Atherosclerosis is the most frequent disease of the arteries; it mainly increases in higher age. The biological ages of our patients are oftenly determined by the condition of their arteries. “The man is as old as
his vessels”. The prevention of an excessive atherosclerosis therefore is an essential purpose of Anti-Aging strategies.
Important secondary injuries of the atherosclerosis are:
- Coronary heart disease, angina pectoris and myocardial infarction
- Vertigo, concentration disturbances and stroke in cases of cerebrovascular ischemia
- Occlusive arterial disease of the leg.
Several risk factors which are found frequently in our civilization society transfer the manifestation of arterial diseases in increasingly younger ages.
Developement of the atherosclerosis:
The illustration opposite demonstrates the development of the atherosclerosis (illus. adapted from
Progredient fat inclusion (atheroma)
Superficial defect of the internal vessel wall
Progressive defect (ulcer) with a small blood clot
Greater blood clot with calcifications.
If a fresh blood clot is separated from the place of its origin, an embolism arises. The blood clot (thrombus) is transported as an embolus with the bloodstream into other vessels which are blocked.
Risk factors of atherosclerosis:
Several risk factors promote the progression of atherosclerosis. The following risk factors are generally accepted: smoking, hypertension, hypercholesterolemia, diabetes mellitus, obesity,
lack of exercise and stress. Newer scientific findings point to further risk factors. So it might be taken into account that increased blood levels of a particular amino acid (homocysteine)
increases the disposition of atherosclerosis. The possibility is also discussed that atherosclerosis might be caused by a chronic bacterial infection in the vessels (Chlamydia pneumoniae). A
lack of some vitamins also might intensify the progress of atherosclerosis (vitamin C and E), a lack of other radical scavengers as well.
On the other hand a premature atherosclerosis may also exist fatefully in cases of genetic or familial predisposition.
In men atherosclerosis can be found about seven years earlier than in women, because the vessels of women regulary show few pathological alterations up to the beginning of the climacterics.
This is caused by protective effects of the estrogens.
The coronary arteries
The coronary arteries have to
guarantee the cardiac blood supply. The left coronary artery (1) and the right coronary artery (RCA, 4) are branches of the aorta (A). The main tribe of the left coronary artery splits up into
two big branches: ramus interventricularis anterior or left anterior descending artery (RIVA, LAD, 3) and ramus circumflexus or circumflex artery (RCX, Cx, 2). The illustration shows the topography of these
aforementioned arteries (illus. adapted from Feneis).
The cerebral arteries
The cerebral blood circulation is maintained by four extracranial cerebral arteries: right and left carotid artery (2), right and left vertebral artery (7).
The common carotid artery (2) runs in the anterior region of the neck to the base of the skull. It divides into two branches: The internal carotid artery (4) runs to the brain (4), the
external carotid artery (3) remains outside of the skull. The right and left vertebral artery (7) are situated in the cervical spine and enter the skull through the great foramen.
The vertebral arteries unite to the basilar artery (8). Two main branches of the internal carotid are the middle cerebral artery (5) and the anterior cerebral artery
(6). The circle of Willis (9) realises a connection between the basilar artery and the branches of the right and left internal carotid artery (illus. adapted from Marx).
Peripheral arteries :
The illustration shows schematically the blood circulation of the legs (illus. adapted from Rudofsky).
The abdominal aorta (1) forks into the right and left common iliac artery (2). The common iliac artery is divided into two branches. The internal iliac artery (3) supplies several internal organs, the
external iliac artery (4) runs to the thigh, there called femoral artery (4). This artery divides itself into two main branches. The superficial femoral artery (6) goes to the popliteal space, the deep
femoral artery (5) runs into the muscles of the thigh. The popliteal artery (7) is divided into three branches(7): posterior tibial artery (9), anterior tibial artery (8) and fibular artery. The fibular artery (in
the illustration without numbering) is situated in the middle of the lower leg between the anterior and posterior tibial
Coronary heart disease and myocardial infarction
Different symptoms can point to diseases of the coronary arteries.
A typical symptom is the angina pectoris. In other cases there are not any symptoms or troubles are low and atypical despite unsatisfactory circulation of the heart.
An extreme ischemia of the heart may cause a myocardial infarction. The ischemic area of the myocardium becomes necrotic and is replaced by a scar from connective tissue.
Cerebrovascular accidents and stroke
Different symptoms can point to illnesses of the cerebral vessels.
Circulatory disorders of the vertebral or basilar arteries may lead to dizziness and imbalances. Circulatory disorders of the carotid artery and her branches most frequently causes
hemiparesis or hemihypesthesia, dysarthria or changes of personality. In cases of strokes patients suffer from permanent deficits.
Occlusive arterial disease
Pain in the leg muscles, mostly in the calf area, may point to ischemia of the leg. Such pain typically arise at running or walking; it goes away, if the walking is stopped (intermittent
claudication). Also permanent pain or finally necroses may arise, if arterial stenoses increase or arteries are occluded.
Prevention of atherosclerosis
Strategies of prevention are directed towards the various risk factors which intensify the atherosclerosis. Nicotine abstinence, low-fat and low-carbohydrate diet, a sufficient supply of radical
scavengers, effective treatment of metabolic disorders and hypertension, weight reduction, regular physical activity and reduction of stress are essential components of vascular prevention.
Hormonal aspects of prophylaxis are based on an medical treatment of climacteric alterations. At present it is discussed controversially, whether medical treatment of chronic bacterial
infections can counteract a progressing of atherosclerosis. Supporters of this hypothesis favour Roxithromycin in a dosage of 300 mg per day for about two or three weeks as antibiotic
treatment, if a chronic infection with TWAR chlamydiae (Chlamydia pneumoniae) is detected.
Radical scavengers may also contribute to a prophylaxis of the atherosclerosis. Some more informations about radical scavengers can be found in the chapter about cancer. Several
radical scavengers have specific antiatherogene effects:
Vitamin C reduces cholesterol level and blood pressure.
Resveratrol (in grapes, grape juice, wine) lowers the blood levels of cholesterol and LDL; in the interaction with alcohol it increases the HDL level. Moreover the platelet aggregation might be inhibited.
Allicin (in garlic, onion, leek) reduces blood pressure and blood-sugar levels; it seems to be able to reduce plaques in the arteries. Garlic must be taken in high doses so that these effects
arise. The required doses can only be realised, if pharmaceutical extracts are taken.
Copyright: Jörg Piper, MD, senior consultant, Clara-Viebig-Str. 4, D-56864 Bad Bertrich, Germany