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THE atherosclerosis is a progressive, multifactorial and multiorgan disease, of still unclear etiology and is the most frequent pathological condition that leads to cardiovascular events and even death.
The main features of the disease are the accumulation of lipids, inflammatory cells and thrombogenic factors in the walls of large arteries, resulting in the formation of atherosclerotic plaques and the occurrence of cardiovascular events, such as myocardial infarction, heart failure, arrhythmias, stroke, peripheral arteropathy, valvular diseases, sudden death, etc.
When does it appear?
Atherosclerosis already appears in fetal age and develops silently for many decades, causing, initially, changes limited to the arterial wall, which later result in the formation of atherosclerotic plaques, causing narrowing and/or occlusion of the vessel lumen, resulting in the appearance of clinical events at older ages. The rate of progression of atherosclerotic plaques is proportional to the influencing risk factors (hereditary, with the main disease being familial hypercholesterolemia, or acquired) for the development of cardiovascular diseases, which are classified into classical (smoking, dyslipidemias, diabetes mellitus, arterial hypertension), predisposing (familial history, genetic/epigenetic changes and transgenerational effects, male sex, unhealthy diet, obesity, menopause, insulin resistance and hyperinsulinemia), and younger (their significance is under investigation).
In people who are under the influence of the above-mentioned risk factors, not being diagnosed early and, therefore, not applying the corresponding therapeutic treatment leads to the occurrence of cardiovascular events at a younger age.
Prevention and treatment
Today, the prevention and treatment of atherosclerosis is focused on the treatment of classic and predisposing, but also some newer risk factors for the occurrence of cardiovascular diseases.
The treatment strategy is based on the modification of healthy-nutritional behavior (smoking cessation, healthy diet and weight control, increased physical exercise, etc.), but also on the administration of medication to stop smoking, regulation of body weight, the treatment of dyslipidemias, diabetes mellitus and arterial hypertension, as well as any established atherosclerotic disease.
However, a percentage of already treated patients still have cardiovascular events, although they are considered to be satisfactorily regulated, while the management of risk factors is considered insufficient in another, rather significant, percentage of patients.
After a thorough investigation of the pathophysiology of atherosclerosis, researches have recently turned towards the basis of the problem, i.e. in the direction of finding therapeutic solutions that target the specific etiopathological mechanisms of atherosclerosis.
They are examined future drugs, aimed at treating atherosclerosis that are being investigated in experimental animal models and some of them are already being tested in clinical trials. Such are drugs* that target adipose tissue function, inflammation and the immune system, T-cells, B-cells, epigenetic programming/transformation, the microbiome, signaling mechanisms, extracellular matrix, etc. .”, concludes Mrs. Kolovou.
*The drugs with the actions mentioned above have been analyzed in the book by Genovefas Kolovos “Atherosclerosis”, Kampyli publications, 2023.