Atherosclerosis

Atherosclerosis is a specific type of arteriosclerosis that occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body become thick and stiff, sometimes restricting blood flow to your organs and tissues.

Healthy arteries are flexible and springy, but over time the walls of your arteries can harden.

Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol, and other substances in and on the walls of your arteries (atherosclerotic plaques), which can restrict blood flow.

The plaque can burst, triggering a blood clot. Although atherosclerosis is often thought of as a heart problem, it can affect arteries anywhere in your body. Atherosclerosis can be prevented and can be treated.

Atherosclerosis develops gradually. Mild atherosclerosis usually has no symptoms until an artery becomes so narrowed or blocked.

Sometimes a blood clot completely blocks blood flow or even breaks and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on the arteries affected. For instance:

• If you have atherosclerosis in the heart arteries ,  you may experience symptoms such as chest pain or pressure (angina).
• If you have atherosclerosis in the arteries leading to your brain, you may experience signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurring, temporary loss of vision in one eye or facial muscles. These reflect a transient ischemic attack (TIA) which, if left untreated, can progress to a stroke.
• If you have atherosclerosis in the arteries of your arms and legs, you may have symptoms of peripheral arterial disease, such as leg pain when walking (claudication).
• If you have atherosclerosis in the arteries leading to your kidneys, you are developing high blood pressure or kidney failure.

The causes of atherosclerosis

Atherosclerosis is a slow, progressive disease that can begin in childhood. Although the exact cause is unknown, atherosclerosis can begin with damage or injury to the inner layer of an artery. Damage can be caused by:

• High blood pressure
• High cholesterol
• High triglycerides
• Smoking
• Insulin resistance, obesity, or diabetes
• Inflammation caused by conditions such as arthritis, lupus, or infections, or inflammation of unknown cause

Once the inner lining of an artery is damaged, blood cells and other substances often clump together at the site of injury and accumulate in the inner lining of the artery.

Over time, fatty deposits (plaque) made up of cholesterol and other cellular products also build up at the site of injury and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then do not receive enough blood to function properly.

Eventually, pieces of fatty deposits can break off and enter your bloodstream.

Additionally, the smooth plaque wall can rupture, spilling cholesterol and other substances into your bloodstream. This can cause a blood clot, which can block blood flow to a specific part of your body, such as when blocked blood flow to your heart causes a heart attack. 

A blood clot can also travel to other parts of your body, blocking the flow to another organ (eg the brain).

Risk factors

Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking and other tobacco use
• A family history of early heart disease
• lack of exercise
• An unhealthy diet

Complications of atherosclerosis

Depending on which arteries are blocked, the complications of atherosclerosis can vary. For instance :

• Coronary artery disease. When atherosclerosis restricts the flow of blood through the arteries leading to your heart, you can develop coronary artery disease, which can lead to chest pain (angina), a heart attack, or heart failure.
• Carotid artery disease. When atherosclerosis narrows the arteries near your brain, you can develop carotid artery disease, which can cause transient ischemic attack (TIA) or stroke.
• Peripheral artery disease. When atherosclerosis affects the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral arterial disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. Rarely, poor circulation in your arms or legs can lead to tissue death (gangrene).
• Aneurysms. Atherosclerosis can also cause aneurysms, a serious and potentially life-threatening complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery.

Most people with aneurysms have no symptoms. Pain and throbbing in the area of ​​an aneurysm may occur and is a medical emergency.

If an aneurysm bursts, you can face life-threatening internal bleeding. Although usually a sudden and catastrophic event, a slow leak is possible. If a blood clot in an aneurysm becomes dislodged, it can block an artery in a distant location.

• Chronic kidney disease. Atherosclerosis can cause the arteries leading to your kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect your kidney function, preventing toxins from leaving your body.

Prevention of atherosclerosis

Recommended healthy lifestyle changes are:

• Stop smoking
• Eat healthy foods
• Exercise regularly
• Maintain a healthy weight

Diagnostic

During a physical exam, your doctor may find warning signs:

• A weak or absent pulse under the affected area of ​​your artery
• Decreased blood pressure in an affected limb
• Noises in your arteries, indicated by a stethoscope

Based on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

• Blood tests. Laboratory tests can detect an increase in cholesterol and blood sugar levels which can increase the risk of atherosclerosis. You will need to go without food or drink anything other than water for nine to 12 hours before your blood test.
• Doppler ultrasound. Your doctor may use a special ultrasound machine (Doppler ultrasound) to measure your blood pressure at different points along your arm or leg. These measurements can help your doctor assess the degree of any blockage, as well as the speed of blood flow through your arteries.
• Ankle-brachial index. This test can determine if you have atherosclerosis in the arteries of the legs and feet.

Your doctor may compare the blood pressure in your ankle to the blood pressure in your arm. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.

• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they pass through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bicycle during an ECG.
• Stress test. It is used to collect information about how your heart is working during physical activity.

Since exercise causes your heart to pump harder and faster than during most daily activities, a stress test can reveal problems in your heart that might not otherwise be noticeable.

A stress test usually involves walking on a treadmill or riding a stationary bike while your heart rate, blood pressure, and breathing are monitored.

• Cardiac catheterization and angiography. This test can show if your coronary arteries are narrowed or blocked.

A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) which is fed through an artery, usually in your leg, to the arteries of your heart. As the dye fills your arteries, the arteries become visible on the x-ray, revealing areas of blockage.

• Other imaging tests. Your doctor may use an ultrasound, computed tomography (CT), or magnetic resonance angiography (MRA) to study your arteries. These tests can often detect hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the walls of the arteries.

Treatment

Lifestyle changes, such as healthy eating and exercise, are often the most appropriate treatment for atherosclerosis. Sometimes medications or surgery may also be recommended.

Medications

Various medications can slow – or even reverse – the effects of atherosclerosis. Here are some types of media:

• Cholesterol medications. Significantly lowering your low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol, can slow, stop, or even reverse the buildup of fatty deposits in your arteries. Raising your high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, can also help.

Your doctor can choose from a range of cholesterol medications, including drugs called statins. In addition to lowering cholesterol, statins have additional effects that help prevent atherosclerosis.

• Anti-platelet drugs. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood of platelets clumping together in narrowed arteries, forming a blood clot and causing further blockage.
• Beta-blocker drugs. These drugs are commonly used for coronary heart disease. They lower your heart rate and blood pressure, reduce the demand on your heart, and often relieve symptoms of chest pain. Beta-blockers reduce the risk of heart attack and certain heart rhythm problems.
• Angiotensin converting enzyme (ACE) inhibitors. These drugs can help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors may also reduce the risk of recurrent heart attacks.
• Calcium channel blockers. These drugs lower blood pressure and are sometimes used to treat angina.
• Diuretics. High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.
• Other drugs. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific drugs to treat the symptoms of atherosclerosis, such as leg pain during exercise, are prescribed.

Surgical interventions

Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage that threatens the survival of muscle or skin tissue, you may undergo one of the following surgeries:

• Angioplasty and stent placement. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its end is then passed through the catheter to the narrowed area.

The balloon is then inflated, pressing the deposits against the walls of your arteries. A mesh tube (stent) is usually left in the artery to help keep the artery open.

• Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is performed on the arteries in the neck (the carotid arteries), it is called a carotid endarterectomy.
• Fibrinolytic therapy. If you have an artery blocked by a blood clot, your doctor may use a clot-dissolving medicine to separate it.
• Bypass surgery. Your doctor can create a graft bypass using a vessel from another part of your body or a synthetic fabric tube. This allows blood to flow around the blocked or narrowed artery.

Home remedies and lifestyle

Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

• Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting smoking is the best way to stop the progression of atherosclerosis and reduce your risk of complications.
• Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently.

Physical activity can also improve circulation and promote the development of new blood vessels that form a natural bypass around blockages (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes.

Aim to exercise for at least 30 minutes most days of the week. If you can’t fit it all into one session, try breaking it up into 10-minute intervals.

You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do sit-ups or push-ups while watching TV.

• Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains – and low in refined carbohydrates, sugars, saturated fats and sodium – can help you control your weight, blood pressure, cholesterol and blood sugar. blood sugar.

Control the amount of salt and fat and use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes.

• Lose extra pounds and maintain a healthy weight. If you are overweight, losing as little as 2 to 5 kilograms can help reduce your risk of high blood pressure and high cholesterol, two of the main risk factors for developing atherosclerosis.

Weight loss helps reduce your risk of diabetes or control your condition if you already have diabetes.

• To manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

Alternative medicine

It is believed that certain herbal foods and supplements can help lower your high cholesterol and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor’s approval, you might consider these supplements and products:

• Alpha-linolenic acid (ALA)
• Barley
• Beta-sitosterol (found in oral supplements and some margarines)
• Black tea or green tea
• Calcium
• Cocoa
• Cod liver oil
• Coenzyme Q10
• fish oil
• Folic acid
• Garlic
• Oat bran (found in oatmeal and whole oats)
• Vitamin C

Before adding any of these supplements to your treatment for atherosclerosis, please speak with your doctor. Some supplements can interact with medication, causing harmful side effects.