Internal illnesses. Atherosclerosis (most important)

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Internal illnesses. Atherosclerosis (most important)

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15. ATHEROSCLEROSIS

A disease of the body, the pathomorphological substrate of which is the accumulation of lipids in the inner and middle membranes of large and medium-sized arteries, followed by the deposition of calcium salts, the development of scar connective tissue.

Etiology and pathogenesis. Impaired lipid metabolism leads to changes in metabolism and permeability of the vascular wall. On the surface of the vascular wall, the formation of atherosclerotic plaques occurs, their ulceration, and the formation of thrombotic masses on the ulcerated surfaces. Secondary deposition of calcium salts occurs in the plaques themselves.

The main types of dyslipoproteinemia (according to G.F. Fredrikson):

1) type 1: increased chylomicron fraction, no risk of atherosclerosis;

2) type 2a: increased LDL fraction, high risk of atherosclerosis;

3) type 2b: increased fractions of LDL, VLDL (very low density), the risk of atherosclerosis is very high;

4) type 3: increased LPPP fractions (intermediate density);

5) type 4: increased VLDL fraction;

6) type 5: increased fractions of VLDL and chylomicrons. Clinic. In type 1, eruptive xanthomas, retinal lipid infiltration, recurrent pancreatitis, and hepatosplenomegaly are noted.

In type 2a, there are: lipoid corneal arch, tuberculate and tendon xanthomas, xanthelasmas.

In type 2b, there are: lipoid corneal arch, xanthelasma, hyperuricemia, impaired glucose tolerance.

Type 3 has palmar xanthomas, tuberculate xanthomas.

Type 4 has recurrent pancreatitis.

Type 5 has xanthomas, dyspnea, hepatosplenomegaly.

Diagnostic research. To determine the type of dyslipoproteinemia, a biochemical study is carried out on the levels of triglycerides, total cholesterol, HDL.

Protein metabolism is being studied (dysproteinemia, decrease in albumin, increase in g-globulin in the sclerotic stage of the course of the disease).

Treatment. Lifestyle change. It is necessary to follow a diet, exercise, monitor body weight, stop smoking.

Initially, diet 1 is prescribed according to nutritional recommendations for atherosclerosis. In the presence of predisposing factors for the development of atherosclerosis, a more rigid diet is prescribed 2 - with familial hypercholesterolemia, the presence of coronary artery disease (coronary heart disease), with the ineffectiveness of the first stage diet. Antioxidants, fish oil are used.

Carrying out drug therapy involves taking anion-exchange resins, HMG-CoA reductase inhibitors (statins), nicotinic acid, niacinamide, drugs of the fibric acid group, drugs with antioxidant properties.

In severe hypertriglyceridemia, plasmapheresis is indicated.

Forecast. Serious, especially with damage to the coronary vessels, cerebral vessels, kidneys.

Prevention. In primary prevention, it is necessary to use the regulation of diet, expand physical activity.

In secondary prevention, an annual determination of the lipid profile is used.

Author: Myshkina A.K.

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