In pathology, an atheroma (plural: atheromata) is an abnormal accumulation of inflammatory cells (macrophage white blood cells), lipids and a variable amount of connective tissue within the walls of arteries. In the context of heart or artery matters, atheromata are commonly referred to as atheromatous plaques. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // 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 (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Diseases Database 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. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ... White Blood Cells is also the name of a White Stripes album. ... 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. ... Section of an artery For other uses see Artery (disambiguation) Arteries are muscular blood vessels that carry blood away from the heart. ...

These anatomic lesions typically 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 is always between the endothelium lining and the smooth muscle wall of the arterial tube. While the early stages, based on gross appearance, have traditionally been termed fatty streaks by pathologists, they are not composed of fat, i.e. adipose cells. 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. ... 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. ...

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. ...

Stages

In humans, atheroma usually begin in later childhood, about ages 5-9, as fatty streaks. These, and older, larger atheroma lesions have long been observed in autopsy examinations of people who have died for unrelated reasons; they are so common, more so with increasing age, they were long considered normal, even though clearly unhealthy. 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. ...

More advanced atheroma develop multiple different internal tissue characteristics within the same atheroma. By light microscopy visualization, pathologists have characterized as many as 10 different tissue subtypes within a single advanced atheroma. Generally, these range from collections of macrophage cells, always the initiating cells in the newest sections of atheroma, to more complex structures including living cells, cellular debris of cells which have died and extracelluar deposits of fibrous tissue & calcified crystals, within the oldest, outermost portions of atheroma structures. Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... It has been suggested that this article or section be merged into microscope. ...

Atheroma typically progress silently for decades and remain undetected by most clinical diagnostic approaches, including cardiac stress testing and angiography. Eventually, their presence is revealed by disastrous clinical events and permanent disability, such as heart attack or stroke, with the majority of people assuming they were healthy until finally proven otherwise by events. For some individuals, warning symptoms do occur before the onset of major debility or death, however these are the minority. 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. ... 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. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease that occurs when the blood supply to a part of the heart is interrupted. ... A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ...

Historically physicians, who are primarily trained to treat symptoms and avoid treatment before onset of clear enough symptoms and physical abnormalities, have just considered the process a normal part of ageing, even though unhealthy.

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. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... 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. ... It has been suggested that this article or section be merged into Disabilities. ... This article or section does not 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. 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 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) Arteries are muscular blood vessels that carry blood away from the heart. ... Smooth muscle of the aorta. ... Section of an artery For other uses see Artery (disambiguation) Arteries are muscular blood vessels that carry blood away from the heart. ... The 1980s refers to the years of 1980 to 1989. ... Germans dancing on the Berlin Wall in late 1989, the symbol of the cold war divide falls down as the world unites in the 1990s. ... 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 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) Arteries are muscular blood vessels that carry blood away from the heart. ... 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 syn = con/plus and pipto = fall, together meaning co-exist) 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. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ...

Most artery flow disrupting events occur at locations with less than 50% lumen narrowing. From elegantly performed clinical studies published in the late 1990s, and using IVUS to better visualize disease status, the typical heart attack occurs at locations with about 20% stenosis, 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. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... 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 wall 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) Arteries are muscular blood vessels that carry blood away from the heart. ... 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) Arteries are muscular blood vessels that carry blood away from the heart. ...

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 and covering tissue, termed fibrous cap, separates an 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. A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... A stroke, also known as cerebrovascular accident (CVA),[1] is an acute neurologic injury in which the blood supply to a part of the brain is interrupted. ... It has been suggested that this article or section be merged with Coronary heart disease. ... 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 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, major symptoms and debility; often rapid death. The main stimulus for aneurysm formation is pressure atrophy of the underlying muscle layers. This causes thinning and the weaker wall balloons allowing gross enlargement to occur. An aneurysm (or aneurism) is a bulge in a blood vessel that bursts usually near the brain. ... An aneurysm (or aneurism) is a bulge in a blood vessel that bursts usually near the brain. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

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. ... Angioplasty is the mechanical, hydraulic dilation of a narrowed or totally obstructed arterial lumen, generally caused by atheroma (the lesion of atherosclerosis). ... 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 only a minimal effect, some would argue no effect, on improving overall survival. Additionally, these treatments are often done only after an individual is symptomatic, often already partially disabled, as a result of the disease. 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). ... Angioplasty is the mechanical, hydraulic dilation of a narrowed or totally obstructed arterial lumen, generally caused by atheroma (the lesion of atherosclerosis). ...

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 progession over decades. Combatants Major Allied powers: United Kingdom Soviet Union United States Republic of China and others Major Axis powers: Nazi Germany Italy Japan and others Commanders Winston Churchill Joseph Stalin Franklin Roosevelt Harry Truman Chiang Kai-Shek Adolf Hitler Benito Mussolini Hideki Tojo Casualties Military dead: 17,000,000 Civilian dead... 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. ...

Since the later 1980s, the best way to see atheroma and better understand atheroma behaviour in living individuals has been IVUS technology. 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, typically detecting and recognizing advanced calcification within the base of atheroma about 10 years before most individuals start having clinically recognized symptoms and debility. However, though these methods are used in research, they are not widely available to most patients, still have mild to significant technical limitations, have not been widely accepted and generally are not covered by medical insurance carriers. The 1980s refers to the years of 1980 to 1989. ... 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. ... 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. ... This article does not cite its references or sources. ... Functional Geometry Electron beam tomography is a specific form of computed axial tomography (CAT or CT) in which the X-Ray tube is not mechanically spun in order to rotate the source of X-Ray photons. ... Magnetic Resonance Image showing a vertical (sagittal) cross section through a human head. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Germans dancing on the Berlin Wall in late 1989, the symbol of the cold war divide falls down as the world unites in the 1990s. ...

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.

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). ... The immune system protects the body from infection by pathogenic organisms. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ...

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) refers to a class and range of lipoprotein particles, varying in their size and contents, which carry cholesterol in the blood and around the body, for use by cells. ... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and 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, (b) abdominal fat reduction, (c) low normal blood glucose levels (glycosylated hemoglobin, also called HbA1c, values < 5.0), (d) aerobic exercise and (e) supplements (most Rx, some OTC) to improve the odds of maintaining better health with absence of either symptoms or worse, catastrophic disease events. Binomial name Monascus purpureus (Went, 1895) Monascus purpureus (syn. ... 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. ...

Use of the newest approved statin within the United States market, rosuvastatin, especially as an addition to several other treatment strategies, has been the first to demonstrate regression of atherosclerotic plaque within the coronary arteries by IVUS evaluation^[1]. See the |ASTEROID trial, especially page 8, which shows a single IVUS image view of one individual's heart artery before and after about 2 years of 40 mg/day treatment; the total wall volume is reduced to about half due to a major decrease in the volume of atheroma. Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceuticals to lower cholesterol levels in people at risk for cardiovascular disease because of hypercholesterolemia. ... 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. ...

References

• Steven Glasgov: Compensatory Enlargement of Human Atherosclerotic Coronary Arteries, N Engl J Med, 316:131-1375, 1987
• Nissen, et. all. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis JAMA. 2006;295:(doi:10.1001/jama.295.13.jpc60002)[1], publication pending

See also

• Atherogenesis
• Atherosclerosis
• Artery
• Heart
• Coronary circulation
• Coronary catheterization
• Angiogram
• IVUS
• EBT
• Lipoprotein
• LDL, HDL, IDL and VLDL