Risk Factors

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Risk Factors
Why is it that certain people get disease of the arteries leading to lost limbs, strokes or death and others seem not to so affected. There does seem to be something in the genes with certain arterial disease but there is no doubt that certain things make the relative risk of getting serious complications in the blood vessels higher. These risk factors are summarised as follows:
SMOKING Tobacco smoking affects the thickness, flow characteristics, tendency to clot of the blood and it is believed, causes damage to the endothelial lining of the blood vessels. The chances of developing serious atheromatous disease are increased tenfold in smokers.
		DIABETES MELLITUS People with sugar diabetes, particularly of long standing, have a peculiar tendency to develop calcification of their arteries. The calcification looks like a cracked eggshell and is very difficult to treat since it occurs often in the smaller vessels in the distal parts of the leg and foot. Things are compounded by the fact that diabetics are prone to infections which spread rapidly through the tissues. Infection can start off with some minor abrasion, trauma around a toenail or from a blister. Diabetes also damages the nerves which tell us when we have discomfort or pain and it is not unusual for a diabetic patient to develop a pressure sore over a bony point and not be aware of it for this reason. Loss of toes due to destruction of joints by infection following a minor ulcer over them is sadly all too common.
HYPERTENSION Atherosclerosis is definitely accelerated in people with high blood pressure and the control of hypertension is a vital activity for thousands of doctors all over the UK. The effect is not entirely worked out but it would seem reasonable to envisage that high blood pressure increases the shear stresses on the vulnerable points in the circulation by the blood flow. This may explain the increased level of coronary heart disease and cerebrovascular problems such as strokes in hypertensives.
		HYPERLIPIDAEMIA The amount of cholesterol and other fatty chemicals that we have in our bloodstream appears to affect the incidence of atheroma in the arteries and the number of people with advanced disease. There are two types of fat linked chemicals in the blood called high density (HDLP) and low density lipoproteins LDLP. The LDLP are considered harmful in excess amounts since they increase the tendency to thrombosis, are attracted to sites of endothelial damage and attract platelets which are involved with formation of clots. The HDLP appear to be protective and so the balance between the two types of lipoproteins is important.
HORMONES The effect of being a woman seems to reduce the chances of arterial disease. The feminine hormonal milieu would appear to be protective. Certain arterial problems such as aneurysms are markedly more common in men.