Aterosclerosi
Table of Contents
Definizione
L’aterosclerosi è una malattia infiammatoria cronica delle arteriedi grande e medio calibro, caratterizzata da deposizione di lipidi nell’intima, che conduce alla formazione di placche giallastre, denominate ateromi, seguite daproliferazione di fibre elastiche, atrofia del tessuto connettivoe da calcificazione. Il processo progredisce dall’ intima verso la media. L’aterosclerosi colpisce le arterie di grosso e medio calibro ed è responsabile della maggior parte della patologia coronarica, cerebrovascolare, aortica e delle arterie degli arti inferiori.
Epidemiologia
L’aterosclerosi rappresenta la principale causa di morte e disabilitànelle società sviluppate. Negli Stati Uniti 13 milioni di persone sono affette da cardiopatia ischemica. Inoltre, le stime attuali suggeriscono che anche per l’anno 2020 le malattie cardiovascolari che rappresentano le manifestazioni cliniche dell’aterosclerosi, saranno la più comune causa di morte in tutto il mondo.
Fattori di rischio
L’aterosclerosi è causata dal concorso di molteplici fattori, tra i fattori di rischio più importanti troviamo:
- Dislipidemia: esiste un’associazione lineare fra livelli di colesterolemia e incidenza delle manifestazioni cliniche dell’aterosclerosi coronarica (infarto miocardico, angina pectoris, morte improvvisa). In particolare esiste un rapporto diretto fra valori ematici di colesterolo LDL o “colesterolo cattivo” e rischio cardiovascolare, mentre l’associazione fra valori ematici di colesterolo HDL “colesterolo buono” il rischio cardiovascolare è inverso, cioè maggiori sono questi valori minore è il rischio.
- Iprocolesterolemia: livello eccessivo di colesterolo LDL nel sangue, il noto colesterolo cattivo nel sangue.
- Ipertensione arteriosa: l’aumento della pressione sistolica (sopra 140 mmHg) e quella della pressione diastolica (oltre 90 mmHg) sono fattori di rischio indipendenti l’uno dall’altro. Studi epidemiologici hanno dimostrato che in una certa popolazione, i soggetti che si trovano nel 20% superiori nella curva di distribuzione delle pressioni arteriose hanno una mortalità cardiovascolare 4 volte superiore a quella dei soggetti che si trovano nel 20% della parte inferiore della curva di distribuzione.
- Fumo:le cause della relazione tra fumo di sigaretta e aterosclerosi sono complesse. I fumatori sono caratterizzati da elevati livelli ematici di fibrinogeno, associata ad una più alta incidenza di eventi cardiovascolari, probabilmente per un effetto protrombotico, e da iperattività piastrinica. Inoltre, i fumatori sono più frequentemente soggetti a infezioni delle vie respiratorie, che possono aumentare il rischio di eventi vascolari potenziando l’attivazione delle cellule infiammatorie.
- Obesità: l’obesità è determinata dalla mancanza di attività fisica e dall’assunzione di una dieta ipercalorica. Indagini epidemiologiche recenti hanno quantificato l’impatto del sovrappeso e dell’obesità su mortalità prematura, malattie cardiovascolari, diabete mellito di tipo 2, neoplasie, malattie croniche respiratorie e altre ancora. Esiste un’ associazione lineare per rischio cardiovascolare e indice di massa corporea (BMI Body-Mass Index) e un’associazione ancora più stretta con l’obesità addominale (circonferenza addominale misurata subito al di sotto delle coste). L’obesità aumenta il rischio di insorgenza di malattie cardiovascolari in parte perché associata ad altri fattori di rischio come l’ipercolesterolemia,ipertensione arteriosa,iperglicemia, in parte per effetto eterogeneo diretto.
- Sedentarietà:l’inattività fisica rappresenta un altro potente fattore di rischio cardiovascolare. La sedentarietà aumenta il rischio in parte perché associata alla presenza di altri fattori di rischio quali l’ipertensione, obesità e diabete e in parte perché viene a mancare l’effetto protettivo dell’attività fisica. Infatti l’aumento della velocità di scorrimento del sangue nelle arterie durante l’attività fisica promuove la sintesi di proteine che aumentano la biodisponibilità di ossido nitrico, il quale, ha una potente azione antiaterogena. Un’attività fisica regolare riduce anche il rischio di diabete.
- Ereditarietà: esistono famiglie predisposte agli accidenti cardiovascolari, alla cardiopatia ischemica.
- Diabete mellito.
Sintomi
La lesione aterosclerotica, non complicata, può restare asintomatica, a meno che non raggiunga dimensioni tali da ostruire il lume del vaso in modo significativo. Un’ importante conseguenza clinica dell’aterosclerosi è rappresentata dalla possibile formazione locale di trombi, con
ostruzione completa o pressoché completa di un’arteria.
- Laclaudicatio intermittensè il sintomo più comune, definito comedolore, crampo, intorpidimento o senso di affaticamento muscolare durante esercizio fisico e attenuato dal riposo. La sede dellaclaudicatio è distale allalocalizzazione della lesione occlusiva.
- Dolore a riposo, sensazione di freddo e intorpidimento di piedie dita. Frequentemente questi sintomi sono presenti durante la notte quando le gambe sono in posizione orizzontale, i sintomi migliorano quando le gambe sono in posizione declive.
- Impotenza negli uomini.
- Difficoltà di parola,balbettio inspiegabile.
- Infarto oictus quando il distaccamento di un trombo blocca completamente la circolazione o si stacca dalle pareti.
- Cute sottile e lucida.
- Ispessimento delle unghie.
Modificazioni dello stile di vita
La prevenzione dell’aterosclerosi rappresenta una sfida a lungo termine per tutti gli operatori in campo sanitario così come per le politiche di sanità pubblica. Lo sforzo consiste nell’ ottimizzare il profilo di rischio dei singoli individui prima che la malattia aterosclerotica divenga manifesta. Uno stile di vita ottimale per minimizzare il rischio di malattie cardiovascolari è basata su tre principi fondamentali:
- Astensione completa dal fumo;
- Assunzione di una dieta che mantenga l’indice di massa corporeatra 20 e 20 kg/m2 e il girovita < 102 cm negli uomini e <88 cm nelle donne;
- Un’attività fisica moderata-intensadi almeno 30 minuti almeno per cinque volte alla settimana;
- Una dieta ottimaledovrebbe prevedere un’adeguata assunzione di frutta, verdure e pesce. Anche una moderata assunzione di vino, un bicchiere di vino a pasto è associato una riduzione del rischio di eventi cardiovascolari;
- Non vi è alcuna evidenza che l’assunzione di integratori alimentari,in particolare di vitamina A riduca il rischio di eventi cardiovascolari (in alcuni casi potrebbero addirittura aumentarlo).
L’educazione sanitaria e uno stile di vita ottimale iniziando in età pediatrica riducono non solo il rischio di eventi cardiovascolari gravi, ma anche la necessità di interventi farmacologici.
Articoli correlati:
- Calcola il tuo BMI:Indice di Massa Corporea
- Colesterolo: le novità per abbassarlo
- Colesterolo: le novità per abbassarlo
- Ipercolesterolemia
- Diabete
- Glicemia: valori
- Ipertensione
- Attività fisica e sedentarietà
- Obesità e sovrappeso
- ORMONE DELLA CRESCITA E ATEROSCLEROSI
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