Risk factors What Is Cholesterol? Know Your Triglyceride Numbers Microorganisms miRNAs: novel players in atherosclerotic processes Medications Classification Diagnosis Surgical procedures Lifestyle and home remedies Alternative medicine Angiotensin-converting enzyme (ACE) inhibitors The Most Common Cholesterol Meds: Statins

1. What Is Cholesterol?
Cholesterol is another necessary substance in the human body. But too much
of it can be a bad thing. There are two main types of cholesterol: high-density
lipoprotein (HDL) and low-density lipoprotein (LDL).
HDL is commonly referred to as “good” cholesterol, and you want to keep HDL
levels above 60 milligrams/dl. LDL, on the other hand, is known as “bad”
cholesterol, which is the type of cholesterol that can clot your arteries and
increase your risk for heart disease and stroke. You should keep your LDL levels
below 100 milligrams/dl.
Know Your Triglyceride Numbers
Here are the levels, based on a fasting blood test.
•Normal: Less than 150 mg/dl
•Borderline: 150 to 199 mg/dl
•High: 200 to 499 mg/dl
•Very High: 500 mg/dl or above

2. Symptoms of moderate to severe atherosclerosis depend on
which arteries are affected. For example:
•If you have atherosclerosis in your heart arteries, you
may have symptoms, such as chest pain or pressure (angina).
•If you have atherosclerosis in the arteries leading to
your brain, you may have signs and symptoms such as sudden
numbness or weakness in your arms or legs, difficulty speaking
or slurred speech, temporary loss of vision in one eye, or
drooping muscles in your face. These signal a transient ischemic
attack (TIA), which, if left untreated, may progress to a stroke.
•If you have atherosclerosis in the arteries in your
arms and legs, you may have symptoms of peripheral artery
disease, such as leg pain when walking (claudication).
•If you have atherosclerosis in the arteries leading to
your kidneys, you develop high blood pressure or kidney
failure.

3. Atherosclerosis

4. There are two types of diuretics that cause increased cholesterol
levels:
•Thiazide diuretics (including hydrochlorothiazide, chlorothiazide, metolazone)
•Loop diuretics (including furosemide, torsemide, bumetanide)
The Most Common Cholesterol Meds: Statins
•Atorvastatin (Lipitor)
•Fluvastatin (Lescol)
•Lovastatin.
•Pitavastatin (Livalo)
•Pravastatin (Pravachol)
•Rosuvastatin (Crestor)
•Simvastatin (Zocor)
Atherosclerosis-Related Diseases.
Atherosclerosis can affect any artery in the body, including arteries in
the heart, brain, arms, legs, pelvis, and kidneys

5. Risk factors
Atherosclerosis is initiated by inflammatory processes in the endothelial cells of
the vessel wall associated with retained low-density lipoprotein (LDL) particles.
The presence of the plaque induces the muscle cells of the blood vessel to stretch,
compensating for the additional bulk, and the endothelial lining thickens, increasing the
separation between the plaque and lumen. This somewhat offsets the narrowing caused
by the growth of the plaque, but it causes the wall to stiffen and become less compliant to
stretching with each heart beat
Modifiable
Diabetes
Dyslipidemia
Tobacco smoking
Trans fat[
Abdominal obesity
Western pattern diet
Insulin resistance
Hypertension[

6. Nonmodifiable
•Advanced age
•Male
•Family history
•Genetic abnormalities
Lesser or uncertain
•South Asian descent
•Thrombophilia
•Saturated fat
•Excessive carbohydrates
•Elevated triglycerides
•Systemic inflammation
•Hyperinsulinemia
•Sleep deprivation
•Air pollution
•Sedentary lifestyle
•Arsenic poisoning
•Alcohol
•Chronic stress
•Hypothyroidism
•Periodontal disease

7. Microorganisms
Microorganisms, living in the body (all together called microbiome), can
contribute to atherosclerosis in many ways: modulation of the immune
system, changes in metabolism, processing of nutrients and
production of certain metabolites that can get into blood
circulation.One of such metabolites, produced by gut bacteria,
is trimethylamine N-oxide(TMAO). Its levels have been associated with
atherosclerosis in human studies and animal research suggest that there can be a
causal relation. An association between the bacterial genes encoding
trimethylamine lyases — the enzymes involved in TMAO generation — and
atherosclerosis has been noted.
Some controversial research has suggested a link between atherosclerosis and the
presence of several different nanobacteria in the arteries, e.g., Chlamydophila
pneumoniae though trials of current antibiotic treatments known to be usually
effective in suppressing growth or killing these bacteria have not been successful
in improving outcomes

8. •miRNAs: novel players in atherosclerotic
processes

9. •Cholesterol medications. Aggressively lowering your low-density
lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even
reverse the buildup of fatty deposits in your arteries. Boosting your high-
density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too.
•Your doctor can choose from a range of cholesterol medications, including
drugs known as statins and fibrates. In addition to lowering cholesterol, statins
have additional effects that help stabilize the lining of your heart arteries and
prevent atherosclerosis.
•Anti-platelet medications. Your doctor may prescribe anti-platelet
medications, such as aspirin, to reduce the likelihood that platelets will clump in
narrowed arteries, form a blood clot and cause further blockage.
•Beta blocker medications. These medications are commonly used for
coronary artery disease. They lower your heart rate and blood pressure,
reducing the demand on your heart and often relieve symptoms of chest pain.
Beta blockers reduce the risk of heart attacks and some heart rhythm problems.
Medications

10. •Angiotensin-converting enzyme (ACE) inhibitors. These
medications may help slow the progression of atherosclerosis
by lowering blood pressure and producing other beneficial
effects on the heart arteries. ACE inhibitors can also reduce the
risk of recurrent heart attacks.
•Calcium channel blockers. These medications lower blood
pressure and are sometimes used to treat angina.
•Water pills (diuretics). High blood pressure is a major risk
factor for atherosclerosis. Diuretics lower blood pressure.
•Other medications. Your doctor may suggest certain
medications to control specific risk factors for atherosclerosis,
such as diabetes. Sometimes specific medications to treat
symptoms of atherosclerosis, such as leg pain during exercise,
are prescribed.

11. Classification
The class of antiplatelet drugs include:
Irreversible cyclooxygenase inhibitors
•Aspirin
•Triflusal (Disgren)
Adenosine diphosphate (ADP) receptor inhibitors
•Clopidogrel (Plavix)
•Prasugrel(Effient)
•Ticagrelor (Brilinta)
•Ticlopidine (Ticlid)
Phosphodiesterase inhibitors
•Cilostazol (Pletal)
Protease-activated receptor-1 (PAR-1) antagonists
•Vorapaxar (Zontivity)

12. Glycoprotein IIB/IIIA inhibitors (intravenous use only)
•Abciximab (ReoPro)
•Eptifibatide (Integrilin)
•Tirofiban (Aggrastat)
Adenosine reuptake inhibitors
•Dipyridamole (Persantine)
Thromboxane inhibitors
•Thromboxane synthase inhibitors
•Thromboxane receptor antagonists
•Terutroban
Beta blocker medications
These medications are commonly used for coronary artery disease. They
lower your heart rate and blood pressure, reducing the demand on your
heart and often relieve symptoms of chest pain. Beta blockers reduce the
risk of heart attacks and some heart rhythm problems.

13. β1-selective beta blockers are also known as
cardioselective beta blockers.
•Acebutolol (has intrinsic sympathomimetic activity, ISA)
•Atenolol.
•Betaxolol.
•Bisoprolol.
•Celiprolol (has intrinsic sympathomimetic activity)
•Metoprolol.
•Nebivolol.
•Esmolol.
Calcium channel blockers.
These medications lower blood pressure and are sometimes used to
treat angina.

14. Classes •Dihydropyridine
Dihydropyridine (DHP) calcium channel blockers are derived from the
molecule dihydropyridine and often used to reduce systemic vascular resistance and
arterial pressure. Sometimes when they are used to treat angina, the vasodilation and
hypotension can lead to reflex tachycardia, which can be detrimental for patients
with ischemic symptoms because of the resulting increase in myocardial oxygen demand
•Amlodipine (Norvasc)
•Aranidipine (Sapresta)
•Azelnidipine (Calblock)
•Barnidipine (HypoCa)
•Benidipine (Coniel)
•Cilnidipine (Atelec, Cinalong, Siscard) Not available in US
•Clevidipine (Cleviprex)
•Efonidipine (Landel)
•Felodipine (Plendil)
•Isradipine (DynaCirc, Prescal)
• Lacidipine (Motens, Lacipil)
•Lercanidipine (Zanidip)
•Manidipine (Calslot, Madipine)
•Nicardipine (Cardene, Carden SR)
•Nifedipine (Procardia, Adalat)

15. Phenylalkylamine calcium channel blockers are relatively selective for
myocardium, reduce myocardial oxygen demand and reverse coronary
vasospasm, and are often used to treat angina. They have minimal vasodilatory
effects compared with dihydropyridines and therefore cause less reflex
tachycardia, making it appealing for treatment of angina, where tachycardia
can be the most significant contributor to the heart's need for oxygen.
Therefore, as vasodilation is minimal with the phenylalkylamines, the major
mechanism of action is causing negative inotropy. Phenylalkylamines are
thought to access calcium channels from the intracellular side, although the
evidence is somewhat mixed.
•Fendiline
•Gallopamil
•Verapamil (Calan, Isoptin)
Non-dihydropyridine
•Phenylalkylamine

16. Benzothiazepine
Benzothiazepine calcium channel blockers belong to the benzothiazepine class of
compounds and are an intermediate class between phenylalkylamine and
dihydropyridines in their selectivity for vascular calcium channels. By having both cardiac
depressant and vasodilator actions, benzothiazepines are able to reduce arterial pressure
without producing the same degree of reflex cardiac stimulation caused by
dihydropyridines.
•Diltiazem (Cardizem) (also used experimentally to prevent migraine)
Nonselective
While most of the agents listed above are relatively selective, there are additional agents
that are considered nonselective. These
include mibefradil, bepridil, flunarizine (BBB crossing), fluspirilene (BBB
crossing), and fendiline.
Others
Gabapentinoids, such as gabapentin and pregabalin, are selective blockers of α2δ
subunit-containing voltage-gated calcium channels. They are used primarily to
treat epilepsy and neuropathic pain.

17. Water pills (diuretics).
High blood pressure is a major risk factor for atherosclerosis.
Diuretics lower blood pressure.
Examples of diuretics include:
•Loop diuretics, such as Lasix (furosemide), bumetanide, Demadex
(torsemide), and Edecrin (ethacrynic acid)
•Thiazide diuretics, like Microzide (hydrochlorothiazide),
chlorthalidone, and Zaroxolyn (metolazone)
Other medications.
Your doctor may suggest certain medications to control specific risk
factors for atherosclerosis, such as diabetes. Sometimes specific
medications to treat symptoms of atherosclerosis, such as leg pain
during exercise, are prescribed.

18. Diagnosis
During a physical exam, your doctor may find signs of narrowed, enlarged or
hardened arteries, including:
•A weak or absent pulse below the narrowed area of your
artery
•Decreased blood pressure in an affected limb
•Whooshing sounds (bruits) over your arteries, heard using a
stethoscope
Depending on the results of the physical exam, your doctor may suggest one or
more diagnostic tests, including:
Blood tests. Lab tests can detect increased levels of
cholesterol and blood sugar that may increase the risk of
atherosclerosis. You'll need to go without eating or drinking
anything but water for nine to 12 hours before your blood
test.

19. Doppler ultrasound. Your doctor may use a special ultrasound
device (Doppler ultrasound) to measure your blood pressure at
various points along your arm or leg. These measurements can help
your doctor gauge the degree of any blockages, as well as the speed
of blood flow in your arteries.
Ankle-brachial index. This test can tell if you have
atherosclerosis in the arteries in your legs and feet.
Your doctor may compare the blood pressure in your ankle with the
blood pressure in your arm. This is known as the ankle-brachial index.
An abnormal difference may indicate peripheral vascular disease,
which is usually caused by atherosclerosis.
Electrocardiogram (ECG). An electrocardiogram records
electrical signals as they travel through your heart. An ECG can often
reveal evidence of a previous heart attack. If your signs and
symptoms occur most often during exercise, your doctor may ask you
to walk on a treadmill or ride a stationary bike during an ECG.

20. Stress test. A stress test, also called an exercise stress test, is used to
gather information about how well your heart works during physical activity.
Because exercise makes your heart pump harder and faster than it does
during most daily activities, an exercise stress test can reveal problems within
your heart that might not be noticeable otherwise.
An exercise stress test usually involves walking on a treadmill or riding a
stationary bike while your heart rhythm, blood pressure and breathing are
monitored.
Cardiac catheterization and angiogram. This test can show if
your coronary arteries are narrowed or blocked.
A liquid dye is injected into the arteries of your heart through a long, thin tube
(catheter) that's fed through an artery, usually in your leg, to the arteries in
your heart. As the dye fills your arteries, the arteries become visible on X-ray,
revealing areas of blockage.
Other imaging tests. Your doctor may use ultrasound, a
computerized tomography (CT) scan or magnetic resonance angiography
(MRA) to study your arteries. These tests can often show hardening and
narrowing of large arteries, as well as aneurysms and calcium deposits in the
artery walls.

21. Surgical procedures
If you have severe symptoms or a blockage that threatens muscle or skin
tissue survival, you may be a candidate for one of the following surgical
procedures:
Angioplasty and stent placement. In this procedure, your doctor inserts
a long, thin tube (catheter) into the blocked or narrowed part of your artery. A
second catheter with a deflated balloon on its tip is then passed through the
catheter to the narrowed area.
The balloon is then inflated, compressing the deposits against your artery
walls. A mesh tube (stent) is usually left in the artery to help keep the artery
open.
Endarterectomy. In some cases, fatty deposits must be surgically removed
from the walls of a narrowed artery. When the procedure is done on arteries
in the neck (the carotid arteries), it's called a carotid endarterectomy.
Fibrinolytic therapy. If you have an artery that's blocked by a blood clot,
your doctor may use a clot-dissolving drug to break it apart.
Bypass surgery. Your doctor may create a graft bypass using a vessel from
another part of your body or a tube made of synthetic fabric. This allows
blood to flow around the blocked or narrowed artery.

22. Lifestyle and home remedies
•Exercise most days of the week. Regular exercise can condition your muscles to use
oxygen more efficiently.
•Physical activity can also improve circulation and promote development of new blood
vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps
lower blood pressure and reduces your risk of diabetes.
•Aim to exercise at least 30 minutes most days of the week. If you can't fit it all into one
session, try breaking it up into 10-minute intervals.
•You can take the stairs instead of the elevator, walk around the block during your lunch
hour, or do some sit-ups or pushups while watching television.
•Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains —
and low in refined carbohydrates, sugars, saturated fat and sodium — can help you control
your weight, blood pressure, cholesterol and blood sugar.
•Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana
or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the
amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or
eliminate sugar and sugar substitutes.

23. Lose extra pounds and maintain a healthy
weight. If you're overweight, losing as few as 5 to 10
pounds (about 2.3 to 4.5 kilograms) can help reduce your
risk of high blood pressure and high cholesterol, two of the
major risk factors for developing atherosclerosis.
Losing weight helps reduce your risk of diabetes or control
your condition if you already have diabetes.
Manage stress. Reduce stress as much as possible.
Practice healthy techniques for managing stress, such as
muscle relaxation and deep breathing.
Stop smoking. Smoking damages your arteries. If you
smoke or use tobacco in any form, quitting is the best way
to halt the progression of atherosclerosis and reduce your
risk of complications.

24. Alternative medicine
It's thought that some foods and herbal supplements can help reduce your high
cholesterol level and high blood pressure, two major risk factors for developing
atherosclerosis.
•Alpha-linolenic acid (ALA)
•Barley
•Beta-sitosterol (found in oral supplements and some margarines, such as
Promise Activ)
•Black tea
•Blond psyllium (found in seed husk and products such as Metamucil)
•Calcium
•Cocoa
•Cod liver oil
•Coenzyme Q10
•Fish oil
•Folic acid
•Garlic
•Green tea
•Oat bran (found in oatmeal and whole oats)
•Sitostanol (found in oral supplements and some margarines, such as Benecol)
•Vitamin C