Atherosclerosis

Definition

This is a disease of the arterial wall in which the layer thickens, causing narrowing of the channel and thus, impairing blood flow.

It can occur in any area of the body, but is most important when it happens in the heart, brain or blood vessels leading to the brain.

Description

The narrowing is due to the formation of plaques (raised patches) in the inner lining of the arteries. These plaques consist of low-density lipoproteins, decaying muscle cells, fibrous tissue, clumps of blood platelets, cholesterol, and sometimes calcium. They tend to form in regions of turbulent blood flow and are found most often in people with high concentrations of cholesterol in the bloodstream.

The number and thickness of plaques increases with age, causing loss of the smooth lining of the blood vessels and encouraging the formation of thrombi (blood clots). Sometimes fragments of thrombi break off and form emboli, which travel through the bloodstream and block smaller vessels.

Atherosclerosis is responsible for more deaths in the U.S. than any other condition. Atherosclerotic heart disease, involving the coronary arteries (coronary heart disease), is the most common cause of death, accounting for one-third of all deaths. Atherosclerotic interference with blood supply to the brain (stroke) is the third most common cause of death after cancer.

Atherosclerosis also causes a great deal of serious illness by reducing the flow of blood in other major arteries, such as to the kidneys, legs, and intestines.

Causes and Risk Factors

Why does atherosclerosis occur in the coronary arteries of some people but not others? An interplay of many factors including hypertension (high blood pressure), smoking, diabetes, obesity, high cholesterol, family history of heart disease, and a sedentary lifestyle are involved.

Symptoms

Unfortunately, atherosclerosis produces no symptoms until the damage to the arteries is severe enough to restrict blood flow.

Restriction of blood flow to the heart muscle due to atherosclerosis can cause angina pectoris or a myocardial infarction (a heart attack).

Restriction of blood flow to the muscles of the legs causes intermittent claudication (pains in the legs brought about by walking and relieved by rest).

Narrowing of the arteries supplying blood to the brain may cause transient ischemic attacks (symptoms and signs of a stroke lasting less than 24 hours) and episodes of dizziness, or ultimately, to a stroke itself.

Treatment

Medication is unsatisfactory for treating atherosclerosis, since the damage has already been done.

Anticoagulant drugs have been used to try to minimize secondary clotting and embolus formation.

Vasodilator drugs are helpful in providing symptom relief, but are of no curative value.

Surgical treatment is available for those unresponsive to medical treatment or in certain high-risk situations.

Balloon angioplasty can open up narrowed vessels and promote an improved blood supply.

The blood supply to the heart can also be restored by coronary artery bypass surgery.

Large atheromatous and calcified arterial obstruction can be removed by endartectomy, and entire segments of diseased peripheral vessels can be replaced by woven plastic tube grafts.

Questions to Ask Your Doctor

Are there any tests that need to be done to diagnose atherosclerosis and the severity of the condition?

Are there any risks to the tests?

How serious is the condition?

Has any other damage been done to any other organs?

Should a specialist be consulted?

What type of treatment will you be recommending?

Will surgery or angioplasty be recommended?

How are they performed?

Are there any risks to these procedures?

Will you be prescribing any medication? What are the side effects?

How successful is the medication in treating this condition?

Are there any signs or symptoms that the doctor should be notified of immediately?

Should a nutritionist be involved in the treatment?

What type of diet would help the condition?

What kind of exercise program will help?