**8. Prevention**

Class I: Conditions for which there is evidence and/or general agreement that a given proce-

Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion

Class III: Conditions for which there is evidence and/or general agreement that the procedure/

ACC, American College of Cardiology; AHA, American Heart Association; CABG, coronary artery bypass grafting; CAD, coronary artery disease; LAD, left anterior descending artery; LBBB, left bundle branch block, LMC, left main coronary artery; LMCE, left main coronary equivalent; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MR, mitral regurgitation; NSTEMI, non-ST elevation myocardial infarction; PCI, percutaneous transluminal coronary angioplasty; STEMI, ST elevation myocardial infarction; VSD, ventricular septal

There are several grafts that are used in CABG. Arterial grafts such as left internal and right internal mammary artery (LIMA and RIMA), especially LIMA has got the longest patency rate (10-year patency is 95%). Radial artery can be used, but it is a muscular artery and has got

This procedure can be performed with cardiopulmonary bypass (CPB) machine (on-pump), without CPB (off-pump CABG-OPCAB), or beating heart procedures. In the last decade, minimally invasive techniques are rising to individual cases. MIDCAB (minimally invasive direct coronary artery bypass) can be performed without full median sternotomy. This can serve

TECAB: this is a robotically assisted total endoscopic coronary artery bypass procedure. This is a complex procedure; surgeon has to steep a learning curve. This procedure can perform

Awake coronary artery bypass (ACAB) procedure: This avoids side effects of general anesthesia. This includes a minimal invasive procedure without intubation and mechanical ventilatory support. A somatosensory and motor block is made via the T1–T8 level of vertebra. This

Early outcomes after CABG continue to improve, and the early cumulative mortality rate is below 2% and lower than 1% in lower-risk patients. The most common reasons for death are heart failure (65%), neurologic events (7.5%), hemorrhage (7%), respiratory failure (5.5%), and

The survival rate after isolated CABG is higher than 98% for the first month and 97% for first year, 92% for 5 years, 80% for 10 years, 65% for 15 years, and 51% for 20 years. Usage of LIMA

a predisposition to vasospasm. Vena saphena magna is the most used venous graft.

dure or treatment is useful and effective.

16 Atherosclerosis - Yesterday, Today and Tomorrow

defect [20].

about the usefulness or efficacy of a procedure.

Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.

treatment is not useful/effective and in some cases may be harmful.

minimal surgical trauma and avoid wound complication.

both on-pump and off-pump CABG.

preserves diaphragmatic ventilation.

is a predictive parameter for late survival.

dysrhythmia (5.5%).

Class IIb: Usefulness/efficacy is less well established by evidence/opinion.

Prevention of the coronary atherosclerosis has to be lifelong. Individuals need to be careful for risk factors. Adopting a healthy lifestyle. What is inside of this healthy lifestyle?

Healthy eating habit for the heart: eating habits are very important in the process of developing atherosclerosis. Healthy diet consists of low amounts of white bread, unsaturated fat products, fast foods, salt, and sugar. It also includes eating dairy products, fruits, vegetables, whole grain, seafood, poultry without skin, lean meats, low-fat milk, or fat-free milk.

After the start of healthy diet for the heart, weight control can be achieved, because overweight and obese people have high risk for coronary atherosclerosis.

Physical activity: stressful and sedentary lifestyles are the risk factors for coronary atherosclerosis. So, a programmed physical activity can improve the fitness level and the health of the individuals.

**Figure 2.** Ten year risk of fatal CVD in high risk regions of Europe by gender, age, systolic blood pressure, total cholesterol and smoking status.

onset of the first lesions begins in the first decade of the life period and proceeds with the lifetime. Risk factors are important and decisive for the progression of the atheromatous plague.

Focus on Coronary Atherosclerosis

19

http://dx.doi.org/10.5772/intechopen.77301

Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Sakarya,

[1] Go AS, Et A. Executive summary: Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation. 2013;**127**(1):143-152. DOI:

[2] Kumar V, Ak A, Fausto N, Jc A, editors. Pathologic Basis of Disease. 8th ed. Pennsylvania(Us):

[3] Hansson Gk. Inflammation, atherosclerosis, coronary artery disease. New England

[4] Falk E. Pathogenesis of atherosclerosis. Journal Of American College Of Cardiology.

[5] Kumar V, Cotran R, Robbins S. Basic Pathology. 6th ed, W.B. Saunders Company; 1997.

[8] Ck G, Jl W. Atherosclerosis. The Road Ahead. Cell. 2001;**104**:503-516. Https://Doi.Org/

[9] Ds W, Law M, Jk M. Homocysteine and cardiovascular disease: Evidence on causality

[10] Akyurek O, Akbal E, Gunes F. Increase in the risk of St elevation myocardial infarction is associated with homocysteine level. Archives of Medical Research. 2014;**45**(6):501

[11] Sara JD, Et A. High sensitivity C reactive protein is an independent marker of coronary endothelial dysfunction in patients with nonobstructive coronary artery disease. Journal

[12] Damjanov I, Linder J, editors. Anderson's Pathology. 10th ed. Missouri(Us): Elseviers; 2009

of the American College Of Cardiology 67.13 Supplement. 2018:360

Journal of Medicine. 2005;**352**:1685-1695. Doi: 10156/Nejmra043430

April 18, 2006;**47**(8 Suppl C):C7-C12. DOI: 10.1016/J.Jacc.2005.09.068

[6] Turkey Statistical Agency 2013 Statistical Analysis, 1 April 2014 Issue: 16162

A healthy and modified life is the key to prevent from the disease.

Hakan Saçlı\*, İbrahim Kara and Mehmet Kaan Kırali

10.1161/Cir.0b013e318282ab8f

Elseviers; 2010

Isbn 0-7216-5122-4

[7] World Health Organization (WHO) Data 2012

from a meta-analysis. BMJ. 2002;**325**:1202

10.1016/S0092-8674(01)00238-0

\*Address all correspondence to: mdhakans@yahoo.com

**Author details**

Turkey

**References**

**Figure 3.** Ten year risk of fatal CVD in low risk regions of Europe by gender, age, systolic blood pressure, total cholesterol and smoking status.

#### **8.1. Stopping tobacco smoking**

We have to mention about risk scores and charts. Risk scores can give us several information about the cardiac risk of our body. This can lead the person to change avoidable habits.

Framingham Risk Score: age, sex, cigarette smoking, cholesterol level, high-density lipoprotein (HDL) cholesterol level, systolic blood pressure, and usage of antihypertensive drugs. Some clinics include diabetes mellitus (DM), low-density lipoprotein (LDL) cholesterol, and diastolic blood pressure to modify this risk score.

Another risk score system is SCORE risk charts. This includes SCORE—European High Risk Chart and SCORE—European Low Risk Chart. This score system is based on gender, age, total cholesterol, systolic blood pressure, and cigarette smoking (**Figures 2** and **3**).

## **9. Conclusion**

Coronary atherosclerosis and coronary artery disease (CAD) are the most frequent causes of hospitalization in western countries. It is an important mortality and morbidity cause. The onset of the first lesions begins in the first decade of the life period and proceeds with the lifetime. Risk factors are important and decisive for the progression of the atheromatous plague. A healthy and modified life is the key to prevent from the disease.
