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At the beginning of the essay, an overview of Peripheral Vascular Disease (PVD) will be given. This will be followed by the prevalence of the disease followed by the clinical factors associated. The PVD is considered to be a multifactorial disease; hence, a discussion will be done on various environmental, genetic factors as well as behavioural factors associated with this disease. Moreover, the role of fat in the development of PVD, dietary management and other care plans will be discussed as well.
Cardiovascular disease (CVD) is a general term describing diseases related to the heart as well as blood vessels. Among all of the diseases, Coronary Heart Disease (CHD) is the most common form that is caused by narrowing of blood vessels due to the accumulation of lipid inside of arteries, also known as “Atherosclerosis”. PVD is referred to as a circulatory disorder that is caused by narrowing down or complete blocking of blood vessels leading to extreme fatigue as well as pain, especially in the lower part of the body. Basically, PVD is one of the results of “Atherosclerosis”. Sometimes PVD is referred to as PAD or Peripheral Arterial Disease where due to narrowed or blocked arteries blood supply to the limbs get reduced significantly and results in excessive pain in legs also known as claudication and extreme fatigue at the same time.
According to Song et al. (2019), the prevalence of developing the PAD is almost equal in countries with high income as well low and middle income. The study has shown that the tendency of developing this disease increases directly with increased age. Around 236.62 million people are suffering from this disease and are aged 25 years or more, globally. Previously there was a concept that lifestyle diseases like CVD, PVD etc. are common in urban people or high-income group people. However, in recent years it can be seen that almost every person regardless of economic status is affected by this disease. It is equally likely to be present in both men and women even though they are below the age of 25. Several prospective and even retrospective cohort studies have already been conducted to know the reason behind this high occurrence among individuals and the result shows that negative lifestyle habits are one of the main reasons for this disease in developed and emerging countries.
One of the major reasons for PVD is atherosclerosis where the medium-sized arteries such as cerebral arteries, coronary and carotid, etc. get affected due to the accumulation of lipids. These are responsible for delivering oxygen as well as nutrients to the lower limbs via blood supply. Specifically, the iliac and femoral arteries of lower limbs are severely affected leaving pain and fatigue. Various clinical signs and symptoms of this PVD are discussed in the following.
PVD is considered to be a multifactorial disease and so, environmental, genetic, as well as behavioural factors are associated and responsible for development of this disease. The risk factors are discussed in the following.
The environment does not directly contribute to the occurrence of the disease or make it more severe. However, pollution can worsen the condition. The patient suffering from PVD, his body already facing difficulties to supply oxygen to the organs and if the pollution is excessive the person will be unable to inhale enough oxygen via lungs and that might worsen the case. Moreover, environmental stress can contribute to the complications of CVD as well as PVD and so it also can be considered to be a risk factor for this disease.
Various studies have shown that men are more prone to develop PVD than women. The main reason behind that is unhealthy lifestyle, stress, smoking, drinking alcohol, eating a lot of junk, etc. However, recent studies have indicated that women are also prone to this disease and the chances enhance after menopause. Around 67% of women in the United States develop one of the many vascular diseases after 45 years or more specifically after hitting menopause (Schramm and Rochon, 2018). Unhealthy lifestyles, lack of physical activities etc. are major reasons for PVD in both men and women.
It could be seen that abnormal ABI or “Ankle Brachial Index” is the indicator of PVD in patients. Therefore, patients having a lower systolic blood pressure of the ankle to the systolic blood pressure in arm ratio have more tendencies to develop PVD and have a phenotype of ABI. However, it is different in people belonging to black ethnicity where lower ABI is the indication of PAD prevalence. In addition, people with active thrombophilic factors have more tendencies to develop venous thrombosis. Other than that, resistance to “Activated Protein C (APC”) is one of the common reasons for “Familial Thrombophilia”. This causes mutation of the “Factor V gene” as well and the probability of PVD development increases among them.
Family history of Diabetes and Dyslipidaemia
Type 1 diabetes mellitus is developed due to the familial history of diabetes. It is considered to be “Insulin Dependent Diabetes Mellitus (IDDM)” or T1DM where very little or no insulin is produced by the body and the person suffering from this disease has to take insulin from outside to regulate the blood sugar levels. Dyslipidaemia or disproportionate levels of “Low-Density Lipoprotein (LDL)", "Very Low-Density Lipoprotein (VLDL)", triglycerides, cholesterol, "High-Density Lipoprotein" (HDL) are responsible for development of PVD. Some people have familial tendencies or genetic prevalence of developing Type 1, type 2A, 2B type of dyslipidaemia (Newman et al. 2017). Hence, this increases the occurrences of PVD among them.
A lot of studies have found out that cigarette smoking increases endothelial damage increases blood pressure as well as heart rates, increases bad lipoprotein such as LDL and VLDL responsible for carrying lipid and cholesterol from the liver to other body parts. Moreover, it decreases HDL which is considered to be a good lipoprotein as it transports lipid to the liver collecting from different body parts (Mattioli et al. 2017). Other than that, the nicotine from cigarettes is responsible for constricting the blood vessels as well which enhances the possibilities of thrombus formation which in the worst scenario can lead to a heart attack. It could be seen that people already having vascular diseases including PVD have faced relief after quitting smoking (Wang et al. 2019). Thus, it cannot be said smoking cigarettes is directly responsible for developing PVD but it contributes to the worsening of the disease.
Heavy drinking is associated with increased chances of development of PVD as it causes narrowing of blood vessels. Moreover, one gram of alcohol gives around 7.1kcal of energy which is very high as compared to carbohydrates and protein. The accumulation of excess amounts of calories, directly and indirectly, makes a person obese over time. It could be seen that obese people have more tendency of developing vascular diseases (Morley et al. 2018). However, consuming little amounts of alcohol lowers the risks of PVD as it improves smooth muscle activities and prevents the accumulation of fat inside of blood vessels. Moreover, light to medium drinking decreases the probability of strokes in individuals as well.
Lack of physical activities or a sedentary lifestyle considerably contributes to the prevalence of PVD. Moreover, stress, anxiety, heavy alcohol consumption increases the tendency of fat accumulation and make people obese (Costa et al. 2017). All of this collectively lead to high blood pressure; further proceed to atherosclerosis and sometimes to PVD.
Consumption of Junk food
Junk food is full of sugar, saturated fat as well as trans-fat. Sugar has no nutritional value and over anything, it majorly adds empty calories to the diet. Saturated fat is not good for health as it has no contribution to the body and it gets accumulated over time and makes a person obese. Similarly, trans fat is more harmful than saturated fat as once it enters into the body it cannot come out and remains for years and negatively impacts physiological functions.
Unhealthy lifestyles including lack of exercise, eating a lot of junk, etc. have majorly contributed to the development of metabolic or lifestyle diseases such as diabetes and dyslipidaemia. Several studies have already identified that T2DM or NIDDM (Non-Insulin Dependent Diabetes Mellitus) are associated with PVD (Wilcox et al. 2018). In addition, dyslipidaemia results in the accumulation of fat in the inner part of blood vessels that leads to high BP, atherosclerosis and over time it leads to PVD. In addition, the age factor is associated with this disease. People aged over 50 years are more prone to this disease; however, it is now seen in younger people as well due to an unhealthy lifestyle of genetic factors.
The fats consumed via diet are mostly triglycerides and cholesterol. The triglycerides get digested and absorbed into the body and some of them again form triglycerides after getting absorbed. Moreover, the body can produce cholesterol. Hence, there are two major sources of lipids in the body. Fat is water-insoluble and so, it requires some carriers to be carried in the blood. The lipoproteins are the compound molecules formed by protein and fat. With the help of this lipoprotein, the fat can be transported from liver to all parts of the body and from body back to the liver (Rigato et al. 2017). These lipoproteins are LDL, VLDL, Chylomicrons, as well as HDL. LDL is the main carrier of cholesterol from the liver to other parts.
Sometimes, these LDLs get stuck inside the blood vessels and decrease the relaxing or dilation effects. It makes the blood vessels narrow down as well and make them stiff over time. The VLDLs carry endogenous triglycerides and unload them to various body parts. Chylomicrons do the same action except it carries glycerols, monoglycerides, and little amounts of cholesterol as well as phospholipids. All these three types of lipoproteins are considered to be “Bad Cholesterol” as they significantly contribute to the accumulation of fat in the inner side of blood vessels (Mattioli et al. 2017). On the other hand, HDL does a completely reverse function. It transports lipid from tissues to the liver and contributes to formation of bile from cholesterol. Thus, it is a "Good Cholesterol". Therefore, if excess amounts of fat are consumed, the liver produces excess VLDL to carry those lipids. The VLDL after emptying the fat molecules to tissues is converted into LDL. The more the LDL is produced, the more the tendency to get stuck in the inner wall of blood vessels. The hyperlipidaemia and an excess amount of these modified lipoprotein fractions, and other free radicals over time accumulate inside the blood vessels and make them narrow.
Therefore, it can be summarised that as a result of hyperlipidaemia and excess amount of modified lipoprotein, the blood vessels get narrowed and can sometimes lead to endothelial injury or dysfunction. This causes the monocytes to convert into macrophages that promote the contraction of vessels. The macrophages try to engulf the accumulated LDL of inner walls and convert them into foam cells (Suzuki, 2019). This causes development of a lipid pool and leads to smooth muscle cell proliferation. The proliferation leads to thickening as well as hardening of the already narrowed blood vessels, meaning atherosclerosis develops through this process (Ghosh et al. 2017). This results in PVD and causes extreme fatigue and pain in the lower limbs.
Diet therapy should be the primary treatment plan for the patient suffering from high BP, dyslipidemia, having high triglycerides, cholesterol, LDL, as well as VLDL levels and low levels of HDL. Maintenance of good nutrition with slight modifications in the diet can help the patient to stay healthy and reduce the symptoms. The diet should be low calorie, low saturated fat and cholesterol, as well as high in “Poly Unsaturated Fatty Acid” or PUFA or omega-3 and omega-6 fatty acids (Soko?a-Wysocza?ska et al. 2018). Other modifications are discussed elaborately in the following section.
The patients suffering from type 1, type 2, and type 3 obesity calorie restricted diet is necessary to reduce some amount of total body weight. The target must be to reach Ideal Body Weight (IBW). Therefore, a diet plan must be followed according to one’s height and weight to reduce the weight and reach the goal (Kolman et al. 2017). Weight loss for obese lead to significant reduction in the workload of heart because the “Basal Metabolic Rate (BMR)” gets reduced; the heart rate gets slowed down and a considerable drop in the BP as well. Hence, it can be said that weight loss can help manage the PVD and improve cardiac efficiency.
Some dieticians prescribe a "Keto Diet" for weight loss that is low in carbohydrates and high in fat and protein. However, it is not a sustainable diet and following this long can negatively affect the kidney by too much pressure. Instead, a sustainable diet plan should be followed containing not more than 20% of the total calorie consumption. This 20% energy from fat must come from good fat only and not from saturated fat or trans-fat.
Importance of consuming PUFA
There are mainly two types of PUFA, Omega 3 and Omega 6 Fatty acids. "Alpha-linolenic acid", "Eicosapentaenoic Acid (EPA)" as well as “Docosahexaenoic acid (DHA)”are omega-3 fatty acids and “Alpha-linoleic acid” and “Arachidonic acid” are omega-6 fatty acids. PUFA promotes the esterification of cholesterol and makes it into an easily utilisable form. Arachidonic acid is the precursor of Thromboxanes, Prostacyclin, as well as Leukotrienes. Thromboxanes are considered to be “Vasoconstrictors” and Prostacyclins to be "Vasodilators" and so, help in making the blood vessels flexible and prevent lipid accumulation (Abdelhamid et al. 2018). Moreover, linoleic acid helps in transporting cholesterol and decreases the synthesis of VLDL, LDL, as well as triglycerides in the body. However, it does not play any role in increasing the levels of HDL or good cholesterol.
Inflammation is one of the major contributors to atherosclerosis and PVD. The EPA and DHA act as anti-inflammatory substances that improve the membrane fluidity of cardiac cells decrease the attachments of cytokines to their receptors and thus reducing the inflammation. The studies say, Eskimos living in "Greenland" of Japan enjoy CVD free lifestyles. The main reason behind that is consumption of large quantities of fish rich in omega-3 fatty acids (Rhee et al. 2017). Fish, especially Salmon, is rich in omega-3 fatty acids and consumption of 100-200g fish three to four times a week can help a person to prevent heart diseases including PVD. Moreover, the person already suffering from PVD can consume fish to balance the lipid profile as well. Other than that, flaxseed, Chia seeds, canola oil, soybean oil, walnut, groundnut oil as well as rice bran oil are moderate to good sources of omega-3 fatty acids and can be incorporated into the regular diet to yield a better result (Hr, 2018). HDL levels are found to be higher in those who consume fish than vegans.
Importance of consuming MUFA
MUFA plays a similar role to omega-3 fatty acids; it also helps in decreasing VLDL, LDL, triglycerides and cholesterol. On the other hand, it helps to improve the HDL levels too (Abdelhamid et al. 2018). Extra virgin olive oil, almond oil, nuts such as cashew, peanut, and avocado are some of the richest sources of MUFA.
A sufficient amount of rest is very necessary for a patient suffering from PVD. The lower limbs must be placed accordingly so that peripheral blood flow is maintained. The sleeping positions can be supine or flat depending on the patient's conditions and as suggested by the doctors. Moreover, medicines are prescribed to ensure proper blood circulation. Sometimes, the patient can undergo surgery such as bypass graft and in this case, sufficient bed rest is very necessary along with medications (Mabunda et al. 2018). The room temperature can be maintained warm and comfortable to prevent cooling of legs.
An elaborate discussion was done about the disease, its prevalence, as well as clinical factors and symptoms of PVD. Due to the accumulation of fat inside of blood vessels, the blood flow in the lower limbs gets interrupted and as a result of that pain, swelling, discolouration, and fatigue occur. Several risk factors including environmental, genetic, behavioural and other factors were discussed to understand the reason behind occurrences of this disease among individuals. It could be found that the diet one consumes plays the most significant role in the development of PVD. Therefore, in the end dietary modification recommendations were given along with additional care plans.
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