Arteries are the vessels that supply blood to the various organs of the body.

The arteries of the heart branch off on it in the form of a crown and are called coronary arteries. The wall of the arteries consists of three coats: the inside, the middle and the outside.

Atherosclerosis is a disease of the arteries and consists of the deposition of fat in the middle sheath, in the form of a plaque, which is called atherosclerotic plaque and consists of the nucleus and the fibrous capsule (fig.1).

The formation of atherosclerotic plaque begins in childhood with the deposition of fat cells in the wall and the formation of white lines.

In adolescence, some of these lines turn into fibrous plaques, which are harmless but some of them will later form the substrate for the formation of atherosclerotic plaques (fig.2).

According to autopsy, studies in people who died in a car accident or in soldiers killed in World War I and the Korean War, atherosclerosis of the coronary arteries exists from the age of 18-20 years but manifests itself after the age of 35-40 years.

The manifestation of the disease depends on:

1.  the degree of obstruction, which must be more than 75% of the transverse diameter of the lumen of the artery; and
2. the irrigated organ.

If the vessels of the lower extremities are blocked by the atherosclerotic plaque, the symptoms will be intermittent lameness (appearance of pain when walking, which gradually disappears after stopping walking), gangrene.

If the arteries in the brain become blocked, the symptom will be a stroke (hemiplegia). If the arteries of the heart (coronary arteries) become blocked, the manifestation will be angina pectoris (the appearance of back pain in fatigue, which gradually disappears with rest) or with the well-known myocardial infarction, or with first and last symptom the sudden death.

The cause of atherosclerosis of the arteries is unknown. After many studies in population groups, it has been observed that it occurs more often in people who have risk factors for atherosclerosis of the arteries. These risk factors are hereditary (there is a hereditary predisposition), age (occurs more often with advancing age), gender (occurs more often in men than women). The above three are called “non-modifiable factors”.

It is also more common in people who smoke, have high blood cholesterol, high blood pressure, diabetes, are obese, anxious and lead a sedentary lifestyle. The above are called modifiable agents. It has been observed that the more risk factors a person has, the more likely he/she is to suffer atherosclerosis of the arteries.

Primary Prevention

Since atherosclerosis of the arteries begins in childhood and the cause is unknown, prevention (which in this case is called primary) should begin in childhood, based on the quadruple:

• proper nutrition (mediterranean diet)
• avoid smoking
• maintaining an ideal body weight (the ideal body weight in a man is: from the height in centimeters we subtract 100, and in a woman 105) and
• maintaining good physical activity with daily exercise.

The above quadrilateral that eliminates the modifiable risk factors will be applied to the home-school axis, because the child there consumes most of the day. In this effort, the main role will be played by the family, the school, the media and health managers (doctors, pharmacists, nurses).

Secondary prevention

If a person becomes ill, then an effort will be made to prevent the disease from recurring (Secondary prevention). The person must apply all the above for primary prevention and in addition receive the appropriate treatment that will be recommended by the treating physician. It should be emphasized that in secondary prevention, the patient must now follow all the instructions to the letter, because the result of the relapse of the disease can be fatal.

Figure1: cross section of an artery with atherosclerosis where we see the fatty nucleus (black arrows) and the capsule (red arrows)

Figure2: progressive growth of atherosclerotic plaque, where its onset is placed in childhood and manifests itself after the 35th -40th year of life.

Advises Ms. Olga Ioanna Lioliou, Pharmacist