Atherosclerosis is a condition connected with narrowing of the arteries. Due to this, the supply of blood to very important organs such as the heart, brain and intestines can be considerably reduced. In this disease the arteries are narrowed when fatty deposits known as plaques build up inside. Normally, plaques comprise cholesterol from low-density lipoproteins (LDL), smooth-muscle cells and fibrous tissue. Sometimes also calcium. Due to the fact that plaque grows along the lining of an artery, a rough area in the artery usual smooth surface is created. This rough area may lead to a blood clot in the interior of the artery, which can completely block the flow of blood. As a consequence, all the organs supplied by the blocked artery starve for blood and oxygen, and hence the cells may either die or become seriously damaged.
Atherosclerosis constitutes the major cause of death and disability in industrialized nations, including the United States. That’s because atherosclerosis constitutes the fundamental medical problem in the majority of patients suffering from any of the following diseases:
* Coronary artery disease — In this chronic (long-lasting) disease, atherosclerosis leads to narrowing the coronary arteries, the arteries supplying blood to the heart. This can result in the chest pain known as angina. Moreover, it increases the risk of a heart attack, which takes place when a coronary artery is totally blocked. Coronary artery disease strikes eleven million citizens of the United States.
* Stroke — A blood clot (thrombus) can mold inside a brain artery that has been narrowed by atherosclerosis. When this thrombus creates, it cuts off the blood supply to part of the brain, leading to a thrombotic stroke. Nowadays, nearly 75 per cent of strokes in industrialized countries are thrombotic strokes.
* Abdominal angina and bowel infarction — When atherosclerosis narrows arteries supplying blood to the intestines, it produces a form of abdominal pain known as abdominal angina. Complete, unexpected blockage of intestinal blood supply can result in a bowel infarction. A bowel infarction is analogous to a heart attack, however it involves the intestines rather than the heart.
* Atherosclerosis of the extremities — Atherosclerosis is also able to narrow the main arteries that supply blood to the legs, particularly the femoral and popliteal arteries. These two arteries are influenced in 80 per cent to 90 per cent of people suffering from this condition. The decreased blood flow to the legs may lead to a crampy leg pain in time of physical activity called intermittent claudication. If blood flow is compromised seriously, it is possible that parts of the leg become pale or cyanotic (turn blue), feel cold to the touch and finally gangrene can develop.
* Other diseases — Atherosclerosis may constitute one of the factors contributing to the development of an aortic aneurysm or renal artery stenosis (narrowing of the kidney arteries).
Factors increasing the risk of experiencing atherosclerosis include:
* High level of blood cholesterol (hypercholesterolemia)
* Very low level of HDL (the "good cholesterol")
* High levels of C-reactive protein, a marker for inflammation
* High blood pressure (known as hypertension)
* Diabetes
* Family history of coronary artery disease at an early age
* Smoking cigarettes
* Obesity
* Physical inactivity (too little regular exercise)
* Older age
Symptoms of Atherosclerosis
Normally, atherosclerosis doesn’t lead to any symptoms until blood supply to an organ is considerably limited. Once this happens, symptoms vary depending on the particular organ involved:
* Heart — The most common symptoms include: the chest pain of angina and shortness of breath, sweating, nausea, dizziness or light-headedness, breathlessness or palpitations.
* Brain — Due to the fact that atherosclerosis narrows brain arteries, headaches may occur; dizziness or confusion; weakness or paralysis on one side of the body; unexpected, serious numbness in any part of the body; visual disturbance, including unexpected loss of vision; problems with walking, including staggering or veering; coordination problems in the arms and hands; and slurred speech or inability to speak. If symptoms completely vanish within less than twenty four hours, the episode is known as a transient ischemic attack (TIA). When atherosclerosis totally blocks the brain arteries and/or the above symptoms last longer, it’s typically called a stroke.
* Abdomen — When atherosclerosis narrows the arteries to the intestines, a patient may experience dull or cramping pain in the middle of the abdomen, normally starting 15 to 30 minutes after having a meal. Total blockage of an intestinal artery results in serious abdominal pain, vomiting, diarrhea or constipation.
* Legs — Narrowing of the leg arteries leads to crampy pain in the leg muscles, particularly in the course of physical activity. If narrowing is considerable, a patient may also experience hair loss on the legs, thickening of the toenails, skin that is cool and a pale or blue color.
Diagnosis
Your healthcare professional will ask you about your family history of heart disease, stroke and other circulatory problems. He would also like to know your family history of high blood cholesterol. He or she will ask about smoking cigarettes, physical activity, alcohol use and symptoms of atherosclerosis. He or she also will measure your blood pressure and check your pulse in your neck and feet.
Your physician will also analyze your medical history, the existing symptoms and any medicines you are taking.
If you do not observe any symptoms of any of the medical problems associated with atherosclerosis, your physician will examine you, and search for signs of poor circulation. Generally, these can include: bruits (the rough sound of turbulent blood flow through narrowed arteries) heard with a stethoscope in the neck, abdomen and elsewhere; weakened pulses, particularly in the groin, legs and feet; and cool skin that is pale or blue in the legs.
Your healthcare provider will recommend blood tests in order to measure your total, LDL and HDL cholesterol levels, triglyceride level, and fasting blood sugar. A routine electrocardiogram (EKG) sporadically will expose electrical changes in the heart suggesting poor blood flow to the heart muscle. Nevertheless, your physician may order an EKG carried out in the course of physical activity stress test due to the fact that this test gives better probability to uncover problems. Other diagnostic tests may be necessary to measure blood circulation to the heart, brain, and legs.
Expected Duration
Atherosclerosis is a long-term condition that keeps on worsening over many decades.
Ways of Prevention
If you are willing to prevent atherosclerosis, you should change your risk factors for the disease. You need to practice lifestyle promoting proper circulation and combating atherosclerosis:
* Avoid smoking cigarettes. If you do smoke, it is necessary to give up the habit.
* Maintain a healthy weight. Obesity, particularly a concentration of body fat around the waist, has been associated with unhealthy levels of HDL cholesterol and triglycerides.
* Have a healthy diet – diet that is rich in vegetables and fruits. Avoid saturated and trans fats. Use only monounsaturated (olive) and polyunsaturated (sunflower, safflower, peanut, canola) oils for cooking. Dietary protein ought to come primarily from fish and plant sources (soy, beans, legumes).
* Practice some sports regularly.
* Always control high blood pressure. You may have no choice but to take medicines to do this. If you have never been diagnosed with high blood pressure, you ought to have it checked every two years.
* If you suffer from diabetes, you have control weight very carefully, practice more sports, reduce LDL cholesterol and triglyceride levels, and keep blood pressure less than 130/85.
* If you diabetes sufferer, you need to have a fasting blood sugar test every few years if you have risk factors for diabetes (overweight or obesity, high blood pressure or high cholesterol) starting at age 45.
* Cooperate with your healthcare provider to sustain proper cholesterol levels. If you have never been diagnosed with cholesterol problems, you ought to have your cholesterol checked every five years starting at age twenty.
Treatment
No cure for atherosclerosis exists, however treatment may slow down or halt the worsening of the disease. The crucial treatment objective is to prevent considerable narrowing of the arteries so that symptoms never develop and vital organs are never damaged. To achieve this, you would start by adopting the healthy lifestyle outlined above. If you have high cholesterol that cannot be controlled by diet and physical activity, medicines may be required. There are nowadays five classes of cholesterol-lowering medicines:
* HMG-CoA reductase inhibitors, including lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), rosuvastatin (Crestor), and atorvastatin (Lipitor). HMG-CoA reductase inhibitors block an enzyme known as HMG-CoA reductase, controlling the cholesterol production in the liver.
* Bile acid-binding resins, including cholestyramine (Questran) and colestipol (Colestid)
* Niacin
* Fibrates, including gemfibrozil (Lopid) and fenofibrate (Tricor)
* Cholesterol-absorption inhibitors, which is the newest class of cholesterol reducing agents. Ezetimibe (Zetia) is at present the only one on the market.
When symptoms of atherosclerosis-related organ damage develop, the particular treatment is dependent on the organ that is involved:
* Heart — Treatments for coronary artery disease include: medicines that control and alleviate symptoms of angina (nitrates, beta-blockers, calcium channel blockers) and prevent heart attacks (aspirin and beta-blockers); balloon angioplasty frequently with wire mesh stents; and, less frequently, coronary artery bypass surgery.
* Brain — Treatments to help prevent transient ischemic attacks (TIAs) and stroke include: antiplatelet medicines like aspirin, dipyridamole and clopidogrel (Plavix), and anticoagulant medicines such as warfarin and heparin.
* Abdomen — If it happens that atherosclerosis narrows arteries supplying the bowel, the patient can be treated with balloon angioplasty with or without stents or a bypass arterial graft.
* Legs — The mainstays of treatment for intermittent claudication are: giving up smoking cigarettes, physical activity (normally a walking program), and aspirin. People suffering from severe arterial narrowing can be treated with balloon angioplasty with or without stents, laser angioplasty, atherectomy or bypass grafts.
When To Contact a Specialist
Atherosclerosis is very likely to exists in patient for many years without revealing any symptoms. If you observe symptoms of an atherosclerosis-related medical condition, call a physician promptly.
Prognosis
Atherosclerosis can result in one of the serious causes of death in the United States for both men and women: coronary artery disease. Nevertheless, people suffering from atherosclerosis live longer with better quality of life than ever before. For a lot of them, this illness can easily be prevented. Even those people genetically programmed for atherosclerosis can delay the outset and worsening of the disease by adopting a healthy lifestyle, the right foods, and medicines to reduce LDL cholesterol.
