Atherosclerosis is one of the most common killers and causes of suffering around the world,
and particularly in our society. Atherosclerosis is the most common cause of heart attack and also
a major cause of stroke. Atherosclerosis is the buildup of fatty material in the blood vessels
of the body and particularly the arteries which are the vessels that carry the oxygenated blood
to the various parts of the body. Atherosclerosis can actually cause blockages of these arteries,
that ultimately can lead to heart attack stroke or other problems. Now how do these blockages
occur? Well fatty material, cholesterol, and other things build up in the arteries to cause
slow narrowing. Then these arteries can either slowly narrow off, or actually rupture a bit like
a pimple bursts when we're adolescents. If that pimple bursts there's a sudden blood clot and
the artery blocks almost instantly causing a heart attack, stroke or other problems.
So atherosclerosis is quite a complex disease and I like to think of the cause of this disease in
two parts. The first is genetics, and the second part is environmental or acquired exposures.
So first in terms of genetics, there are thousands of genes that all contribute to
the causality of atherosclerosis and we are starting to understand more and more about
these genes. In most people with atherosclerosis it appears that these hundreds or thousands of
genes each give a minor contribution to the likelihood of acquiring the disease.
In terms of the other or environmental factors, these are things like diabetes,
high blood pressure, smoking, lack of exercise, high salt diet, and so on - all of these factors
combine to what go on to cause atherosclerosis. The symptoms of atherosclerosis can be quite
different and varied from different people. It can change from sudden death for someone who has
a heart attack and dies suddenly, to more slow and progressive symptoms like pain in the legs
when we're walking if there's atherosclerosis causing blockages of the arteries to the leg.
Other features can include angina which is a recurrent heart pain we get when we're exercising,
or people can actually go on to have kidney problems and go on to dialysis. So kidney
failure is yet another one of the features of atherosclerosis. Different ethnicities and races
tend to have different proportions of the features of atherosclerosis. Tor example, African-American
and Indigenous Australian people tend to suffer from peripheral vascular disease, or pain in the
legs when they're walking, and kidney problems. Whereas Caucasians tend to suffer more from heart
attacks and strokes. Is atherosclerosis different in men and women? Yes it is. In men it tends to
occur about a decade earlier, and it tends to also occur in association with specific risk factors
such as smoking, diabetes, and being overweight. In women atherosclerosis tends to come on about a
decade later but is also associated with specific risk factors such as high blood pressure and age.
The manifestations of atherosclerosis can also be a little bit different in men and women. Men
tend to suffer from heart attacks, women also do however the chest pain and the features of
the heart attack can be quite different between men and women .The best way to actually diagnose
atherosclerosis is before we've had any events - before we've had a heart attack or a stroke
obviously. Atherosclerosis can be fairly reliably predicted by different risk scores,
calculating risk based on things like diabetes, age, smoking status, cholesterol levels,
and so on we can fairly reliably predict who's got the most severe forms of atherosclerosis and
what their likelihood of having a heart attack, stroke, or death over the next 10-year period is.
There's other ways to diagnose atherosclerosis that also include imaging studies such as CTA
geography or invasive catheter-based angiography, such as a coronary angiogram. Atherosclerosis is
actually a fairly treatable disease and we actually now have very effective medications
that can reduce cholesterol to reduce the the amount of atherosclerosis. The medications
we're all familiar with are these statin drugs such as atorvastatin, simvastatin, rosuvastatin,
and there are even newer more powerful medications called PCKS9 inhibitors that have just come on
the market. These medications can powerfully reduce cholesterol, and also reduce the extent
of blockages. We can't fully undo the blockages, or fully stop atherosclerosis, but we can buy
medication reduce the amount of blockage. It's also important to say that we can open
blocked arteries by procedures, such as coronation bypass graft surgery - which actually bypasses a
blockage - or stenting, which can actually open a blocked artery once it's actually become occluded.
Both globally and at the Victor Chang Cardiac Research Institute there are intense efforts
underway to better understand atherosclerosis and to develop more focused target treatments.
thank you