Atherosclerosis

Atherosclerosis

Atherosclerosis is a disorder in which arterial wall stiffens and loses its elasticity caused by the formation of thickening (atherosclerotic plaque) in its inner layers, which can reduce or obstruct blood flow. Although it is more common in the male population, its prevalence increases in women after the menopause and equalizes with the prevalence of the men of the same age.

Atherosclerosis affects heart, brain, kidneys and other vital organs and extremities and thus represents the leading cause of illness and mortality in the US and most Western countries. Mortality due to coronary heart disease among white males between the age of 55 and 65 is 1 in 100.

How does it happen?

An atherosclerotic plaque is forming after the large amount of “bad cholesterol” LDL-c accumulates in arteries where they get oxidized, causing inflammation. In order to defend itself, the organism sends macrophages, a form of white blood cells to capture the cholesterol.

They transform the oxidized cholesterol into large foam cells which cause even more inflammation. As a consequence of that, arterial smooth muscle cells activate, migrate and proliferate forming a “cap” above the inflamed area.

This doesn’t represent good protection because lipid part beneath can be dangerous if it gets torn out, potentially causing a heart attack or stroke. Over time the organism forms a thick layer thus narrowing the space for blood flow even more.

Signs and symptoms

Since the atherosclerosis is a slowly developing disorder, at first it shows no symptoms that will warn you about it. The first symptoms are seen when the artery gets obstructed. Signs and symptoms depend on the body part where an arterial obstruction occurred.

Atherosclerosis in heart arteries will be expressed via chest pain, feeling a pressure or discomfort (angina) which may progress into arms, legs or neck.

Atherosclerosis in brain arteries can cause difficulty speaking, blurred vision, loss of coordination or balance, numbness, weakness or paralysis in one side of the face, arm or leg, etc (TIA signs and symptoms).

Atherosclerosis in leg arteries will manifest itself in leg pain, difficulty walking or intermittent claudication.

Atherosclerosis in kidney arteries can cause hypertension or kidney failure.

Some of the most dangerous consequences of atherosclerosis are a heart attack and stroke as it could cause both these health emergencies.

Atherosclerosis - risk factors

Risk factors for atherosclerosis

There are some risk factors for atherosclerosis on which we can’t influence such as family history, genetic abnormalities, advanced age, and male gender but many other risk factors are modifiable. You can find some of them in the text below.

Unhealthy diet – It is known that nutrition rich in saturated animal fats and carbohydrates is correlated to atherosclerosis development. Moreover, people who have a diet poor with vitamins, minerals, amino acids, and essential fatty acids have an even larger chance of atherosclerosis.

Obesity – Obesity is associated with high cholesterol levels, hypertension, diabetes, poor physical activity which all may potentially lead to various cardiovascular diseases, as well as atherosclerosis.

Lack of physical activity – People who are physically inactive have a greater chance to develop atherosclerosis.

DyslipidemiaHigh concentrations of LDL-c and low concentrations of “good cholesterol” HDL-c favors atherosclerosis.

Diabetes – Diabetes can cause many metabolic disorders which can affect change on arteries which supply different organs.

Hypertension – High blood pressure increases atherosclerotic changes significantly.

Smoking – Nicotine from tobacco smoke cause constriction of blood vessels increasing the atherosclerotic changes.

Atherosclerosis - prevention

Prevention

Primary prevention involves fighting risk factors in people who have no expressed symptoms and signs. First of all, it is necessary to carry out proper nutrition, reduce body weight and exercise adequately.

If the patient’s health condition is good but he/she has elevated cholesterol or triglycerides in the blood, stated preventive measures are recommended for 3 – 6 months. There is evidence that people with these conditions may benefit from Omega 3 unsaturated fatty acids.

Pharmacological treatment

If primary prevention does not help the usage of medications is needed. Here are some of the most used drug classes.

First line drugs are statins, lipid-lowering medications which can stop, reduce, or even reverse the atherosclerotic plaque (other lipid-lowering medications may be used). Likewise, a good antiplatelet drug that may prevent thrombotic complications of atherosclerosis is aspirin (100 mg) or some other medication from this class. Various other cardiovascular medication such as beta blockers, calcium channel blockers, ACE inhibitors or diuretics may also be introduced into therapy. Furthermore, control and treatment of hypertension and diabetes are part of the recommendations for the prevention of cardiovascular diseases.

Platelets (Thrombocytes)

Platelets (Thrombocytes) represent the fragments of the cell named megakaryocyte, which is a type of bone marrow cells sent into the circulation. Thrombocytes are small and oval plates with a diameter of only 2 – 4 mm. Normal platelet count range from 150.000 – 450.000 per μL of blood.

Platelet development

Megakaryocyte comes from hematopoietic stem cell precursors from the bone marrow like all other blood cells. Its transformation into a defined stem is the beginning of the thrombocytopoiesis process. Megakaryoblast is formed from the myeloid stem cell after which it becomes a megakaryocyte. Due to its large size, a megakaryocyte can‘t leave the bone marrow, but it adheres to the walls of the sinus capillary, partially participating in the formation of its wall. As the cell consists of segments, its parts are separated and put into circulation as platelets. Several thousand platelets can be made from one megakaryocyte. Thrombocytes do not come from the normal cell division, as they have no core, and in the true sense of the word, they are not cells. Therefore, the more adequate name is platelet. However, the name thrombocyte is still used sometimes.

platelets

Platelet maturation is regulated by factors of colony growth that controls the production of megakaryocytes. In addition to that, a plasma protein which facilitates the maturation of megakaryocytes and their fragmentation called thrombopoietin is constantly being generated in the liver and kidneys.

Structure of platelets

Membrane

Platelets have a very complex structure. Their membrane consists of three layers including

The outer shell – which is responsible for platelet adhesion and aggregation

Middle layer – which represents a source of platelet phospholipids involved in the blood clotting process

The inner layer – which is responsible for the platelet shape

Cytoplasm

Platelet cytoplasm also has a very complex structure. It contains an open channel system responsible for the discharge of the platelet granules’ content into the outer environment. Moreover, the cytoplasm contains a powerful contractile system that allows an easy change in the platelet‘s shape.

Role in the organism

The main role of platelets is in hemostasis, a process of bleeding stopping in an injured blood vessel. Hemostasis is a process that reduces or prevents blood loss in times of blood vessel injuries. As the blood in the blood vessels is under pressure, cutting or spraying the blood vessel results in blood leakage, and this phenomenon is called bleeding (hemorrhage). If a small blood vessel is injured, bleeding is usually spontaneously stopped by the hemostasis process. However, in the case of injuries of large arteries and veins, hemostasis is not as effective and the injuries must be surgically sanitized. After the damage to the wall of the blood vessel, blood clots accumulate at the site of the injury where they

1. Liberate the substances that cause the blood vessel to contract, which reduces the blood loss

2. Form an aggregate, a platelet plug at the site of the injury

3. Participate in the process of blood clotting, due to coagulation factors that contain

4. Take part in the healing of the injury.

platelets

Aggregation

Platelets begin to adhere to collagen fibers within a few seconds after the occurrence of the damage to the inner part of a blood vessel, and that process is called platelet adhesion. Adhered platelets are activated and they alter their shape while emptying their granules that stimulate further aggregation. The interconnection of a large number of platelets at the site of a blood vessel injury is called platelet aggregation.

Platelet life span

Circulating platelets have a lifespan of 1 to 2 weeks. Older blood platelets, which are not used during blood clotting, are destroyed by macrophages from liver and spleen. A spleen is not just a place which destroys old platelets, as it is also an important reservoir of these blood elements. It releases a large number of stored platelets into the circulation under the influence of the nervous system in certain occurrences including bleeding or burns.

Disorders

An increased platelet count called thrombocytosis increases the tendency of a pathological blood clot (thrombus) formation. That blood clot can induce life-threatening complications such as heart attack and ischemic stroke. A decrease in blood platelet count is called thrombocytopenia. Physiological thrombocytopenia occurs normally in the women immediately prior to menstrual bleeding. Female sex hormones reduce the formation and maturation of blood platelets. Severe thrombocytopenia causes spontaneous bleeding, especially in the gums and digestive tract.

Sleep apnea

What is sleep apnea

Sleep apnea is a sleep disorder that is manifested with short-term interruption of external breathing with preservation of internal breathing, or a pause in breathing that lasts between 3 and 10 seconds. Insufficient attention is given to this disease although it’s not such a rare disorder, as it is estimated that about 5% of the world’s adult population (especially men) suffer from this condition.

How does sleep apnea look like

This problem is mostly recognized by a partner of the affected person, and it is distinguished by loud and heavy snoring. Sleep apnea may be recognized when the other person isn’t present, and common symptoms include chronic fatigue, headache, lack of attention and concentration, sleepiness, etc.

Sleep apnea manifests during the night in the form of respiratory failure and “fight” for the air. The sight of an endangered person may look quite dramatic for someone who watches it, even though the patient is not aware of the apnea. However, advanced apnea can affect people who suffer from this disorder and have a feeling of choking, and can also cause many other health complications.

sleep apnea

Risk factors for sleep apnea

Everything that increases the chance of developing sleep apnea symptoms in a person, can be identified as risk factors. The most common risk factors for the occurrence of sleep apnea are:

anatomical anomalies – people with a narrowed diameter of upper airways are more likely to have sleep apnea

body weight – obese people have about 6 times more chance of developing apnea than people who maintain normal body weight

sex the reason is not known, but the fact is that the risk of developing apnea is almost twice as high in men than in women

age – older people are more likely to develop sleep apnea as it most commonly occurs in people older than 60 years of age

nasal congestion – sleep apnea is about 2 times more likely to occur in people who have nasal deviations or congestion during sleep

snoring – people who have a problem with snoring in their sleep are more prone to experience sleep apnea

smoking – smokers have 3 times more chances of suffering from this disease

Diagnosis of sleep apnea

Nocturnal polysomnography is the gold standard for diagnosing sleep apnea and respiratory disorders during the sleep in general. Polygraphic factors are those who are monitored during sleep including respiration, thoracic and abdominal movements using elastic belts with sensors, while also monitoring heart, eye, lung, and brain activity, and oxygen saturation in the blood. Other home sleep tests exist, where breathing, heart rate, airflow and oxygen level in blood are monitored.

Treatment

For mild cases of apnea, a doctor may only recommend a lifestyle change such as weight loss, alcohol avoiding, quit smoking, regular sleeping, and sleeping on the side.

Certain devices can help in opening of the blocked respiratory tract. In other cases, surgical treatment may be required.

CPAP sleep apnea

In severe cases of obstructive apnea, an airway pressure device is used. Most commonly device of this type is CPAP (Continuous positive airway pressure). It consists of a small turbine that creates a positive air pressure that flows through the mask on the face of the patient. In this way, the breathing path is maintained continuously open. It’s a sophisticated device that works almost silently and is comfortable for patients.

Surgery is usually an option only after other treatments have failed. It involves the reconstruction of the upper respiratory tract, with the aim of increasing the passability through the airway and removing the cause of snoring. One of the solutions is also the tracheotomy or the opening of the trachea.

Effects on cardiovascular system

People with sleep apnea have a 50% higher risk of arterial hypertension, 25% higher risk for atrial fibrillation, and a 60% higher chance of stroke occurrence. During the stopping of breathing, the supply of blood with oxygen is reduced. This results in the development of oxidative stress, dysfunction of the endothelium of the blood vessels, and inflammation. Consequences of those occurrences lead to the development of blood vessel diseases and the processes of atherosclerosis, platelet activation, as well as the ischemia of the heart muscle.

Effects of alcohol consumption on cardiovascular system

Light to moderate alcohol consumption – up to one drink per day for a woman and 1-2 glasses per day for a man – would be expected to reduce mortality, risk of coronary heart disease, diabetes or stroke prevalence. Is alcohol good or bad for your health and how much should you drink?

 American researchers who publish an article on this subject in Mayo Clinic Proceedings confirm that cardiovascular benefits are observed with a light to moderate consumption of alcohol, ideally of red wine taken before or during the evening meal. But the most important thing in their research is dose of alcohol that people consume and serious toxic effect in an exposed individual. The overconsumption of alcohol is in fact is linked to serious pathologies: cirrhosis, stroke, cancers of the colon/rectum, breast, larynx and liver. Alcohol also increases violence and the risk of traffic accidents.

Regarding general mortality, a meta-analysis involving 1,2 million people found that small amounts of alcohol to moderate alcohol consumption was associated with decreased mortality: the maximum protection was raised with half to one drink per day for women and 1 to 2 glasses a day for men. But 2.5 glasses a day for women and 4 a day for men increased the risk of death.

The benefits do NOT outweigh the risks

alcohol consumption impact on cardiovascular health

Chronic consumption of alcohol in large amounts can lead to a condition called alcoholic cardiomyopathy. Consume a lot of alcohol (four to five drinks a day for several years) leads to weakening of the heart muscle.  This weakening becomes even more important when a person consumes alcohol in excessive amounts.  Excessive consumption of alcohol (on the same occasion, four or more drinks for women, and five or more drinks for men) and heavy alcohol consumption can increase blood pressure and the risk of developing arrhythmias (irregular heartbeat), such as atrial fibrillation. Such alcohol consumption can increase the risk of death, whether or not the person has heart disease. People who survive a heart attack and report excessive alcohol use are twice as likely to die of any condition, including heart disease, as those who do not consume alcohol excessively. There is no doubt that excessive alcohol consumption, even once a week, puts you at higher risk for heart disease or stroke.  We tend to minimize this point, but if you are trying to lose weight healthily, reducing your alcohol intake can save you a lot of calories. Light and non-alcoholic beers are a better choice than standard beers when it comes to caloric and alcohol content.

Summary and conclusions

If you do not consume alcohol, you do not deprive yourself of any benefit and it is not recommended that you change your good habits. The risk of cancer, liver disease, pancreatitis, accidents, suicide and exposure to violence are also important negative effects of alcohol. 

There are better ways to reduce the risk associated with heart disease, such as exercising, eating a balanced diet, and quitting smoking and alcohol at the same time. All of these methods offer benefits without the added risks associated with alcohol consumption. However, consuming a small amount of alcohol from time to time is not necessarily detrimental to your health, ergo, moderation is the solution.  As there are some exceptions, it is important to talk to your doctor and pharmacist about your use of alcohol. Some people should avoid taking it to avoid aggravating their condition. Mixing alcohol and certain medications can also cause dangerous side effects that can be fatal.

Modifying alcohol consumption

Limit your alcohol consumption in the following ways:  two drinks a day most days, for a maximum of 10 per week for women and three drinks a day most days, for a maximum of 15 per week for men.  Consumption is:  341 ml or 1 bottle of beer at normal alcohol level (5%), 142 ml or 5 oz of wine (12% alcohol) 43 ml or 1½ oz of spirits (40% alcohol content). Chronic consumption of alcohol can raise blood pressure and contribute to the development of heart disease and stroke.  If you drink alcohol, avoid taking more than:  two drinks a day for up to 10 drinks a week for women  and three drinks per day for up to 15 drinks per week for men

Take care of your health and safety. If you are worried about the effects of alcohol on your health, consult your doctor or pharmacist.

Effects of nicotine on cardiovascular system

It is clearly established that tobacco and nicotine has increased mortality and cardiovascular events (CV), however, the price of smoking is often neglected. Behavioral interventions and stop assisting treatments are effective and do not increase the risk of CV events when used over a specified period. E-cigarettes (or vaporettes) contain potentially cardiotoxic substances but lower concentrations than those of cigarettes. The CV effect of vaping is difficult today to evaluate and depends on the type of device used and its mode of consumption. Consumers have been advised to quit using sprays and it is recommended that they be discontinued as soon as they are stabilized.

nicotine structure

Smoking is one of the major cardiovascular (CV) risk factors. Despite the fact that the link between smoking and cardiovascular disease (CVD) has been known for more than 60 years, 1 tobacco still kills nearly 5 million people every year according to WHO. According to estimates by the Federal Statistical Office, 9,500 deaths in Switzerland in 2012 are attributable to diseases caused by tobacco, which represents 1 out of 7.3 deaths CVD accounts for 39% of the causes of tobacco-related deaths (15 % of ischemic heart disease, 24% of other CVD). Despite this, the prevalence of smoking remains high even among people with a CV event. Smoking cessation is one of the recommendations for primary and secondary prevention.  In this article, we will consider the CV effects of smoking, the CV benefits of stopping as well as the effectiveness and possible risks of some cessation aid treatments.

What are the health effects of cigarette smoking?

 Smoking has 5 main adverse effects on your cardiovascular system: 

  • Cigarettes significally reduces the concetration of oxygen in the blood, causing shortness of breath and impaired functioning of your muscles.
  •  It hurts your arteries, which lose their ability to expand normally. It also causes spasms (sudden narrowing of the caliber of the artery) that potentially can be fatal.
  • It can cause blood clotting and promotes, among other things, the formation of clots and thus the potential release of an infarct, a phlebitis or a stroke (stroke). 
  • It causes inflammation of the blood vessels, a phenomenon that also promotes the formation of clots and atherosclerosis.
  • It lowers the level of good cholesterol, which is an additional risk factor for your cardiovascular system in the long term. In fact, the good cholesterol or HDL-cholesterol acts as a “scavenger of the arteries” by cleaning the plaque that forms there. 

Smoking also has an indirect effect: the relative loss of taste and smell associated with tobacco promotes smoker’s attraction to more tasty foods, usually much richer in saturated (bad) fats and more salty. However, a diet high in salt and saturated fat further increases the risk of developing cardiovascular disease.

The pathophysiology of cigarette smoking and cardiovascular disease

Nicotine is naturally occurring liquid alkaloid. An alkaloid is an organic compound made out of carbon, hydrogen, nitrogen and sometimes oxygen, and it can have potent effects on human body. Nicotine is a major addictive ingredient found in all tobacco products. Nicotine primarily binds to nicotinic cholinergic receptors in the brain and acts as a sympathomimetic substance. As a result, it stimulates the release of catecholamines (epinephrine, norepinephrine), which lead to an increase in heart rate, blood pressure and myocardial contractility, which in turn increases myocardial work  and oxygen requirements. Nicotine has a toxic effect on the endothelium and, acting also on alpha-adrenergic receptors, causes vasoconstriction. This leads to a decrease in arterial, coronary and cerebral flows. The harmful effects of nicotine are mainly due to long-term consumption and affect the overall health of the body.

As nicotine narrows the blood vessels and also lower the temperature of the skin (it also leads to increased sweating). The increased blood pressure permanently increases the risk of clot formation. Indirectly, nicotine also promotes the development of arteriosclerosis. Thus, there are numerous gases and substances (for example nitrogen monoxide) in tobacco smoke, which are deposited in the vessels and harden them. This reduces the oxygen supply to the vessels and leads to loss of function. In the further course it can come to a complete stop of the blood supply of individual body regions, which can cause sometimes the death of body parts. As arteriosclerosis also affects the heart, it increases the risk of heart attack. A lack of blood flow in the brain increases the risk of stroke and has a negative effect on the health of the brain. Overall, the cardiovascular system also suffers from red blood cells taking up carbon monoxide instead of oxygen. Thus, there is a shortage of oxygen throughout the body, which among other things accelerates cell death.

The chemical process of burning tobacco creates high levels of harmful chemicals, CO is one among them. It binds to hemoglobin more easily than oxygen, thus decreasing the oxygenation of different organs resulting in moderate hypoxemia that can lead to ischemic events. Erythrocyte production is stimulated by hypoxemia, causing hyperviscosity that contributes to hypercoagulability.  The smoke contains a considerable number of oxidizing gases. These lead to inflammation, endothelial dysfunction and lipid oxidation, which contributes to the pathogenesis of CVD. Oxidizing gases also participate in platelet activation and thermogenesis and increase coagulability. Other components of the smoke, such as heavy metals and polycyclic aromatic hydrocarbons, destroy endothelial cells and contribute to the progression of atherosclerosis.

Nicotine substitutuion

The cardiovascular effects of cigarettes are well known and preventable. They are caused by nicotine, CO, heavy metals on the other side nicotine substitutes contain low dose nicotine and are relatively safe to use even in people with CV risk. Precautions are required during a severe acute cardiac event, but even in these situations, the use of nicotine replacement therapy remains preferable to smoking. Data on the efficacy and safety of varenicline in CVs are favorable. With respect to vaping, the exposure to nicotine and other compounds in the vapor differs with respect to the type and generation of the device and its use. It is therefore extremely difficult to generalize the results of the studies. In addition to nicotine, other substances in the liquid may have a CV effect. The CV toxicity of the vapote nevertheless seems to be lower compared to cigarettes but medium and long term data on the CV safety of the current devices are necessary. In the meantime, it is recommended that people who have quit smoking by vaporettes stop using them as soon as the cessation of smoking is consolidated and that they feel confident enough not to relapse.

Famous people who died from a stroke

A stroke or brain attack is a medical condition in which the blood supply to the part of your brain is reduced or interrupted, depriving brain tissue of oxygen which results in cell death. There are two main types:

  1. Hemorrhagic, when the blood vessel in your brain leaks or ruptures, causing bleeding
  2. Ischemic, when the arteries to your brain become narrowed or blocked, causing reduced blood flow

Throughout the history many famous people have died from a stroke, mainly because risk factors are smoking, alcohol, obesity, high blood cholesterol. The main risk factor is high blood pressure.

Famous politicians who died from a stroke

richard nixon is one of famous people who died from stroke

Most of the famous politicians who died from a stroke died in their 60s-80s. Some of them were famous presidents and some were prime ministers. Here is the list of famous politicians who died from a stroke:

  • Winston Churchill (1874-1965) – Statesman, politician, journalist, and orator.
  • Joseph Stalin (1878-1953) – Politician and soldier
  • Richard Nixon (1913-1994) – 37th President of  the USA, Military officer and politician
  • Woodrow Wilson (1856-1924) – 28th President of the USA, politician and professor
  • Jawaharlal Nehru (1889-1964) – Prime Minister of India, politician and writer
  • Joseph P. Kennedy, Sr (1888-1969) – Politician, diplomat and investor
  • Millard Fillmore (1800-1874) – 13th President of the USA, politician and lawyer
  • John Tyler (1790-1862) – 10th President of the USA, politician and lawyer
  • Franklin Delano Roosevelt (1882-1945) – 32nd President of the USA and politician
  • Margaret Thatcher (1925-2013) – Prime Minister of Great Britain and stateswoman.

Famous actors who died from a stroke

Grace Kelly actress who died from stroke

Many famous actors, TV producers, comedians have died from a stroke. Here is the list of famous actors who died from a stroke:

  • Cary Grant (1904-1986) – Actor
  • Mel Blanc (1908-1989) – Actor, comedian
  • Mae West (1893-1980) – Comedian, actor, singer, screenwriter
  • Glenn Ford (1916-2006) – Actor
  • Paul Robeson (1898-1976) – Actor, athlete, singer, social activist, lawyer
  • Rue McClanahan (1934-2010) – Comedian, Author, Actor
  • Patrice O’Neal (1969-2011) – Actor, Screenwriter, stand-up comedian
  • Anita Louise (1915-1970) – Actor
  • Aaron Spelling (1923-2006) – TV producer, film producer, screenwriter, actor, singer
  • Peter Lorre (1904-1964) – Actor
  • Ida Lupino (1918-1995) – Actor, TV director, screenwriter, film director
  • Minnie Pearl (1912-1996) – Comedian, actor
  • Jay Silverheels (1912-1980) – Actor
  • Grace Kelly (1929-1982) – Actress, Princess of Monaco.
  • Charlie Chaplin (1889-1977) – ComedianActor, composer and Filmmaker.

Famous musicians who died from a stroke

Most of the famous musicians who died from a stroke were known all around the world for their music, and some of them are already among historical figures. The list of famous musicians who died from a stroke:

  • Johann Sebastian Bach (1685-1750) – Musician, Harpsichordist, Composer, Cantor, Organist.
  • Gene Kelly (1912-1996) – Actor, Singer, TV producer, Film producer, choreographer
  • John Cage (1912-1992) – Actor, Film score composer, musician, author
  • Aaron Spelling (1923-2006) – TV producer, film producer, screenwriter, actor, singer
  • Miles Davis (1926-1991) – Actor, film score composer, songwriter, musician, bandleader
  • Isaac Hayes (1942-2008) – Musician, songwriter, film score composer
  • Giuseppe Verdi (1813-1901) – Italian composer

Other famous people who died from a stroke

Among many other famous people who died from a stroke there are novelists, mathematicians, chemists, kings and leaders. Here is the list of other famous people who died from a stroke:

  • Charles Dickens (1812-1870) – Novelist, Author.
  • L Ron Hubbard (1911-1986) – Religious leader, novelist, writer
  • Al Capone (1899-1947) – Gangster, Mafioso
  • Louis Pasteur (1822-1895) – Microbiologist, chemist, physician, scientist.
  • Nicolaus Copernicus (1473-1543) – Mathematician, diplomat, physician, artist, economist
  • Kirby Puckett (1960-2006) – Baseball player
  • Norman Vincent Peale (1898-1993) – Author, pastor, writer, motivational speaker, preacher
  • Vladimir Ilyich Ulyanov (1870-1924) – Marxist Revolutionary and Soviet Leader
  • Ivan the Terrible (1530-1584)- Russian Tsar
  • Edward III (1312-1377) – King of England
  • Friedrich Nietzsche (1844-1900)- German philosopher.
  • Samuel de Champlain (1567-1635) – French explorer