CC BY
4
УДК .616.13
Tuychieva F. G.
Assistant of the Department of Pathological Anatomy Tashkent Pediatric Medical Institute. Tashkent city.
MODERN ASPECTS OF ATHEROSCLEROSIS Annotation: The article describes the modern aspects of atherosclerosis Keywords: atherosclerosis, medicine.
Brain stroke of atherosclerotic genesis is one of the main causes of mortality and persistent disability of patients in most countries of the world. Thus, in the United States, the incidence of stroke is 160 cases per 100 thousand population, in Europe there are 139 cases per 100 thousand inhabitants, and in Russia this figure is 382 per 100 thousand population. A close relationship between ischemic stroke, myocardial infarction and peripheral arterial disease was shown in the SARUE study. To date, the correlation between common coronary atherosclerosis and extracranial carotid atherosclerosis has been well studied. It is known that in patients with lesions of the coronary arteries the probability of a combined lesion of the carotid arteries is 31%, and in the case of a reduced left ventricular ejection fraction, the frequency of the combined lesion increases to 46%. On the other hand, coronary disease is detected in 30-60% of patients with transient cerebral circulatory disorders or stroke.
In a prospective study conducted by I. Neupap et al., It was shown that in 450 patients who were scheduled for intervention on the carotid arteries, 61% had a coronary lesion, while 29% of patients needed myocardial revascularization. Patients with a combined lesion of the coronary arteries and blood vessels that feed the brain have an increased risk of death, both from myocardial infarction and from stroke. In addition, a combined lesion of the coronary and brachiocephalic vessels, as a rule, is an age-related pathology. However, even at quite a young age, the incidence of cerebral circulatory failure can reach 30%. Clinical manifestations in the combined lesions of the coronary and internal carotid arteries, as a rule, manifest in one of the vascular pools, while the atherosclerotic lesion of the other arterial pool proceeds until a certain time asymptomatic. The strong correlation between atherosclerotic lesions of the coronary and carotid arteries explains both the high risk of transient ischemic attacks and stroke in patients undergoing coronary artery bypass surgery and the high risk of myocardial infarction in patients undergoing endarterectomy on the carotid arteries.
Aneurysms of the abdominal aorta occupy a significant place among the manifestations of atherosclerosis. The prevalence of abdominal aortic aneurysms (ABA) among the population has no tendency to decrease, despite the widespread use of methods for preventing atherosclerosis and improving methods for early diagnosis.
In the US, per 100 thousand of the population accounts for 31.9 cases of abdominal aortic aneurysms, while the incidence of diabetes, according to WHO, is 15 cases per 100 thousand people. Mortality from ABA ranges from 0.91 per 100
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thousand population per year among women, to 47.1 per 100 thousand population per year among men. Screening examination of patients with coronary artery disease showed that concomitant aneurysmal expansion of the abdominal aorta of atherosclerotic nature occurs in 4-7% of cases, and pre-aneurysmal atherosclerotic changes of the ascending aorta in 6.3 - 19.3% of cases. However, abdominal aortic aneurysms themselves can be markers of coronary artery disease, since the incidence of coronary heart disease in this category of patients ranges from 44 to 100%. In addition, it has been observed that the lesion of the ascending aorta usually occurs in patients with severe coronary artery disease - as a rule, these are patients with a trivascular lesion of the coronary arteries. Also, in these patients, damage to the trunk of the left coronary artery (50%) and damage to other, except for the coronary, vascular basins are more often recorded: the carotid arteries - 79%, the aorto-iliac arteries of the lower extremities - 98.
It is cardiovascular complications that are the cause of mortality after operations for atherosclerosis of the abdominal aorta in more than 50-70% of cases.
One of the options for the development of atherosclerosis is coronary kidney disease (UPS). UPS, as a rule, develops in patients with widespread atherosclerosis and is characterized by progressive renal failure, high risk of cardiovascular diseases and poor prognosis. A number of studies have demonstrated the frequent association of ups with atherosclerotic lesions of arteries of other localization (coronary, carotid, lower limb arteries). It is shown that patients suffering from IBP usually have a long (more than 14 years) "experience" of diabetes mellitus (DM) type 2, diabetic microangiopathy, as well as ischemic heart disease and atherosclerotic lesion of lower limb arteries.
The arteries of the lower extremities are the third most frequent localization of atherosclerosis. Peripheral atherosclerosis of the lower extremities often manifests pains in the calves of the legs when walking (intermittent claudication), which pass when stopped for 10 minutes. With the progression of the disease, pain occurs both during exercise and at rest; the appearance of pain of rest, as a rule, indicates the presence of critical ischemia of the lower extremities. In the future, with the development of the disease appear trophic ulcers; progressive critical ischemia can result in gangrene and amputation.
The prevalence of peripheral atherosclerosis in developed countries is quite high. It is known that the prevalence of chronic obliterating diseases of the arteries of the lower extremities (including peripheral atherosclerosis) is 2-5% of the total population, among the elderly - about 10-20%.
According to Eogtapeu 1.A. (1999), in the United States and Western Europe, 6.3 million people after 50 years of age have intermittent claudication. According to the Transatlantic Consensus, the frequency of occlusive-stenotic lesions in the arterial bed of the lower extremities is 300 cases per million population per year. In addition, in epidemiological studies, the majority of patients with peripheral atherosclerosis fall into the category of asymptomatic peripheral atherosclerosis, although, according to some studies, these patients have pains in the
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legs with a load that is different from the classic symptoms of intermittent claudication. The frequency of non-intermittent claudication in the case of asymptomatic peripheral atherosclerosis ranges from 30% to 45%. As for critical lower limb ischemia, among all patients with peripheral atherosclerosis, the proportion of patients with critical ischemia is 5-10%.
The relationship of atherosclerotic lesions of the coronary and main arteries of the lower extremities has not been fully studied. If CHD as the most urgent problem of modern health care is beyond doubt, then obliterating atherosclerosis of the aorta and lower limb arteries is not a life-threatening condition; nevertheless, it leads to a significant percentage of disability in patients, especially among working-age patients. It is known that the lesion of the peripheral arteries of the lower extremities and the decrease in ABI less than 0.9 are reliable subclinical factors predicting the course of atherosclerosis. Their presence is associated with an unfavorable prognosis and a high incidence of atherothrombotic complications. Atherosclerosis of the coronary arteries is detected in 90% of patients with atherosclerosis of the peripheral arteries, with hemodynamically significant stenosis in 60%. According to other data, a combination of coronary artery disease and peripheral atherosclerosis of lower limb arteries occurs in 33-74% of cases, including a combination of myocardial infarction with peripheral atherosclerosis in 18.6-22% of cases . In this case, lower limb ischemia is mainly due to occlusion of the superficial femoral arteries. A REACH study (2006) showed that the clinical manifestations of a combination of IHD and atherosclerosis of peripheral arteries occurred in 4.7% of cases, including among Russian patients in 7.5% of cases. It is noteworthy that the condition of the above-mentioned category of patients is worsening with age - thus, re-examination of patients with peripheral atherosclerosis of lower limb arteries reveals a significant increase in the number of people suffering from coronary heart disease from 44% to 72%.
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