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Treatment of High Cholesterol
And Its Consequences Consequences of uncontrolled high
cholesterol:
As plaque builds up in these arteries, blood flow is reduced. In the arteries to the heart, this process is known as coronary heart disease (CHD) or coronary artery disease (CAD). In the main arteries to the brain, it is called carotid atherosclerosis. If the arteries become completely blocked, or the plaque becomes unstable, blood flow to the heart or brain is blocked, causing a heart attack or stroke. It is estimated that 7 million American adults have CHD. While other factors such as high blood pressure, diabetes, smoking, or a family history, contribute to CHD, more than half of all heart disease is associated with lipid abnormalities. If you have high cholesterol levels, your doctor has probably already told you to improve your cholesterol profile by reducing LDL (the "bad" cholesterol) levels and increasing HDL (the "good" cholesterol) through lifestyle changes such as eating less fat, losing weight if you need to, quitting smoking, and getting more exercise. Your doctor may also recommend lipid-lowering medications. While these measures can decrease your risk of developing CHD, if it is already present or if these efforts are not successful, then you will need treatment. Catheter-based or surgical procedures can be used to remove the blockage in the arteries and restore blood flow in order to prevent heart attack or stroke. Symptoms of CHD Episodes of angina occur when the heart's need for oxygen increases beyond
what is being provided by blood flow. It is most commonly triggered by physical
exertion, when the heart has to work harder. It usually feels like a pressing
or squeezing pain, usually in the chest under the breastbone, but sometimes in
the shoulders, arms, neck, jaw, or back. Angina will usually subside with rest,
or sometimes anti-angina medication is prescribed to control the pain.
Sometimes the symptoms of angina are unusual, and it is often confused with
other disorders such as stomach upset or indigestion. The presence of angina
does not necessarily mean that a heart attack is happening, or about to happen.
It DOES mean that CHD is present.
How is CHD diagnosed?
How is CHD treated? Lifestyle changes and medications control CHD in many patients. But if
angina becomes disabling or serious blockages are discovered in the coronary
arteries, procedures that will restore blood flow, called revascularization,
may be recommended. Which procedures are done depends on the location and
extent of the patient’s blockage. They include: Angioplasty, or balloon angioplasty, begins like the angiography
procedure used to diagnose CHD. In this case, a tiny balloon attached to the
tip of the catheter is inflated and deflated to stretch or break open the
narrowing and improve the passage for blood flow. This procedure is also called
percutaneous transluminal coronary angioplasty, or PTCA.
Today up to 90% of these procedures include the placement of a metal coil
called a stent in the narrowed portion of the artery to keep it propped open.
The stent is passed to the blocked area via the balloon catheter. When the balloon
is inflated, the stent expands and locks in place where it forms a scaffold to
hold the vessel open. It stays in the artery permanently, improving blood flow
and relieving symptoms. When angioplasty and stenting are performed together,
the procedure is called percutaneous coronary intervention, or PCI.
Use of stents has improved the success of angioplasty. The coronary arteries
have a tendency to re-narrow, called restenosis, in the weeks and months
following the procedures. Restenosis occurs in about 30 to 40% of people
receiving balloon angioplasty and in about 15 to 30% of those who receive
stents. The latest research analysis of more than 1500 patients found a success
rate of 93.7% after one year; stents were used in 70% of these cases.
Newer stents are under development, including some that are coated with
drugs to help prevent restenosis. In another new procedure, patients receive
a radiation treatment at the site of the stent, which is showing promise in
preventing restenosis.
Another procedure, called atherectomy, is sometimes used before, or
in place of, balloon angioplasty. This may be done with a rotating shaver device
to shave off and remove thin strips of the plaque blocking the artery or with a
laser catheter tip which vaporizes the plaque to open the blocked artery.
If CHD severely affects more than one area of the arteries to the heart,
coronary artery bypass surgery may be considered. In this operation, a blood
vessel is taken from the leg or chest and grafted onto the blocked artery,
bypassing the area that is blocked. If more than one artery is blocked, a
bypass can be done on each. The blood then flows through the graft around the
obstruction to supply the heart with enough blood.
Usually during this type of open-heart surgery, the heart is stopped and
the blood is routed through a heart-lung machine to mimic the action of the
heart and lungs to oxygenate the blood and remove waste products.
Surgeons are developing new types of coronary surgery that are minimally
invasive, called limited access coronary artery surgery, as an alternative
to open-heart procedures. Two approaches gaining use are:
For people who are not candidates for repeat angioplasty or bypass surgery,
a procedure called transmyocardial revascularization, or TMR, is
occasionally used to increase blood flow to the heart. The surgeon uses a
laser to drill a series of holes from the outside of the heart into the heart’s
pumping chamber. The channels close up on the outside of the heart but seem to
improve blood flow to the heart muscle from within. Early results are promising,
with significant improvement of severe angina in 80 to 90% of patients one year
later.
When plaque is located in the carotid artery, which supplies blood to the
brain, the risk of stroke is increased significantly. In this case, a surgeon
can remove the plaque from the arterial wall in a procedure called a carotid
endarterectomy. Physicians are also looking into the possibility of stenting
the carotid arteries as well.
None of these procedures cure CHD. They open the vessels, improving blood
flow and relieving symptoms, but lifestyle changes or medication will still
be needed to halt the progress of the underlying disease. Related articles |
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As the world’s top supplier of commercial blood pressure monitors and health management systems, Lifeclinic is committed to helping to improve the health and wellbeing of individuals across the globe. Active monitoring of blood pressure, heart rate, weight, body fat, body mass index (BMI) and blood oxygen levels when combined with proper diet, nutrition and physical fitness can help ensure a longer, more healthy lifestyle. © 2009 Lifeclinic International, Inc. |
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Consequences |