Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a condition characterized by narrowing of the arteries due to an accumulation of plaque. Arteries are blood vessels that are responsible for circulating nutrients and oxygen from the heart to other body parts.

As one age, fats, cholesterol, and calcium get collected in the arteries to form plaques. This accumulation can occur in any artery in the body, even those in the heart, legs, and kidneys.

The resultant effect is a decrease in the supply of blood and oxygen to other body tissues. The plaque can break down thereby causing a blood clot. When left untreated, it can culminate in heart attack, stroke, or heart failure.

Atherosclerosis is a common disease that accompanies aging but it can be prevented and even treated successfully. A condition known as arteriosclerosis is often used interchangeably with atherosclerosis but really, arteriosclerosis is the much broader term referring to arterial hardening.

Causes of atherosclerosis

Following a buildup of plaque and eventual narrowing of the arteries, blood flow in the arteries is restricted thus making the organs and tissues inadequately perfused with the oxygenated blood they need for proper functioning.

The common causes of atherosclerosis include:

High cholesterol

Cholesterol is a waxy, yellow colored substance that occurs naturally in the body and in some plants. When the blood cholesterol levels are too high, the arteries can become clogged. This clogged cholesterol can obstruct blood flow to the heart and other organs.

Diet

You should always endeavor to eat healthily. The American Heart Association (AHA) recommends a dietary pattern that lays emphasis on taking:

• A variety of fruits and vegetables
• Whole grains
• Low-fat dairy products
• Poultry and fish, with the exception of their skin
• Nuts and legumes
• Non-tropical vegetable oils, including olive oil or sunflower oil

Additional diet tips include:

• Avoiding foods and drinks with added sugar such as candy, sugared beverages, and desserts. AHA recommends a maximum of 6 teaspoons or 100 calories of sugar a day for many women, and a maximum of 9 teaspoons or 150 calories a day for most men.
• Do away with foods with high salt content. Daily accepted salt requirement is about 1,500mg but you should not exceed 2,300mg of sodium per day.
• Avoid foods with unhealthy fats, such as trans-fats. Substitute them with unsaturated fats which are healthier. If you want to decrease your blood cholesterol then reduce saturated fat intake to a maximum of 5 to 6 percent of total calories taken. For an individual who eats 2,000 calories a day, the saturated fat intake should be about 13grams.

Aging

Organs begin to fail as aging sets in. The heart has to increase its work and the blood vessels too, to pump and receive blood. The arterial walls may be weakened and lose their elasticity thereby making them vulnerable to more accumulation of plaque.

Risk factors for atherosclerosis

The risk factors for atherosclerosis can be classified as modifiable and non-modifiable. They include:

• Family history: if you have a relative with atherosclerosis then you are more likely to have it too. It is an inherited condition just like other heart-related problems. It is non-modifiable.
• Lack of exercise: exercising regularly improves the health of the heart. It does this by strengthening the heart muscles and improving oxygen and blood circulation all through the body. When you live a sedentary life, you will be at risk of other medical conditions including heart disease. This factor is modifiable
• High blood pressure: it is a modifiable risk factor. High blood pressure level damages the blood vessels by weakening them. Cholesterol and even other substances present in the blood can reduce the elasticity of the arteries with time.
• Smoking:  tobacco smoking damages the heart and blood vessels

Diabetes: those with diabetes have a more frequent occurrence of coronary artery disease (CAD).

Symptoms of atherosclerosis

Majority of the time, atherosclerosis is symptomless. Symptoms only manifest when there is an obstruction. The usual symptoms include:

• Chest pain or angina
• Pain in any body part housing a blocked artery such as the leg or arms
• Shortness of breath
• Fatigue
• Confusion due to the blocking of arteries that supply blood to the brain
• Muscle weakness in the leg from the decreased blood supply

It is essential to know the symptoms of stroke and heart attack as these two conditions can be caused by atherosclerosis and are medical emergencies.

The symptoms of a heart attack include:

• Chest pain or discomfort
• Abdominal pain
• Shortness of breath
• Pain in the shoulders, back, neck, arms, and jaw
• Sweating excessively
• Lightheadedness
• Nausea or vomiting
• A feeling of impending doom

The symptoms of stroke include:

• Weakness or paralysis of the face or limbs
• Difficulty in speaking
• Difficulty in comprehending speech
• Visual disturbances
• Loss of balance
• Sudden, severe headache

Once you experience any of the symptoms of stroke or heart attack, call 911 or your local emergency services and present at an emergency room as soon as possible.

Diagnosis of atherosclerosis

If you have symptoms of atherosclerosis, the doctor will conduct a physical examination on you. They will look for the presence of the following:

• Weak pulsation
• Aneurysm, which is an abnormal ballooning of an artery due to weakness in its wall
• Poor wound healing due to the decreased blood supply

A cardiologist may listen to the heart using a stethoscope, the sound usually listened for is a whooshing sound that is produced when an artery gets blocked.

Further tests will be requested by a doctor following suspicion that you have atherosclerosis. The additional tests include:

• Blood lipid profile, to check the cholesterol level
• Doppler ultrasound scan, which makes use of sound waves to produce a picture of an artery to exclude any obstruction
• Magnetic resonance angiography (MRA) or a computed tomography angiography (CTA) which visualizes the large arteries in the body
• Cardiac angiogram, a form of chest X-ray used to visualize large arteries after injection with contrast dyes
• Ankle-brachial index (ABI), a test which searches for any blockage in the upper or lower limbs by comparing the blood pressure in each limb
• Electrocardiogram, which gives a measure of the electrical activities in the heart and recognizes an area with insufficient blood supply.

Check out this awesome audiobook on ECG written by Alex Hall, MD.

The stress test also called an exercise tolerance test: it monitors the blood pressure and heart rate while you are actively exercising on a treadmill or stationary bicycle.

Treatment for atherosclerosis

Treatment of this condition will require a lifestyle modification focused on diets and exercise. For diets, reduce the amount of fat and cholesterol you consume. Exercise is important for the enhancement of the heart’s health and blood vessels Too.

You may not need additional care when your condition is mild because basic lifestyle adjustments can control it but you need additional treatment involving the use of drugs or surgery if it is severe.

Medications

They can halt the progression of atherosclerosis. The different medications that can be used to treat it include:

• Cholesterol-lowering drugs such as statins and fibrates
• Anticoagulants and antiplatelet medications to prevent blood clots formation as these can block the arteries
• Beta-blockers or calcium channel blockers: used to reduce raised blood pressure
• Diuretics: also for high blood pressure management
• Angiotensin-converting enzyme (ACE) inhibitors such as Ramipril, will help to prevent arterial narrowing

Surgery

Surgery may be required if the extent of muscle or tissue damage is severe.

The likely surgeries for the condition include:

• Bypass surgery: here, blood is diverted around the area of the blocked artery with the use of a synthetic vessel or a vessel from another body part
• Thrombolytic therapy: this involves the dissolution of blood clots by injecting a drug into the involved artery
• Angioplasty: this makes use of a catheter with its inflatable balloon to expand the artery and even leaving a stent in there to make it patent
• Endarterectomy: a surgical procedure where fat is removed from the artery
• Atherectomy: it is the removal of plaque from arteries with the aid of a catheter which has a sharp blade at one end.

Long-term outcome

There will be an improvement in health following treatment though this may take time. The treatment success depends on the following factors:

• Degree of severity of the condition
• Promptness of treatment
• Affectation of other organs

Arterial hardening cannot be reversed but its progression can be slowed down or prevented by treating the underlying cause and adopting a healthy lifestyle and dietary changes. Work with your doctor to effect the necessary lifestyle adjustments. Be compliant with your prescribed medications so that you can get better and complications do not ensue.

Complications

Atherosclerosis can result in a vast number of complications including:

• Heart failure
• Heart attack
• Stroke
• Arrhythmias
• Death

It is also linked to the following diseases:

Coronary artery disease (CAD)

The heart tissue and muscle is being supplied with blood from the coronary arteries, this blood contains oxygen and nutrients. Coronary artery disease happens when there is a hardening of the coronary arteries.

Carotid artery disease

The carotid arteries are located in the neck and are responsible for supplying blood to the brain. When these arteries have an accumulation of plaque in their walls, their function is reduced. There is a subsequent reduction in blood circulation to the brain.

Peripheral artery disease

Arteries are responsible for supplying blood to the upper and lower extremities. Peripheral artery disease occurs when there is decreased blood flow to those regions (arms, legs, lower body). Arterial hardening cause circulatory problems in those body regions.

Kidney disease

Kidneys are responsible for the excretion of nitrogenous wastes from the body. The renal arteries are the vessels that supply the kidneys with blood. When these arteries harden, kidney failure may result.

LIFESTYLE CHANGES THAT ARE HELPFUL IN THE MANAGEMENT OF ATHEROSCLEROSIS

Lifestyle adjustments will help to prevent and even treat atherosclerosis, particularly for those with type 2 diabetes.

Beneficial lifestyle changes include:

• Eat healthily, the quantity of cholesterol and saturated fats consumed should be low
• Limit the intake of fatty foods
• Include fish in your diet, twice per week
• Exercise vigorously for 75 minutes weekly or exercise moderately for 150 minutes weekly
• Cessation of smoking
• Intentional weight loss if you are overweight or obese
• Stress management
• Treat associated conditions such as hypertension, diabetes, and hypercholesterolemia