obstruct vascular lumen and weaken the underlying tunica media.
Ref-Robbins/8/496
Common sites of atherosclerosis / atheroma formation:
1. Elastic arteries: aorta, carotid & iliac arteries.
2. Large and medium sized muscular arteries: coronary & popliteal arteries.
Ref-Robbins/89/564
Risk factor of atherosclerosis:
A. Major risk factors:
a. Non-modifiable:
1. Increasing age.
2. Male gender.
3. Family history.
4. Genetic abnormalities.
b. Modifiable:
1. Hyperlipidaemia.
2. Hypertension.
3. Cigarette smoking.
4. Diabetes.
5. C-reactive protein.
B. Minor risk factors:
a. Non-modifiable:
1. Obesity.
2. Physical inactivity.
3. Stress (type-A personality).
4. Post-menopausal oestrogen deficiency.
5.High carbohydrate intake.
b. Modifiable:
1. Alcohol.
2. Lipoprotein Lp (a)
3. Hardened (trans) unsaturated fat intake.
4. Chlamydia pneumoniae.
[Ref-Robbins/8/497-8]
Pathogenesis of atherosclerosis:
1. Endothelial injury: Usually subtle with resultant endothelial dysfunction, yielding increased permeability, leukocyte adhesion and thrombotic potential. Chronic endothelial injury is caused by hyperlipidaemia, hypertension, smoking, homocysteine, haemodynamic factors, toxins, viruses, immune reactions.
2. Accumulation of lipoproteins: Mainly LDL, with its high cholesterol content, in the vessel wall.
3. Modification of lesional lipoproteins by oxidation.
4. Adhesion of blood monocytes (and other leukocytes) to the endothelial followed by their migration into the intima and their transformation into macrophases and foam cells.
5. Adhesion of platelets
6. Release of factors from activated platelets, macrophages or vascular cells that cause migration of smooth muscle cells (SMCs) from media into the intima.
7. Proliferation of smooth muscle cells in the intima and elaboration of extracellular matrix, leading to accumulation of collagen and proteoglycans.
8. Enhanced accumulation of lipids both within cells (macrophages & smooth muscle cells) and extracellularly.
[Ref-Robbins/8/4991]
Prevent atherosclerosis:
A. Primary prevention:
1. Cessation of cigarette smoking.
2. Moderation of alcohol consumption.
3. Weight reduction.
4. Control of hypertension.
5. Aerobic exercise.
6. Lowering total cholesterol and LDL, and increasing HDL level.
B. Secondary prevention:
1. Prevention of recurrence of events resulting from atherosclerosis such as MI. %
[Ref-Robbins/k/5241]
Read more: