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Encyclopedia > Atheroma
Atheroma
Classification & external resources
ICD-10 I70.9
ICD-9 440
DiseasesDB 1039
MeSH C14.907.137.126.307

In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue. In the context of heart or artery matters, atheromata are commonly referred to as atheromatous plaques. It is an unhealthy condition, but is found in most humans.[citation needed] The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... Section of an artery For other uses, see Artery (disambiguation). ... Figure 1: Basic lipid structure. ... Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ...


These anatomic lesions usually begin in later childhood, well before age 10, and progress over time. Veins do not develop atheromata, unless surgically moved to function as an artery, as in bypass surgery. The accumulation (swelling) is always between the endothelium lining and the smooth muscle wall central region (media) of the arterial tube, see IMT. While the early stages, based on gross appearance, have traditionally been termed fatty streaks by pathologists, they are not composed of fat cells, i.e. adipose cells, but of accumulations of white blood cells, especially macrophages that have taken up oxidized low-density lipoprotein (LDL). After they accumulate large amounts of cytoplasmic membranes (with associated high cholesterol content) they are called foam cells. When foam cells die, their contents are released, which attracts more macrophages and creates an extracellular lipid core near the center to inner surface of each atherosclerotic plaque. Conversely, the outer, older portions of the plaque become more calcific, less metabolically active and more physically stiff over time. In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... In medicine, a bypass generally means an alternate or additional route for blood flow, which is created in bypass surgery, e. ... The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ... It has been suggested that this article or section be merged with Intima media thickness. ... Fatty streak is the term generally given to the earliest stages of atheroma, as viewed at autopsy, looking at the inner surface of arteries, without magnification. ... Adipocytes are cells present in adipose tissue, specialized in storing energy as fat. ... White Blood Cells is also the name of a White Stripes album. ... Macrophages (Greek: big eaters) are cells found in tissues that are responsible for phagocytosis of pathogens, dead cells and cellular debris. ...


Collectively, the process of atheroma development within an individual is called atherogenesis and the overall result of the disease process is termed atherosclerosis. Atherosclerosis is a disease of arterial blood vessels. ...

Contents

Difficulty of Tracking, Researching and Better Understanding Atheroma

For most people the first clinical symptoms result from atheroma progression within the heart arteries, most commonly resulting in a heart attack and ensuing debility. However, the heart arteries, because (a) they are small (from about 5 mm down to invisible), (b) they are hidden deep within the chest and (c) they never stop moving, have been a difficult target organ to track, especially clinically in individuals who are still asymptomatic. Additionally all mass applied clinical strategies focus on both (a) minimal cost and (b) the overall safety of the procedure. Therefore existing diagnostic strategies for detecting atheroma and tracking response to treatment have been extremely limited. The methods most commonly relied upon, patient symptoms and cardiac stress testing, do not detect any symptoms of the problem until atheromatous disease is very advanced. The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... A cardiac stress test is performed to evaluate the ability of arterial blood flow to the left ventricular atherosclerosis, thus usually misses disease which most commonly produces future angina or heart attack events. ...


Evolving Concepts and Understanding

In First World countries, with improved public health, infection control and increasing life spans, atheroma processes have become an increasingly important problem and burden for society. Atheroma continue to be the number one underlying basis for disability and death, despite a trend for gradual improvement since the early 1960s (adjusted for patient age). Thus, increasing efforts towards better understanding, treating and preventing the problem are continuing to evolve. The terms First World, Second World, and Third World were used to divide the nations of Earth into three broad categories. ... Public health is concerned with threats to the overall health of a community based on population health analysis. ... Look up disability in Wiktionary, the free dictionary. ... This article or section does not adequately cite its references or sources. ... The 1960s decade refers to the years from January 1, 1960 to December 31, 1969, inclusive. ...


In the mid-twentieth century, it was assumed (incorrectly) that atheromata simply expanded into the lumen and produced stenoses as they grew, since the disease always developed between the inner endothelial lining and the muscular wall. This belief was based on angiographic views of the blood column within arteries and a belief that the smooth muscle wall of an artery (the thickest and strongest portion of the artery wall in a healthy artery) would not change in size and structure over time. This belief continued despite increasing contradicting evidence that this was an overly simplistic theory and did not explain many empirical observations. Most artists' illustrations of atheromata and the atherosclerosis process in 2004 still portray this concept, even though quite incorrect. By the late 1980s and early 1990s, careful pathology work and research using intravascular ultrasound (IVUS) showed clearly that this angiographic assumption was incorrect. artery anatomy, showing lumen The lumen (pl. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Section of an artery For other uses, see Artery (disambiguation). ... Cultured Smooth muscle of the aorta. ... Section of an artery For other uses, see Artery (disambiguation). ... This article does not cite any references or sources. ... For the band, see 1990s (band). ... Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ...


Since the early to mid 1990s, better research has led to a somewhat wider recognition that one of two changes typically occur in the artery wall structure as an atheroma develops and progresses: (a) wall thickening and external enlargement with associated lumen (blood flow opening) preservation until late in the process; or (b) wall thickening with both external and lumen enlargement. These processes both have survival value, as they reduce and hide some of the effects of the atheroma process and help prevent symptoms, for a time. However they also prevent detection of the disease process by most conventional diagnostic tests, (e.g. cardiac stress tests and angiography), until advanced stages. Section of an artery For other uses, see Artery (disambiguation). ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ...


According to United States data, 2004, for about 65% of men and 47% of women, the first symptom of cardiovascular disease is heart attack or sudden death (death within one hour of symptom onset.) The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...


Most artery flow disrupting events occur at locations with less than 50% lumen narrowing. From clinical studies published in the late 1990s to IVUS (in-the-artery-ultrasound) to visualize disease status, the typical heart attack occurs at locations with about 20% stenosis (narrowing), prior to sudden lumen closure and resulting heart attack. Cardiac stress testing, traditionally the most commonly performed non-invasive testing method for blood flow limitations generally only detects lumen narrowing of ~75% or greater, although some physicians advocate that nuclear stress methods can sometimes detect as little as 50%. Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band...


Actual Artery/Atheroma Behavior:

1. External Artery Enlargement; Eventual Possible Stenosis and/or Closure

Over time, atheroma usually progress in size and thickness and induce the surrounding muscular central region (the media) of the artery to stretch out, termed remodeling, typically just enough to compensate for their size such that the caliber of the artery remains unchanged until typically over 40-50% of the artery wall cross sectional area consists of atheromatous tissue (see: Glagov, below). Section of an artery For other uses, see Artery (disambiguation). ... The word calibre (British English) or caliber (American English) designates the interior diameter of a tube or the exterior diameter of a wire or rod. ... Section of an artery For other uses, see Artery (disambiguation). ...


If the muscular wall enlargement eventually fails to keep up with the enlargement of the atheroma volume, then the lumen of the artery begins to narrow, commonly as a result of repeated ruptures of the covering tissues separating the atheroma from the blood stream. This becomes a more common event after decades of living, increasingly more common after people are over 40 years old. Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band...


The endothelium (the cell monolayer on the inside of the vessel) and covering tissue, termed fibrous cap, separate atheroma from the blood in the lumen. If a rupture occurs of the endothelium and fibrous cap, then a platelet and clotting response over the rupture rapidly develops. Additionally, the rupture may result in a shower of debris. Platelet and clot accumulation over the rupture may produce narrowing/closure of the lumen and tissue damage may occur due to either closure of the lumen and loss of blood flow beyond the ruptured atheroma and/or by occlusion of smaller downstream vessels by debris. See vulnerable plaque. The endothelium is the layer of thin, flat cells that lines the interior surface of blood vessels, forming an interface between circulating blood in the lumen and the rest of the vessel wall. ... The fibrous cap is a layer of fibrous connective tissue, which is thicker and less cellular than the normal intima. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... A 250 ml bag of newly collected platelets. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... A vulnerable plaque is an atheromatous plaque which is particularly prone to produce sudden major problems, such as a heart attack or stroke. ...


This is the principal mechanism of heart attack, stroke or other related cardiovascular disease problems. As research has shown, this process is not a result of stenosis. Prior to the rupture, there may have been no lumen narrowing, even aneurysmal enlargement, at the atheroma. On average, by clinical research using IVUS, there is a minor stenosis, about 20%, present over those unstable atheroma which rupture and result in major disability or death. Comparatively, stenoses of about 75% are required to produce detectable abnormalities during cardiac stress tests. Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ... Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Lumen can mean: Lumen (unit), the SI unit of luminous flux Lumen (anatomy), the cavity or channel within a tubular structure Thylakoid lumen, the inner membrane space of the chloroplast 141 Lumen, an asteroid discovered by the French astronomer Paul Henry in 1875 Lumen (band), an American post-rock band... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ...


2. External Artery Enlargement and Lumen Enlargement

If the muscular wall enlargement is overdone over time, then a gross enlargement of the artery results, usually over decades of living. This is a less common outcome. Atheroma within aneurysmal enlargement (vessel bulging) can also rupture and shower debris of atheroma and clot downstream. If the arterial enlargement continues to 2 to 3 times the usual diameter, the walls often become weak enough that with just the stress of the pulse, a loss of wall integrity may occur leading to sudden hemorrhage (bleeding), major symptoms and debility; often rapid death. The main stimulus for aneurysm formation is pressure atrophy of the structural support of the muscle layers. The main structural proteins are collagen and elastin. This causes thinning and the wall balloons allowing gross enlargement to occur, as is common in the abdominal region of the aorta. Post surgical photo of brain aneurysm survivor. ... Post surgical photo of brain aneurysm survivor. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Tropocollagen triple helix. ... Elastin, also known as elasticin, is a protein in connective tissue that is elastic and allows skin to return to its original position when it is poked or pinched. ...


Evolution of Strategies and Changing Focus

The sudden nature of the complications of pre-existing atheroma, vulnerable plaque, have led, since the 1950s, to the development of intensive care units and complex medical and surgical interventions. Angiography and later cardiac stress testing was begun to either visualize or indirectly detect stenosis. Next came bypass surgery, to plumb transplanted veins, sometimes arteries, around the stenoses and more recently angioplasty, now including stents, most recently drug coated stents, to stretch the stenoses more open. A vulnerable plaque is an atheromatous plaque which is particularly prone to produce sudden major problems, such as a heart attack or stroke. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... A cardiac stress test is performed to evaluate the ability of arterial blood flow to the left ventricular atherosclerosis, thus usually misses disease which most commonly produces future angina or heart attack events. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... In medicine, a bypass generally means an alternate or additional route for blood flow, which is created in bypass surgery, e. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Section of an artery An artery or arterial is also a class of highway. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... This article does not cite any references or sources. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ...


Yet despite these medical advances, with success in reducing the symptoms of angina and reduced blood flow, atheroma rupture events remain the major problem and still sometimes result in sudden disability and death despite even the most rapid, massive and skilled medical and surgical intervention available anywhere today. According to some clinical trials, bypass surgery and angioplasty procedures have had at best a minimal effect, if any, on improving overall survival. Typically mortality of by-pass operations is from 1-4%, of angioplasty about 1-1.5%. [citation needed] angina tonsillaris see tonsillitis. ... Blood flow is the flow of blood in the cardiovascular system. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ... This article does not cite any references or sources. ...


Additionally, these vascular interventions are often done only after an individual is symptomatic, often already partially disabled, as a result of the disease. It is also clear that both angioplasty and by-pass interventions do not prevent future heart attack. Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...


The older methods for understanding atheroma, dating to before World War II, relied on autopsy data. Autopsy data has long shown initiation of fatty streaks in later childhood with slow asymptomatic progression over decades. Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000... Fatty streak is the term generally given to the earliest stages of atheroma, as viewed at autopsy, looking at the inner surface of arteries, without magnification. ...


One way to see atheroma is the very invasive and costly IVUS ultrasound technology; it gives us the precise volume of the inside intima plus the central media layers of about 2.5 cm of artery length. Unfortunately, it gives no information about the structural strength of the artery. Angiography does not visualize atheroma; it only makes the blood flow within blood vessels visible. Alternative methods that are non or less physically invasive and less expensive per individual test have been used and are continuing to be developed, such as those using computed tomography (CT; lead by the Electron Beam Tomography form, given its greater speed) and magnetic resonance imaging (MRI). The most promising since the early 1990s has been EBT, detecting calcification within the atheroma before most individuals start having clinically recognized symptoms and debility. Interestingly, statin therapy (to lower cholesterol) does not slow the speed of calcification as determined by CT scan. Most visualization techniques are used in research, they are not widely available to most patients, have significant technical limitations, have not been widely accepted and generally are not covered by medical insurance carriers. Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... This page meets Wikipedias criteria for speedy deletion. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Blood flow is the flow of blood in the cardiovascular system. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... It has been suggested that Synchrotron X-ray tomographic microscopy, X-ray tomography be merged into this article or section. ... Patent illustration showing a cutaway view of an electron beam computerized tomography system. ... “MRI” redirects here. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... For the band, see 1990s (band). ...


From human clinical trials, it has become increasingly evident that a more effective focus of treatment is slowing, stopping and even partially reversing the atheroma growth process. However, this effort has been slow, partly because the asymptomatic nature of atheromata make them especially difficult to study. Promising results are found using B-vitamins that reduce a protein corrosive, homocysteine and that reduce neck carotid artery plaque volume and thickness, and stroke, even in late-stage disease. Homocysteine is a chemical compound with the formula HSCH2CH2CH(NH2)CO2H. It is a homologue of the naturally-occurring amino acid cysteine, differing in that its side-chain contains an additional methylene (-CH2-) group before the thiol (-SH) group. ... The carotid artery is a major artery of the head and neck that supplies blood to the head and neck. ...


Additionally, understanding what drives atheroma development is complex with multiple factors involved, only some of which, such as lipoproteins, more importantly lipoprotein subclass analysis, blood sugar levels and hypertension are best known and researched. More recently, some of the complex immune system patterns that promote, or inhibit, the inherent inflammatory macrophage triggering processes involved in atheroma progression are slowly being better elucidated in animal models of atherosclerosis. A lipoprotein is a biochemical assembly that contains both proteins and lipids. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... For other forms of hypertension, see Hypertension (disambiguation). ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ...


Detection and Diagnosis Options

Arterial wall fixation, staining and thin section: historically this has been the gold standard for detection and description of atheroma, though only done after at autopsy. With special stains and examination, micro calcifications can be detected, typically with smooth muscle cells of the arterial media near the fatty streaks within a year or two of fatty streaks forming.


IVUS is the current most sensitive method detecting and measuring more advanced atheroma within living individuals, though it is typically not used until decades after atheroma begin forming due to cost and body invasiveness. Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ...


CT Scans using state of the art higher resolution spiral, or the higher speed EBT, machines have been the most effective method for detecting calcification present in plaque. However, the atheroma have to be advanced enough to have relatively large areas of calcification within them to create large enough regions of ~130 Hounsfield units which the CT scanner software can recognize as distinct from the other surrounding tissues. Typically, such regions start occurring within the heart arteries about 2-3 decades after atheroma start developing. CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... EBT can mean: Electron beam tomography Electronic Benefit Transfer Emmental - Burgdorf - Thun Bahn (a railway in Switzerland) This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... The Hounsfield scale is a quantitative scale for describing radiodensity. ...


Arterial ultrasound, especially of the carotid arteries, with measurement of the thickness of the artery wall, offers a way to partially track the disease progression. As of 2006, the thickness, commonly referred to as IMT for intimal-medial thickness, is not measured clinically though it has used by some researchers since the mid 1990's to track changes in arterial walls. Traditionally, clinical carotid ultrasounds have only estimated the degree of blood lumen restriction, stenosis, a result of very advanced disease. More progression clinicians have begun using IMT measurement as a way to quantify and track disease progression or stability within individual patients. The carotid artery is a major artery of the head and neck that supplies blood to the head and neck. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ...


Angiography, since the 1960s, has been the traditional way of evaluating for atheroma. However, angiography is only motion or still images of dye mixed with the blood with the arterial lumen and never show atheroma; the wall of arteries, including atheroma with the arterial wall remain invisible. The limited exception to this rule is that with very advance atheroma, with extensive calcification within the wall, a halo-like ring of radiodensity can be seen in most older humans, especially when arterial lumens are visualized end-on. On cine-floro, cardiologists and radiologists typically look for these calcification shadows to recognize arteries before they inject any contrast agent during angiograms. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Radiocontrast agents (or simply contrast agents) are compounds used to improve the visibility of internal bodily structures in an X-ray image. ...


Treatment Options

Many approaches, including food choices, staying slender (especially in the abdominal area), aerobic exercise and many different supplements have been promoted as methods to reduce atheroma progression. For most people, changing their internal physiologic behaviors, mostly hidden within, from the usual ones which promote atheroma progression (i.e. high risk, meaning high event rates for symptomatic cardiovascular disease) to reduced risk, requires a combination of strategies, including taking several compounds, on a daily basis and indefinitely. More and more human treatment trials have been done and are ongoing which demonstrate improved outcome for those people using more complex and effective treatment regimens which change physiologic behavior patterns to more closely resemble those which humans more commonly exhibit in childhood at a time before fatty streaks begin forming. Calculated LDLipoprotein cholesterol levels at this time of life are usually in the 20 to 40 mg/dL range, far below what are usually considered "normal" adult concentrations. Fatty streak is the term generally given to the earliest stages of atheroma, as viewed at autopsy, looking at the inner surface of arteries, without magnification. ... Low-density lipoprotein (LDL) belongs to the lipoprotein particle family. ... Cholesterol is a sterol (a combination steroid and alcohol), a lipid found in the cell membranes of all body tissues, and is transported in the blood plasma of all animals. ...


The group of medications referred to as statins, originally discovered in 1972 by a Japanese researcher as a compound produced by certain strains of fungi, e.g. Aspergillus terreus, Monascus ruber and Monascus purpureus, have been the most successful single approach, with the lowest rates of undesirable side-effects, to reducing atherosclerotic disease events. However, current research evidence continues to support using a combination of several approaches, including: (a) food choices (such as consuming omega-3 containing fats), (b) abdominal fat reduction, (c) low normal blood glucose levels (glycosylated hemoglobin, also called HbA1c, values < 5.0), (d) aerobic exercise and (e) micronutrient (multivitamin and magnesium) supplements to improve the odds of maintaining better health with absence of either symptoms or worse, catastrophic disease events. Aspergillus terreus is a fungus, noteworthy for its refractoriness to amphotericin B therapy [1]. It was also the initial source for the drug mevinolin (lovastatin), a drug for lowering serum cholesterol. ... Binomial name Monascus purpureus (Went, 1895) Monascus purpureus (syn. ... Omega-3 fatty acids are polyunsaturated fatty acids found in certain fish tissues, and in vegetable sources such as flax seeds, walnuts, and canola oil. ... Glycosylated (or glycated) hemoglobin (hemoglobin A1c, Hb1c , HbA1c or HgA1c) is a form of hemoglobin used primarily to identify the plasma glucose concentration over time. ... HbA1c is shorthand for glycated hemoglobin A1c, a surrogate marker for blood glucose levels. ... General Name, symbol, number magnesium, Mg, 12 Chemical series alkaline earth metals Group, period, block 2, 3, s Appearance silvery white solid at room temp Standard atomic weight 24. ...


The latest statin approved in the United States but not in some other countries, rosuvastatin, showed regression of atherosclerotic plaque (in fact, a decrease in intima + media volume) in the coronary arteries by IVUS evaluation[1] in the prospective treatment ASTEROID study which utilized IVUS to directly visualize volume plaque changes with treatment. Page 8, shows an artery before and after about 2 years of 40 mg/day treatment; the relevant wall volume is reduced to about half by a decrease in the volume of atheroma. However, keep in mind that the IVUS images on page 8 are only for illustration and are not presented as typical for the group. A careful ready on the article provides a clearer, though still favorable than other trial view of the outcomes. This is the first human clinical trial, with any treatment agent available within the USA, that has produced some plaque regression (as opposed to only slowed rates of increase in quantified volume). Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease. ... Rosuvastatin is a member of the drug class of statins, used to treat hypercholesterolemia and related conditions, and to prevent cardiovascular disease. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ... Intravascular ultrasound (IVUS) is an medical imaging methodology using (a) specially designed long thin complex manufactured catheters attached to (b) computerized ultrasound equipment. ...


Also be aware that controversy over treatments continue and reportedly Health Canada issued a "Dear doctor" warning concerning the dose used in the ASTEROID study. As another instance, someone editing this page claimed that the PROSPER trial[2], which used a much less potent statin, showed no evidence of mortality reduction; actual reading of the trial results and interpretation by the investigators demonstrates another conclusion.


A key issue is that there is no magic pill. The important issues are multiple internal physiologic behaviors within each of us; supplements, including the far more rigorously researched precription agents, are simply tools, which if used with wisdom, in careful combinations with a goal of dramatically changing physiologic behaviors to emulate patterns known to much healthier, often work very well. All always, no single approach is perfect or applicable to everyone, at least not without careful attention to detail and individual adjustments.


References

  1. ^ JAMA, "Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis".
  2. ^ Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, Ford I, Gaw A, Hyland M, Jukema JW, Kamper AM, Macfarlane PW, Meinders AE, Norrie J, Packard CJ, Perry IJ, Stott DJ, Sweeney BJ, Twomey C, Westendorp RG; PROSPER study group. PROspective Study of Pravastatin in the Elderly at Risk. url=http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=12457784&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract

References

  • Glasgov S: Compensatory Enlargement of Human Atherosclerotic Coronary Arteries, N Engl J Med, 316:131-1375, 1987
  • Nissen, et al. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis JAMA. 2006;295: (doi:10.1001/jama.295.13.jpc60002)[1]
  • Vos E, Rose CP: Questioning the benefits of statins CMAJ • Nov. 8, 2005; 173(10)[2]

See also


  Results from FactBites:
 
Atheroma - Patient UK (618 words)
Atheroma is the root cause of various cardiovascular diseases.such as angina, heart attack, stroke and peripheral vascular disease.
Atheroma is also known as 'atherosclerosis' and 'hardening of the arteries'.
Atheroma is the root cause of a number of cardiovascular diseases.
Reference.com/Encyclopedia/Atheroma (2842 words)
In pathology, an atheroma (plural: atheromata) is an accumulation and swelling (-oma) in artery walls that is made up of cells, or cell debris, that contain lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.
Atheroma continue to be the number one underlying basis for disability and death, despite a trend for gradual improvement since the early 1960s (adjusted for patient age).
However, the atheroma have to be advanced enough to have relatively large areas of calcification within them to create large enough regions of ~130 Hounsfield units which the CT scanner software can recognize as distinct from the other surrounding tissues.
  More results at FactBites »

 
 

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