It’s also the commonest cause of stroke if it blocks the artery that supplies the brain with blood. It is a major problem.

There is another term called arteriosclerosis. What’s the difference?

Arteriosclerosis just implies that the arteries are hardened up and usually that may not necessarily imply that there’s a blockade. That’s the difference. In fact, ageing is an important cause of arteriosclerosis. As people age, the arteries become hardened and it’s one of the changes that the body undergoes.

Back to atherosclerosis; what is the trigger?

Basically, atherosclerosis is caused by abnormal lipids. That is the most important reason why people develop atherosclerosis. We can say that abnormal lipids are the cornerstone or cause of atherosclerosis.

How are these abnormal lipids formed in the body?

Surprisingly, we can say that the body itself manufactures the cholesterol, although, you hear a lot of emphasis being placed on dietary cholesterol and so on but the body itself synthesizes the cholesterol for its own use and it’s when it becomes excessive that it causes problems. That is the first concern.

Some people have very high levels of cholesterol. There is what is called familial dyslipidemias or hyperlipidemias and in those conditions, the body manufactures very high levels of cholesterol but dietary factors also play a role, particularly in people who have the predisposition to the development of cholesterol and if one also eats cholesterol-rich food liberally, then the risk becomes significant because the body may not be able to control the synthesis of the cholesterol. So, dietary factors are also very important.

We all know about cholesterol-rich foods; for example, lamb, beef, too much of eggs (particularly egg yolk), cooking oil with high cholesterol, and so on. Some cooking oils have high levels of cholesterol. Also, butter and raisins have high levels of cholesterol. That is why it’s important to be wary of what we eat.

Apart from food substances, our lifestyle also matters. A sedentary lifestyle is also a factor. When we eat, the body can convert some of the food to fat for storage but if one burns off some of the calories that one eats, then the likelihood of fat storage in the body becomes less. Diabetes is an important risk factor for the development of dyslipidemia. Apart from high cholesterol, another thing is the integrity of the arteries themselves.

Who are the people particularly at risk of atherosclerosis?

For some reason, some people’s cholesterol level in the blood is high, which is partly due to genetics. Some people naturally have more lipids than others. There’s a form of heredity, which sometimes may combine with environmental factors like lifestyle. For instance, someone that eats a lot of fatty foods, people with sedentary lifestyles, people living with hypertension, diabetes mellitus and cigarette smokers are at risk. Obesity is also a risk factor. To an extent, these are the most important risk factors. There are some others that are of lesser significance when you talk about control but these are the most important ones.

What are the symptoms of atherosclerosis?

It depends on where it is. Atheroma, a fatty deposit of an artery, can form in all the arterial parts we can think of. When they block the coronary arteries (the arteries that supply the heart), then, there is a risk of a heart attack. If it occurs in the arterial part that supplies the brain with blood, then there is a risk of stroke there. It can also occur in any other part of the body.

What parts of the body or organs are most vulnerable to atherosclerosis?

As I mentioned earlier, the heart and the brain are the most critical. It can also affect the other parts. It can affect the artery that supplies the kidney, for example. It can also block the artery that supplies the intestine, the big artery called aorta, and so on.

It actually can affect very important organs in the body but I can say that the arteries that supply the heart are the most critical, but also those that supply the kidney. There are two kidneys in the body. If one gets blocked, the other one can take up the function unlike the brain and the heart.

What are the complications of atherosclerosis?

The most important complication is a heart attack. In a heart attack, the muscles of the heart suffer because there is no form of blood supply to the muscle or tissues of the heart, so, the heart becomes compromised. In a heart attack basically, the heart muscle is dying and the patient will come up with severe pain. In fact, patients can describe it as the worse pain they have ever felt. Patients will stretch because of the pain and the heart may fail. Apart from pain, there will be breathing difficulty and the heart may beat abnormally- this is called arrhythmias. Unfortunately, sometimes it may lead to rupture of the heart muscles itself and surgical emergencies. It can also cause stroke and what stroke means is that the blood supply to the brain is compromised. That part (of the brain) appears to die and begin to lose its function and usually, the patient may have an impairment in the level of consciousness. The patient may even go into a coma immediately. Half of the body may become weak and so on. These are the critical ones, depending on the organs affected. Other symptoms might also come up.

How common is this condition?

Atheromatous cardiovascular disease is becoming more common now. In fact, where I work in Kano, we are experiencing an escalation of this condition and now in my team, about half of the patients will have either one form of atherosclerotic cardiovascular disease or the other. In fact, we are just wondering why we have many patients that are coming up with heart attacks. Right now, we have a 37-year-old patient with a heart attack and it has weakened the heart. He needs urgent treatment, and intervention; he may need surgery on the heart to solve the problem. So, it’s becoming more common. It is about the most common cause of heart failure. It is becoming more common and more difficult to handle because normally the treatment needs some sophisticated equipment, which is lacking in most public hospitals. These are some of the issues.

Stroke too is a common problem. It’s an important cause of not just mortality but it also deters function, such that the patient will not be able to walk and there are a lot of problems associated with that in the family and so on.

How can it be diagnosed?

For example, a patient coming down with a heart attack will come up with difficult symptoms like the ones I mentioned. So when you see a patient having chest pains, we would like to do an ECG (electrocardiography). That may help to confirm if something is wrong with the blood supply to the heart. But also, we can do some blood tests for cardiac enzymes, because when the heart muscle is dying, there may be a release of some substances into the blood, which can also significantly suggest that this is a heart attack but there are more sophisticated types of equipment like an electrocardiogram, which scans the heart to support the diagnosis.

Usually, one needs investigations that will provide an image of the arteries that supply the heart with blood. We need to image them to confirm that there’s an obstruction and that’s where we get to confirm that the patient may need some specific important treatment.

For stroke, it can be diagnosed by the symptoms and signs that the patient might come up with. Again, most of the time, an image of the brain is done which is called a brain CT scan – Computed Tomography scan of the heart is widely available now, at least in the big teaching hospitals in the country. It is also available in big general hospitals and many private hospitals.

We can diagnose it alright. Unfortunately, most of the time, patients come late at the time when much cannot be done. The level of awareness is important. People should know about this condition and that if they present early in the hospital, something can be done. For example, if someone presents a heart attack very early, some injections can be given to help open up the arteries. Specific treatments can be given that may help the patients. If there’s a delay, there’s where there’s a problem.

How is this condition treated?

As a cardiologist, you see that I talk more about heart attacks because that is of greatest concern to me and my colleagues, particularly because it is a killer and it is the number one killer in the world. In this part of Africa, it was not this common before now but now we are catching up with the rest of the world in terms of this pattern of disease. It can be treated with some drugs to quite an extent if patients come to the hospital early. If patients present with more complications and worse disease patterns or present late, then, some invasive investigation and invasive treatment, including surgical treatment may be needed. Unfortunately, this invasive investigation and treatment are not readily available. Very few centres in the country are having these facilities. In fact, in the whole of northern Nigeria, apart from Abuja, if you talk about North-East, North-Central, North-West, basically, you have very little access to these facilities. There’s a centre in Usmanu Danfodiyo University Teaching Hospital, which has started running some of these investigations. Even when available, they are expensive. The availability may be there but affordability is another issue. Even in countries where some of these things are available and patients enjoy them, there’s an insurance cover that bears the cost. That cover is very important, even when available, I’m not sure if it can cover conditions like this because, in situations where the investigations or treatments are expensive, you find out that the insurance does not cover them but this needs to be looked into by relevant authorities, particularly now that these conditions are becoming more common. Anybody can be a victim. It used to be a condition common with the aged, but not anymore.

What’s usually the first sign that gives clue about this condition?

If it relates to heart attack, chest pain in the centre of the heart. Initially, early signs come when the person has strong emotions or exercises; the patient feels pain or discomfort. At times the person may not describe it as pain but constriction. Either the person will feel severely constricted in the middle of the chest or have a choking sensation and then this pain might subsequently not be limited to a period of physical activities or strong emotions. They might even occur during very mild exertion, like talking or even during a period of rest. When it occurs during a period of rest, then we start talking about heart attack. It might start very early and progress till the end of the spectrum. Patients should not ignore chest pain. Anybody having chest pain should get it checked, particularly if it’s in the middle of the chest. Sometimes, it can radiate towards the jaw or the left arm or sometimes down into the upper part of the abdomen. So, these are some of the signs and sometimes, the patient may become breathless and the pattern of heartbeats will change. Normally we don’t feel our heartbeat but when things go wrong like a heart attack, patients may actually feel their heart pumping very hard. That’s a warning that something is wrong. When the pains become much, the patient may begin to sweat and be very restless and the patient should immediately be rushed to the hospital. These are some of the obvious signs of a heart attack.

What’s the worst-case scenario with the condition?

The worst-case scenario sometimes may be sudden death. The patient may suddenly die. Sometimes it doesn’t give time to react, so, the earlier one gets checked with these risk factors, the better. The worst-case scenario is usually a heart attack and if you see someone with a heart attack, you will really feel sorry for them because you will see the way they will be screaming and rolling on the floor because of the severity of the pain. Sometimes, it is described as the worst pain ever. Another worst-case scenario is stroke because when a stroke occurs, there’s nothing one can do; one just has to manage the effects. Some persons may go into a coma. These are some of the worst-case scenarios.

Are there other conditions that exhibit the same symptoms and how can they be differentiated?

Yes, there are mimickers of heart attack, for example, chest pain might be caused by so many other conditions but anyone who has central chest pain should please go to the hospital and get checked to know which condition it is. There are other conditions like peptic ulcers and pains occurring from other parts of the heart, not necessarily from coronary arteries. There could also be pains from the chest bone or some other internal organs.

What advice can you give on prevention?

The best way to prevent atherosclerosis is to take care of the risk factors earlier mentioned. That’s the best way. It is called primary prevention. Once you are able to identify the risk factors, take care of them before it occurs. That’s the best.

Source: healthwise