After formation, plaques are detectable as vessel narrowing as indicated with angiography. This and related techniques only detect severe disease. However, the rupture of the plaque and arterial occlusion from thrombosis can occur within seconds or minutes with less than severe cases of atherosclerosis. Ruptured plaques are known as complicated plaques because the extracellular matrix that separates the lesion from the lining of the arterial wall is disrupted and blood flow is impaired by debris or by thrombus formation. The obstructed artery is what causes the symptoms of heart attack or stroke. Serious disease is not indicated by a certain degree of stenosis but by having an unstable or vulnerable plaque with any degree of stenosis but is vulnerable to occlusion. Things like carotid intimal media thickness measurement (by ultrasound), calcium scoring of the coronary arteries by CT scanning, and lab tests, such as a homocysteine level, hs-CRP level, lipid levels, and Hgb A1c levels will detect disease before angiography can show a significant lesion. Certain imaging that are not commonly used (such as the PET scan and the SPECT scan) can detect the severity of plaque formation. The main preventative measures in ASCVD is the avoidance of modifiable risk factors (such as smoking, obesity, and poor dietary habits). Exercise improves circulation and will decrease the patient’s chances of obesity. Statins will lower cholesterol levels and antihypertensives will decrease blood pressure. Aspirin taken daily will prevent blood clots that lead to arterial occlusion. Surgical or interventional strategies are used as prevention of complications when drugs and lifestyle modifications do not control the atherosclerosis. Treatments of ASCVD are not as effective as preventative measures. Combined approaches are more effective than singular treatments. Treatments include anticoagulation measures, anti-diabetic drugs, statin drugs, and antihypertensive drugs. Behavioral methods include increasing fruits and vegetables in the diet. Dairy product reduction has no effect. Serious cases require bypass or cardiovascular intervention procedures.
Chronic Lung Disease Chronic lung diseases are primarily secondary to smoking, although there are other causes of these diseases. The most common classification of chronic lung disease is COPD or chronic obstructive pulmonary disease, of which there are two types: chronic bronchitis and emphysema. These are terms used for different manifestations of this disease state and have slightly different symptoms. In chronic bronchitis, a productive cough must be present for two years and for at least three months each year. Tobacco smoke combined with things like air pollutions, occupational exposures, and genetics to create the disease state. Poor ventilation and cooking fires contribute to COPD in the developing part of the world. While lung testing (spirometry) is the gold standard for testing for COPD, it can mimic asthma but doesn’t improve when beta-agonists are given. About 2.4 percent of people throughout the world have COPD, primarily in patients who are older than 40 years and who smoke. More than 90 percent of deaths come from people in developing countries, where there is limited access to treatment. The incidence is increasing in developing countries because of higher smoking rates and increased longevity.
