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Arteriosclerosis/atherosclerosis

Definition

Arteries are blood vessels that carry oxygen and nutrients from your heart to the rest of your body. Healthy arteries are flexible, strong and elastic. Over time, however, too much pressure in your arteries can make the walls thick and stiff — sometimes restricting blood flow to your organs and tissues. This process is called arteriosclerosis, or hardening of the arteries.

Atherosclerosis is a specific type of arteriosclerosis, but the terms are often used interchangeably. Atherosclerosis refers to the buildup of fats in and on your artery walls (plaques), which can restrict blood flow. These plaques can also burst, causing a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis is a preventable and treatable condition.

Symptoms

Atherosclerosis develops gradually. There are usually no atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply adequate blood to your organs and tissues. Sometimes a blood clot completely obstructs blood flow, or even breaks apart and causes blood clots that can trigger a heart attack or stroke.

Atherosclerosis symptoms depend on which arteries are affected. For example:

• If you have atherosclerosis in your heart arteries, you may have symptoms similar to those of a heart attack, such as chest pain (angina).
• If you have atherosclerosis in the arteries leading to your brain, you may have symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face.
• If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral arterial disease, such as leg pain when walking (intermittent claudication).

Sometimes atherosclerosis causes erectile dysfunction in men.

When to see a doctor
If you think you have atherosclerosis — or risk factors for hardening of the arteries — talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a medical emergency.

Causes

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Development of atherosclerosis In atherosclerosis, arteries are clogged by an accumulation of plaques — which are made up of cholesterol particles, fat, calcium, cellular waste and other substances.

Development of atherosclerosis

Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, researchers suspect that atherosclerosis starts with damage or injury to the inner layer of an artery. The damage may be caused by:

• High blood pressure
• High cholesterol
• An irritant, such as nicotine
• Certain diseases, such as diabetes

Once the inner wall of an artery is damaged, blood cells called platelets often clump at the injury site to try to repair the artery, leading to inflammation. Over time, fatty deposits (plaques) made of cholesterol and other cellular waste products also accumulate at the injury and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then don't receive enough blood to function properly.

Eventually pieces of the fatty deposits may rupture and enter your bloodstream. This can cause a blood clot to form and damage your organs, such as in a heart attack. A blood clot can also travel to other parts of your body and partially or totally block blood flow to another organ.

Risk factors

Hardening of the arteries occurs over time. In addition to simply getting older, factors that increase the risk of atherosclerosis include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking
• A family history of aneurysm or early heart disease

Complications

The complications of atherosclerosis depend on the location of the blocked arteries. For example:

• Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina) or a heart attack.
• Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
• Peripheral artery disease. When atherosclerosis narrows 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. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene).
• Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Pain and throbbing in the area of an aneurysm is a common symptom. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may obstruct an artery at some distant point.

Preparing for your appointment

Your doctor will first perform a physical exam if you think you have atherosclerosis. You'll have your blood pressure checked to see if you have high blood pressure, a common sign of atherosclerosis. Your doctor may also listen to the blood flowing through your arteries using a stethoscope to see if there are any abnormalities.

One of the most common tests doctors perform when checking for atherosclerosis is a blood test to check your cholesterol level and blood sugar. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit.

If your doctor thinks you have atherosclerosis, you may need more tests to confirm the diagnosis.

Tests and diagnosis

Your doctor may find signs of narrowed, enlarged or hardened arteries during a physical exam. These include:

• A weak or absent pulse below the narrowed area of your artery
• Decreased blood pressure in an affected limb
• Whooshing sounds (bruits) over your arteries, heard with a stethoscope
• Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
• Evidence of poor wound healing in the area where your blood flow is restricted

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

• Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis.
• Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
• Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
• Angiogram. To better view blood flow through your heart, brain, arms or legs, your doctor may inject a special dye into your arteries before an X-ray. This is known as an angiogram. The dye outlines narrow spots and blockages on the X-ray images.
• Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or a magnetic resonance angiogram (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

Treatments and drugs

Lifestyle changes, such as eating a healthy diet and exercising, are often the first line of defense in treating atherosclerosis. But sometimes, medication or surgical procedures may be recommended as well.

Various drugs can slow — or sometimes even reverse — the effects of atherosclerosis. Here are some common choices:

• Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates.
• Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
• Anticoagulants. An anticoagulant, such as heparin or warfarin (Coumadin), can help thin your blood to prevent clots from forming.
• Blood pressure medications. Medications to control blood pressure — such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers — can help slow the progression of atherosclerosis.
• Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed.

Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:

• Angioplasty. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Angioplasty may also be done with laser technology.
• Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's known as carotid endarterectomy.
• Thrombolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may insert a clot-dissolving drug into your artery at the point of the clot to break it up.
• Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.

Lifestyle and home remedies

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

• Stop smoking. Smoking damages your arteries. If you smoke, quitting is the best way to halt 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 development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Ideally, you should exercise 30 to 60 minutes most days of the week. If you can't fit it all in 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 some sit-ups or push-ups while watching television.
• Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains - and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Try substituting whole-grain bread in place of white bread, grabbing an apple, banana or carrot sticks as a snack, and reading nutrition labels to control the amount of salt and fat you eat.
• Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.

Prevention

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. You've heard it before — stop smoking, eat healthy foods, exercise regularly, maintain a healthy weight, drink less alcohol. Just remember to make changes one step at a time, and keep in mind what lifestyle changes are manageable for you in the long run.