ARTEROSCLEROSIS

DEFINITION

Atherosclerosis is a disease caused by an inflammatory response in blood vessels (large and

medium arteries), progressive in nature, which is characterized by mass deposits of collagen,
fat, cholesterol, cell waste products and calcium accompanied by myocyte ploriferation
which causes thickening and hardening of the artery walls, resulting in stiffness and fragility
of the arteries.

Atherosclerosis is strongly influenced by high cholesterol levels (especially LDL),

smoking, high blood pressure, DM, obesity, and lack of physical activity.
 Epidemiology

The process of atherosclerosis or plaque formation on the walls of blood vessels, is the
forerunner of CHD. If atherosclerosis occurs inside the arteries leading to the brain (carotid
arteries), then a stroke can occur.
According to a household health survey (1992), Coronary Heart Disease (CHD) is the number
one cause of death in Indonesia. Estimated at 53.5 per 100,000 inhabitants
The results of the 2021 national health survey showed that three out of 1,000 Indonesians
suffer from CHD. The prevalence of CHD (Coronary Heart Disease) is estimated to reach 50%
and the mortality rate reaches more than 80% which means that every 2 (two) elderly people
one has CHD and if attacked by CHD then death is so high and only 20% can be saved.
 The World Health Organization (WHO) recorded more than 11.7 million people died from
CHD worldwide in 2012. This figure is estimated to increase by 11 million people in 2030.

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RISK FACTORS

Elevated blood cholesterol levels – these include high LDL

cholesterol (sometimes called bad cholesterol) and low HDL
cholesterol (sometimes called good cholesterol).

High blood pressure – blood pressure is considered high if

it stays at or above 140/90 mmHg over a period of time.

Smoking – this can damage and tighten blood vessels, raise

cholesterol levels, and raise blood pressure – smoking also doesn't
allow enough oxygen to reach body tissues.
Overweight or obesity – overweight is having extra weight from muscle, bone,
fat, and/or water – obesity is having a high amount of extra body fat. Research by
Muscatine and Bogalusa (2010) shows that obesity in children and adolescents is
associated with several risk factors for CVS disorders including atherogenic
dyslipidemia, hypertension, ventricular hypertrophy, atherosclerosis.

Lack of physical activity – lack of activity can worsen other risk factors for
atherosclerosis.

Age – as the body ages increases the risk of atherosclerosis and/or lifestyle genetic factors
cause plaque to gradually build up in the arteries – by mid-age or so, enough plaque has built
up causing signs or symptoms; in men, the risk increases after age 45, while in women, the
risk increases after age 55.
Diabetes Millitus (DM) has been known to play an important role in the occurrence of
CVS disease in adults, Hyperglycemia and insulin resistance can cause dysfunction of
the endothelium by interfering with VLDL synthesis from the liver thereby increasing
LDL and cholesterol levels. In addition, insulin resistance is also associated with
hypertension through the retention mechanism of sodium, and sympathetic nerve
activity. Hyperinsulinemia stimulates atherogenic pack formation through smooth
muscle proliferation, LDL deposition of plaque, and connective tissue formation.

Stress – research shows that the most commonly

reported "triggers" for heart attacks are
emotionally upsetting events—specifically those
involving anger

Alcohol – heavy drinking can damage the heart muscle and worsen
other risk factors for atherosclerosis – men should not have more
than two alcohol-containing drinks a day, while women should not
have more than one alcohol-containing drink a day.
 Genetics: Manosa-binding lectins (MBL) are protein molecules
whose levels are strongly influenced by genetics and have an
important role in immune mechanisms against infection. The
MBL genotype associated with arterial structure disease is
characterized by widespread carotid plaque, increased
myocardial infarction especially if diabetes and
hypercholesterolemia are acquired. MBL deficiency leads to
inadequate or impaired clearance of atherogenic agents, so its
deposition in the arteries can lead to atherogenesis.

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 PATOFISIOLOGIS

White blood cells Moving to the artery wall Thickening spots occur
(monocytes) is converted into cells2 in the arteries
that collect fat (atheromas)

Arteries affected by atherosclerosis will

Atheroma collects calcium
lose their flexibility and as atheroma
deposits, so it becomes
continues to grow, the arteries will
brittle and can break.
narrow.

Atheroma becomes larger and narrows the

arteries more.
Pathogenesis

There are various hypotheses about the pathogenesis of atherosclerosis, including:

According to the theory of fat infiltration, as a result of high levels of low-density
lipoprotein (LDL) in plasma, there is an increase in plasma lipoprotein transport
through the endothelium Elevated fat levels in blood vessel walls The ability of
cells to take fat beyond the threshold resulting in accumulation.
The theory of endothelial trauma occurs due to various factors including
hyperlipidemia, hypertension, hormonal dysfunction, etc.
The monoclonal theory states that each atherosclerosis lesion originates from a
single smooth muscle cell that acts as a source for the proliferation of other cells.
1. The theory of clonal senescence is based on the relationship between age gain
and reduced cell replication activity in cultures

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 SYMPTOM

Chronic pain in the legs: A patient suffering from atherosclerosis generally

complains of chronic pain in the legs. The color of the legs also changes to dark and
usually cold. Due to pain, the patient may have difficulty in walking and show
lethargy in performing work.

Loss of hair on the feet: If hair is normally present on the feet and hands of the
patient, significant hair loss is seen when he suffers from atherosclerosis. A
decrease in the number of hairs is quite noticeable in such cases.

Muscle pain: The patient may feel pain in the thighs, calves, or legs; and difficult to sit or sleep
comfortably. This symptom should not be ignored and needs to be consulted by a doctor if pain
persists for a long period of time.
 Numbness of the legs: The sufferer may often find his legs become numb in case he sits in one
position for a long time. He may also feel stiffness in the muscles and feel pain to walk under such
conditions.

Fatigue: Watch for unusual fatigue. Reduced blood flow through the arteries can
cause a person to feel tired quickly for no apparent reason.

Elevated Cholesterol Levels: High cholesterol levels are one of the main warning signs associated with
atherosclerosis. A person with high cholesterol levels, should check themselves and consult a doctor about the
most appropriate method to reduce high cholesterol levels.
 DIAGNOSTIK

ABI (ankle-brachial index), dilakukan

pengukuran tekanan darah di IVUS (intravascular
pergelangan kaki dan lengan ultrasound)

skrening ultrasonik duplex

CT scan di daerah yang
terkena

arteriografi resonansi magnetik,

arteriografi di daerah yang terkena
 TREATMENT

Actions to reduce the risk of atherosclerosis, in this way the plaque formed is
not expected to increase in size, for example by:
Overcoming high blood pressure, lowering cholesterol, and controlling
diabetes.
Lifestyle changes: not smoking, eating a nutritious diet, and exercise.
Actions to overcome existing complications such as heart attack, heart failure,
kidney failure, stroke, and cramps in the limbs.
•
Measures to unobstruct atherosclerosis, for example by:
Balloon angioplasty and stend insertion e.g. on heart blood vessels. The blocked
blood vessel is opened by inflating a balloon at the end of the catheter, then a
stent is placed to keep the blood vessel open.
bypass surgery. Healthy blood vessels in a specific place, often from the leg or
chest are removed and fitted to bypass blocked arterial segments.
• Cholesterol-lowering drug therapy: The recommended drug therapy to lower
blood cholesterol levels is statins. This drug has many classes (for example:
Pravastatin, Simvastatin, Lovastatin, Atorvastatin, Cerevastatin, Fluvastatin)
 aterosklerosis

Prevention
Maintain blood cholesterol levels
Maintain ideal body weight
Lowers high blood pressure and keeps it
stable
Maintain blood sugar levels
 No smoking and quitting smoking

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 PREVENTION

Regular exercise (min 30 minutes

daily)
Avoid stress
Avoid/limit foods high in
fat/cholesterol
Multiply eating vegetables and fruits

Early Detection

1. Ct scan
Evaluating the structure of arteries is the measurement of coronary artery
calsification (CAC) using computed tomography (CT) electron beam or spiral or helical
CT.
2. Magnetic resonance imaging (MRI)
To evaluate whether the arterial plaque formed is unstable and the risk of rupture.
3. Ultrasonograph (ultrasound) is also used to evaluate the presence or absence of
atherosclerosis. By looking at the arterial structure: carotid intimal-medial thickness.
4. Evaluate the function of arteries with FMD (Flow mediated dilatation) and NED (non-
endothelium dependent)

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Penelitian

Penelitian oleh Gidding dkk pada remaja dan dewasa muda usia antara
11 s/d 23 tahun dengan riwayat hiperkolesterolemia pada keluarga
menunjukkan 7 dari 29 subjek penelitian terjadi kalsium pada
a.koronaria. Calsium lebih sering terjadi pada keadaan dimana obesitas
dan peningkatan kadar kolesterol terjadi.Pada beberapa penelitian juga
menunjukkan bahwa faktor tekanan darah sistolik, body mass index
(BMI), kolesterol LDL dan HDL adalah faktor prediktor terkuat untuk
menentukan risiko terbentuknya calsium pada a.koronaria, walaupun
berat badan dan BMI, tekanan darah diastolik dan kadar kolesterol pada
usia remaja juga dihubungkan dengan meningkatnya risiko terjadinya
kalsium pada a. koronaria (Urbina, EM et.all,2009)

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 Aterosklerosis dapat terjadi pada usia muda :
Dari 125 anak usia 15–19 tahun yang diuji
diperoleh persentase yang ada sdLDL (LDL/
ApoB ≤1,2) tinggi, hal ini membuktikan bahwa
aterosklerosis sudah bisa terjadi pada usia muda yang
diawali dengan adanya sdLDL (Nurahmi, 2006)

1. Pemberian perasan pare (Momordica charantia)

dapat menurunkan kadar kolesterol total, kolesterol
LDL, trigliserida, meningkatkan kadar HDL pada tikus
aterosklerotik,
2. Pemberian pare plus kuning telur menghasilkan
penurunan kadar kolesterol total, kolesterol HDL,
kolesterol LDL dan trigliserida (Malaya dan Pratiwi,
2008)

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 Curcumin memiliki potensi sebagai antioksidan dan anti inflamasi,
merupakan senyawa kimia utama dalam kunyit dan mudah ditemukan
dalam kehidupan sehari-hari. Hal ini berdasarkan :
1. Penelitian Shisodia, et all ( 2005) bahwa Curcumin menghambat
aktivasi faktor transkripsi NF-ĸβ yang
berperan dalam respons inflamasi.

2. Penelitian Mahfouz et all (2009) di mana Curcumin mencegah

oksidasi LDL menjadi oxLDL pada plasma
darah

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PENELITIAN TERBARU
Penelitian terbaru meyebutkan bahwa ganja dapat mengatasi aterosklerosis,dimana ditemukan
reseptor cannabinoid dimana terdapat senyawa kimia yang secara alami,terdapat lebih dari
480 kompenen alami yang ditemukan dalam tanaman cannabis sativa atau ganja.
Cannabinoid reseptor - tipe 1(CB1R) dan tipe 2(CB2r)

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 Atherosclerosis process video

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