Dr. Guyton is recognized nationally as an expert in clinical management of lipid disorders and a leader in postgraduate education in this area. Both nationally and internationally, Dr. Guyton is known for his work on lipid deposition in the arterial wall.
His work is exceptionally understandable and is available in PDF format for download. For ease of readability, separate sections will be presented on this website. Please see the chapters menu to the right.
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Introduction
Atherosclerosis is a disease of arteries that causes more death and disability than any other disease in the industrialized world, more than all types of cancer combined. Atherosclerosis is known by several other names - arteriosclerosis (though technically arteriosclerosis also includes some other rare and minor arterial conditions), hardening of the arteries, cholesterol deposits in the arteries, and arterial blockages. Coronary heart disease is the result of atherosclerosis in the coronary arteries, which supply the heart muscle. We will discuss below how the slow development of coronary atherosclerosis over decades can result in a sudden, severe event - a heart attack - that takes only minutes to happen. The most common cause of strokes is atherosclerosis in an artery supplying the brain.
In this article, we will see how the cells of artery wall, including the lining cells (endothelial cells), special muscle cells (smooth muscle), and inflammatory cells participate in atherosclerosis. Cholesterol carried by lipoproteins in the blood enters the artery wall and builds up in enormous amounts, leading to tissue damage, inflammation, and fibroproliferative scarring. Breakdown of tissue in the inner part of the artery wall sets the stage for blood clots that cause heart attacks and strokes.
Medical research has found opportunities for treatment and prevention. Coronary bypass operations and heart catheterization balloon and stent procedures can relieve the pain of blocked coronary arteries, but these operations and procedures do not prevent future heart attacks very well at all. Instead, we have come to understand that most heart attacks and many strokes can be prevented by medical treatment. Effective treatment includes the right kind of diet and lifestyle, drugs that change cholesterol-carrying lipoproteins, and drugs such as aspirin that partially block blood clotting. This article will try to show how effective medical treatment can be, although we do not have time and space to discuss detailed treatment plans. Reversal of arterial blockage by medical treatment is slow and difficult. However, by removing cholesterol from atherosclerotic plaques, the tendency of the plaques to break down, rupture, and cause clots can be greatly reduced. This may be the reason that heart attacks and strokes can be largely prevented.
Finally, we will look at the interesting way the calcium is involved in atherosclerosis. At this time, calcium does not seem to be as big a player as cells, cholesterol, and clotting. There is no reason to think that chelation therapy works in the treatment of atherosclerosis. Yet calcium does offer the possibly of detecting and measuring coronary atherosclerosis at an early and very treatable stage.
John R. Guyton, MD