In the beautiful city of ElGouna and by the charming Red Sea, the third Aswan
Heart Centre Science and Practice Series took place from 1-2-2013 to 3-2-2013.
The conference, directed by Prof. Sir Magdi Yacoub and titled “The Unstable
Plaque”, focused on one of the major cardiovascular burdens in Egypt.
Epidemiology of cardiovascular disease was an interesting topic addressed during
the meeting. Speakers emphasized that coronary artery disease (CAD) is the major
cause of death not only in the industrialized world (Europe and North America),
but also in the developing world (Africa, Middle East, Asia and South America).
Hypertension, diabetes and smoking are the major risk factors for CAD. Moreover,
many studies prove the correlation between CAD and individual variables such as
age, sex, race and social standard.
The pathophysiology of atherosclerosis was also extensively discussed. Metabolic
imbalance and high levels of harmful fats (cholesterol and triglycerides)
circulating in the blood vessels play a major role in atherosclerosis,
especially in diabetic patients. The large fat molecules precipitate on the wall
of the blood vessels of the heart, kidneys, limbs and cerebral arteries.
Macrophages attack and swallow these molecules, but fail to degrade them. In
turn, these macrophages deposit on the vessel wall as fatty “foam cells”. With
time, the vessel wall progressively weakens by the foam cells and becomes prone
to calcium deposition, especially in hypertensive patients. This process results
in the narrowing of the arterial lumen with the subsequent decrease of blood
flow to the organ. Chest pain with exertion “angina” is an alarming symptom of
atherosclerotic CAD which is caused by insufficient coronary blood flow to
suffice the heart oxygen demand. If this weakened “unstable” vessel wall cracks,
it leads to the activation of the blood clotting cascade with the formation of a
blood clot obstructing the lumen of the artery and leading to a “myocardial
infarction”. Early revascularization (with balloon angioplasty and stenting) is
life saving in the first hours of myocardial infarction. If early
revascularization within 12 hours was not possible, part of the heart muscle
will die and become fibrotic leading to heart muscle loss and heart failure.
Therefore, it is paramount to raise public awareness on the prevention of
atherosclerosis and coronary artery disease and on the early management of acute
coronary syndromes.
As mentioned before, diabetes leads to fat deposition in the arterial wall and
atherosclerosis. The intensity, composition and the degree of instability of the
atherosclerotic plaque determine the incidence of unstable angina and myocardial
infarction. Therefore, the European and American guidelines recommend
cholesterol blood level of less than 100 mg and less than 70 mg for patients
with established coronary artery disease. The guidelines also emphasize on the
importance of exercising for 30 minutes a day and eating a diet rich in fruits
and vegetables for the prevention of Coronary Heart Disease. Intriguingly, the
correlation between metabolism, atherosclerosis and cancer was highlighted.
Studies showed that weight gain may have a positive or a negative effect on some
cancers. For example after menopause, breast cancer probability increases with
obesity. However, overweight in girls and women before menopause, protects
against breast cancer. Uterine cancer incidence increases with weight gain.
Furthermore, prostatic cancer as well as colon cancer possibility increases in
obese men. Diet rich in fish, fiber, vegetables and fruits is protective against
cancer colon.
Last, but definitely not least, there was a lecture about atherosclerosis in the
pharaohs. A team of cardiologists and Egyptian archaeologists analyzed the
multi-detector computed tomography (MSCT) scans of the hearts of ancient
Egyptian mummies. The group discovered that the ancient Egyptians had also
suffered from atherosclerosis. The Pharaohs wrote in one of the papyrus that "if
you experienced chest pain that extends to the left arm, then death is close".
Although there was no cigarette smoking in the ancient Egyptian life, exposure
to fumes at home during burning wood for warming or cooking can be one of the
possible factors that facilitated atherosclerosis.
In summary, we quote the comment of Prof. Mohamad Said Fawzy (FRCP,FACC,FESC,
prof of cardiology at 6th October University,Egypt) on the meeting: “The meeting
was a very exciting and a valuable one because it updated us about the cellular
level of atherosclerosis and its management. It stimulated young cardiologists
and allowed them direct interaction with eminent cardiologists from Egypt and
all over the world. The lecture about atherosclerosis in Egyptian mummies proves
that it is an ancient historical problem”
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