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Atherosclerosis

Atherosclerosis is a disease affecting arterial blood vessel. It is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple plaques within the arteries. Pathologically, the atheromatous plaque is divided into three distinct components: more...

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The atheroma ("lump of porridge", from Athera, porridge in Greek,) is the nodular accumulation of a soft, flaky, yellowish material at the center of large plaques, composed of macrophages nearest the lumen of the artery, sometimes with underlying areas of cholesterol crystals and possibly also calcification at the base of older/more advanced lesions.

Arteriosclerosis ("hardening of the artery") results from a deposition of tough, rigid collagen inside the vessel wall and around the atheroma. This increases the stiffness, decreases the elasticity of the artery wall. Arteriolosclerosis (hardening of small arteries, the arterioles) is the result of collagen deposition, but also muscle wall thickening and deposition of hyaline cartilage.

Calcification, sometimes even ossification (formation of complete bone tissue) occurs in the thickest parts of sclerosed vessel wall.

Some sources draw a distinction between "Arteriosclerosis", "Atherosclerosis," and "Arteriolosclerosis". In these contexts, "Atherosclerosis" is used when referring to larger arteries, and "Arteriolosclerosis" is used when referring to arterioles, with "Arteriosclerosis" used as a parent of both terms. Atherosclerosis causes two main problems. First, the atheromatous plaques causes stenosis (narrowing) of the artery and, therefore, an insufficient blood supply to the organ it feeds. This complication is chronic, slowly progressing. A common scenario is claudication from insufficient blood supply to the legs. Second, the soft plaque may suddenly rupture (see vulnerable plaque), causing the formation of a blood clot (thrombus) that will rapidly stop blood flow, leading to death of the tissues fed by the artery. This catastrophic event is called an infarction. The most common scenario is a thrombosis of a coronary artery causing myocardial infarction (a heart attack).

Symptoms

Atherosclerosis typically begins in later childhood, is usually found in most major arteries, yet is asymptomatic and not detected by most diagnostic methods during life. It most commonly becomes seriously symptomatic when interfering with the coronary circulation supplying the heart or cerebral circulation supplying the brain, and is considered the most important underlying cause of strokes, heart attacks, various heart diseases including congestive heart failure and most cardiovascular diseases in general. Atheroma in arm or more often leg arteries and producing decreased blood flow is called Peripheral artery occlusive disease (PAOD).

According to United States data for the year 2004, for about 65% of men and 47% of women, the first symptom of atherosclerotic cardiovascular disease is heart attack or sudden cardiac death (death within one hour of symptom onset).

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Influence of L-arginine on development of atherosclerosis: what is the therapeutically assured?
From Alternative Medicine Review, 6/1/05 by S.M. Bode-Boger

Bode-Boger SM. Dtsch Med Wochenschr 2005;130:593-598. [Article in German]

L-arginine is the substrate for the enzyme nitric oxide synthase (NOS), which is responsible for the production of nitric oxide (NO), an endogenous messenger molecule involved in many of the processes associated with the development of atherosclerosis. Acute and chronic administration of L-arginine has been shown to improve endothelial function in animal models of hypercholesterolemia and atherosclerosis. Therefore, a lot of studies were conducted to elucidate whether dietary L-arginine supplementation can augment NO production in man and thereby improve vascular health. In this review the results of studies of intravenous and oral L-arginine supplementation with a colorful spectrum of doses, study duration and surrogate parameters of endothelial function are summarized. The pharmacokinetics of L-arginine have been investigated, side effects are rare and mostly mild and dose-dependent. Several possible mechanisms of action of L-arginine are discussed. An assessment of L-arginine as a therapeutic agent from the point of view of a clinical pharmacologist is given.

COPYRIGHT 2005 Thorne Research Inc.
COPYRIGHT 2005 Gale Group

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