Cholesterol

Cardiovascular disease

Atherosclerosis eventually leads to cardiovascular disease (CVD), resulting in a variety of clinical manifestations including coronary heart disease (CHD), cerebrovascular disease and peripheral vascular disease (PVD). CVD is the leading cause of death in Europe, accounting for over 4.3 million deaths a year.¹ Nearly half (48%) of all deaths are from CVD (54% of deaths in women and 43% of deaths in men).¹ The most significant clinical manifestation, in terms of morbidity and mortality, is CHD.

Coronary heart disease:
Restriction of blood flow to the myocardium can be caused by an atherosclerotic plaque narrowing the lumen of the coronary arteries. If the diameter of the coronary artery is reduced significantly, ischaemia will develop and the patient will experience tightness or crushing pain in the chest (angina pectoris). However, pain does not always accompany myocardial ischaemia: this is called silent ischaemia. Coronary plaque rupture and erosion have been shown to result in thrombus formation within coronary arteries. Complete obstruction of the blood flow, either due to a thrombus or by a large atherosclerotic plaque, can cause death to part of the myocardium, resulting in a myocardial infarction (MI). Depending on the magnitude or site of the damage to the myocardium the pumping action of the heart may be impaired and/or the heart rate and rhythm may become disturbed. These can result in congestive heart failure or, if very severe, sudden cardiac death.

Cerebrovascular disease:
Narrowing of the carotid, vertebral and cerebral arteries supplying blood to the brain can cause a brief interruption in the blood supply to the brain resulting in a transient ischaemic attack. This may cause temporary impairment of vision, speech, sensation or movement and may be followed by a stroke. A stroke can also be caused by formation of a thrombus or embolus, arterial rupture or haemorrhage of the cerebral arteries stopping the oxygen supply to parts of the brain. Sudden loss of consciousness often occurs with subsequent paralysis of parts of the body. This can lead to permanent damage and disability or sudden death.

Peripheral vascular disease:
When the arteries such as the femoral and iliac arteries supplying blood to the legs become significantly narrowed, symptoms of intermittent claudication become evident. These include cold and painful feet, and an aching or cramping pain in the legs when walking, which occurs when insufficient oxygen is reaching the muscles in the legs. In advanced cases of peripheral arterial disease, blood supply to the legs can become completely blocked, and painful leg and foot ulcers may develop. If left untreated, gangrene may eventually ensue, requiring amputation of the affected limb.

Reference:
1. European Cardiovascular Disease Statistics 2008 Edition, British Heart Foundation