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For people who smoke, have high cholesterol levels, high blood pressure and diabetes, death and disability are likely to come in three’s – heart attack, stroke or peripheral arterial disease (PAD). These life-threatening conditions have one thing in common: they are caused by atherothrombosis.

Atherothrombosis occurs when a blood clot forms on fatty deposits in the wall of a blood vessels. The formation of a blood clot is a called thrombosis and the fatty deposit in the blood vessels is often referred to as an atheroma.

The rupture of plaques, and the subsequent development of a clot, can cause partial or complete blockage of an artery in various parts of the body. When a vessel in the heart is partially or completely blocked by a clot, the result can be a heart attack.

The same process can cause a stroke or brain attack. This process can also lead to reduction or blockage of blood flow in the arteries of the legs – a condition known as peripheral arterial disease, a significant risk factor for heart attack or stroke.

Atherothrombosis is responsible for more than 28 percent of deaths worldwide, according to the World Health Organization. In Asia, 4.5 million deaths in 2001 were attributed to atherothrombosis. In the Philippines, the prevalence of atherothrombosis is unknown, but heart attack and stroke have become the number one causes of death, accounting for more than 25 percent of all deaths in the country.

Smoking cessation, weight loss, and control of diabetes, hypertension, and dyslipidemia are essential in preventing a stroke or heart attack. However, since lifestyle modification alone is not enough, it will have to be combined with drug therapy.

It is necessary to reduce cardiovascular and cerebrovascular risks in all these patients with anti-platelet therapy. Currently available anti-agents include aspirin and clopidogrel.

Clopidogrel has been shown to be effective in multiple clinical trials in both coronary and peripheral arterial disease. Currently, clopidogrel is the only anti-platelet agent that is US FDA approved for reduction of thrombotic events in patients with established PAD.

Manila Bulletin

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