Atherosclerosis and Early Cardiovascular Disease in Childhood

What Does Atherosclerosis Mean?

Atherosclerosis is caused by the thickening or hardening of the artery walls. This thickening is caused by the accumulation of plaque on the inner walls of the arteries. Plaque buildup results in the thickening and narrowing of blood vessels and results in an inadequate supply of oxygen, which finally leads to cardiac disease.

What Is Plaque?

Plaque comprises an accumulation of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it deposits upon the arteries, the artery walls become thickened and stiff, resulting in atherosclerosis. Plaque accumulation is a prolonged process that deposits gradually in childhood and progresses rapidly at later stages.

What Is the Prevalence of Atherosclerosis?

Atherosclerosis is highly prevalent. Individuals over the age of 40, who are generally in good health, face approximately a 50 percent likelihood of developing significant atherosclerosis, with this prevalence of atherosclerosis increasing as they age. By the time individuals reach the age of 60, a majority of them exhibit some degree of atherosclerosis, although symptoms may not always be noticeable.

What Causes Accelerated Atherosclerosis?

Physicians first observed accelerated atherosclerosis, a rapid form of artery hardening, in patients undergoing heart transplants, CABG, or PTCA in the 1980s. Heart transplant patients are primarily at risk for two types of artery problems: accelerated atherosclerosis, which occurs within the first year after surgery and causes widespread narrowing of small vessels, and regular artery problems, which appear after the first year following surgery. Damage to the inner lining of the arteries constitutes the second type of injury, which can be caused by immune system reactions, viral infections, loss of nerve supply, injury prior to transplantation, and high cholesterol. Patients with cytomegalovirus infection are more likely to have premature artery hardening following transplantation.

While immune injury has been linked to type 2 injury in transplanted hearts, treatments that suppress the immune system have not been proven to lower the likelihood or seriousness of accelerated atherosclerosis in transplanted hearts. This suggests that the cause of this condition is likely due to multiple factors. Since drug-eluting stents were introduced, accelerated atherosclerosis after treating the affected blood vessel's problem area is less common.

What Are the Risk Factors for Developing Atherosclerosis and Early Cardiovascular Diseases in Children?

• Cardiovascular disease (CVD) symptoms, like myocardial infarction, stroke, and vascular disease, appear in middle age, and atherosclerosis can begin early in childhood.

• The early development of atherosclerosis in young adults is associated with many risk factors like obesity, hypertension, dyslipidemia (a condition in which there are imbalanced lipids), smoking, and the presence of specific diseases, such as diabetes mellitus and Kawasaki disease.

• So, a study indicates that preventive measures for atherosclerosis and cardiovascular diseases should be taken in childhood only.

• Early intervention reduces atherosclerosis and thus decreases the risk of cardiovascular diseases at a young or older age.

• Any damage in the arteries leads to plaque accumulation on the inner walls of the arteries. Risk factors like lifestyle habits, health conditions, or family history can lead to this damage.

• Inflammatory cells reach the damaged areas of the artery and release chemical signals. The chemical signals help cholesterol and cell waste to collect at the damaged spots. Thus, plaque deposits and the artery narrows, and as a result, it will not supply the required amount of oxygen to the vital organs, which leads to tissue damage.

• In the long term, the plaque accumulated on the inner walls of arteries can break and move into the bloodstream and lead to the formation of blood clots, which can block blood flow. If this happens, nearby tissues die due to the lack of oxygen.

Is Arteriosclerosis Considered a Congenital Condition?

Arteriosclerosis is not regarded as a congenital disorder. Congenital conditions are those that are present from birth and are frequently caused by influences during pregnancy or heredity. This disorder is marked by the accumulation of plaque that causes the arteries to harden and narrow. It is mostly linked to things like advanced age, a poor diet, inactivity, smoking, and elevated cholesterol. Arteriosclerosis can be inherited, but it usually does not develop at birth; instead, it develops gradually as a person ages and is exposed to risk factors. This condition is, therefore, not regarded as a congenital disorder.

What Raises the Risk of Atherosclerosis?

The risk factors for atherosclerosis and plaque buildup are usually associated. For example, smoking and a lack of physical activity may increase unhealthy cholesterol levels, which can lead to plaque buildup. Plaque accumulation results in decreased oxygen supply to the vital organs and extremities.

• High Blood Pressure: Over time, the artery walls get damaged due to increased blood pressure. This accumulation of plaque in the arteries results in decreased oxygen supply to the heart, leading to cardiovascular diseases.

• Diabetes: Increased sugar levels destroy the inner walls of arteries, thus resulting in plaque accumulating.

• Metabolic Syndrome: Increased cholesterol levels and triglycerides in the blood will increase the risk of plaque accumulation, ultimately resulting in atherosclerosis.

• Unhealthy Diet: Eating unhealthy foods that contain saturated fats can increase cholesterol levels, which is also a risk factor for atherosclerosis.

• Obesity: Childhood obesity is also one of the most common risk factors for atherosclerosis.

• Family History: The risk may be due to any family history of atherosclerosis or any record of hypercholesterolemia.

• Older Age: Generally, in most people, plaque buildup starts in childhood and progresses rapidly, and it may get worse as age advances. Women with polycystic ovaries and endometriosis (a condition where cells similar to the uterus or endometrium lining grow outside the uterus) are at higher risk of atherosclerosis.

• Inflammatory Diseases: Chronic conditions such as arthritis and psoriasis are inflammatory diseases, and high levels of inflammation can irritate the blood vessels, leading to plaque buildup.

What Are the Symptoms of Atherosclerosis?

Signs and symptoms may start gradually and, in later stages, progress rapidly, resulting in plaque accumulation. Signs and symptoms may differ from each other; it varies the amount of plaque deposition on the inner walls of the arteries. Plaque accumulation on the inner walls of arteries results in blockage of arteries. This blocked artery supply decreases the amount of oxygen to the vital organ failing organs.

How Is Atherosclerosis Diagnosed?

Complete clinical and medical history is recorded first. Doppler sonography is done to diagnose atherosclerosis. Also, a few other diagnostic procedures can be done as well, including:

1. Cardiac catheterization.

2. Blood pressure comparison.

3. MUGA or radionuclide angiography.

4. Thallium or myocardial perfusion scan.

5. Computerized tomography or CT scan.

How Is Atherosclerosis Treated?

Treatment of atherosclerosis includes various medical, lifestyle, and surgical methods.

• Lifestyle Modifications: Lifestyle modifications such as breaking smoking habits, healthy eating, daily exercise, controlled blood sugar levels, and controlled blood pressure will certainly decrease the risk of atherosclerosis.

• Medications: Medicines that are used in treating atherosclerosis are:

1. Antiplatelet Medicines - These medicines are used to decrease platelet action; they help in preventing clots.

2. Anticoagulants - Also called blood thinners, these differ from antiplatelet medicines in decreasing the blood's ability to clot. Examples of anticoagulants are Warfarin and Heparin.

3. Cholesterol-Lowering Medicines - These medicines reduce the fats (lipids) in the blood, particularly (LDL) cholesterol. Statins are a group of cholesterol-lowering drugs. Examples of cholesterol-lowering medications are Simvastatin, Atorvastatin, and Pravastatin.

4. Blood Pressure Medicines - Different blood pressure medicines work differently to decrease blood pressure.

• Surgical - The surgical procedures for treating atherosclerosis include:

1. Coronary angioplasty.

2. Balloon angioplasty.

3. Atherectomy.

4. Laser angioplasty.

5. Coronary artery stents.

6. Coronary artery bypass.

What Are the Complications of Atherosclerosis?

Plaque buildup in the inner walls of arteries reduces blood flow. A heart attack may occur if the blood supply is reduced to the heart. The heart muscle may not pump as well, which can lead to heart failure due to a lack of oxygen supply to the heart muscle.

Conclusion:

Atherosclerosis begins in early childhood, and the clinical manifestations of cardiovascular diseases such as myocardial infarction, stroke, and peripheral vascular disorders start in the middle ages. So proper care and lifestyle habits like regular exercise and dietary changes may help overcome atherosclerosis.