CONDITIONS
Atherosclerosis
Atherosclerosis
Plaque buildup, or fatty deposits, in the arteries is called atherosclerosis. Blood vessels that carry blood from the heart throughout your body are called as arteries.
Plaque is a sticky substance made up of cholesterol, fatty substances, and other products in the blood. As plaque builds up in the blood, it sticks to the wall of the blood vessel making it thick.
This narrows the channel within the artery and reduces its elasticity – reducing blood flow and thereby reducing the amount of oxygen and other nutrients reaching the body.
What are the symptoms of Atherosclerosis?
Mild atherosclerosis do not have any symptoms. Generally, symptoms for atherosclerosis is not seen until the arteries are so clogged and become narrow enough to obstruct the flow of blood, decreasing oxygen supply to organs or tissues.
Sometimes, a blood clot may completely block the flow triggering a heart attack or stroke. Depending on arteries affected, symptoms may include the following:
For coronary (heart) arteries:
- An unusual heartbeat/rhythm (Arrhythmia)
- Pain or pressure in upper body, including your chest, arms, neck, or jaw (Angina).
- Shortness of breath
For arteries of brain:
- Sudden numbness or weakness in arms or legs
- Difficulty in speaking or understanding someone who’s talking
- Drooping facial muscles
- Paralysis
- Severe headache
- Trouble seeing in either eye.
For arteries of arms, legs, and pelvis:
- Leg pain when walking (intermittent claudication).
- Decreased blood pressure in affected limb
- Aching or burning in your toes and feet while resting
- Frequent sores or infections on feet that won’t heal
For kidneys:
- High blood pressure
- Kidney failure
What are the causes and risk factors of Atherosclerosis?
Atherosclerosis begins when the thin layer of cells lining the arteries (the endothelium), gets damaged.
Common causes of damage are:
- High cholesterol
- High blood pressure
- High triglycerides (increased levels of a type of fat in the blood)
- Inflammation from a condition like arthritis
- Obesity or diabetes
- Smoking
- Chewing tobacco
Hardening of the arteries occurs over time, but certain conditions increase the risk factors of atherosclerosis:
- Aging
- Family member having early heart disease.
- Unhealthy diet
- High levels of C-reactive protein (CRP), a marker of inflammation
- Lack of exercise
- Sleep apnea (repetitive pauses in the breathing causing sleep disruption)
- Smoking and other tobacco use
How is Atherosclerosis diagnosed?
A physical exam is performed by doctor and questions about personal and family health history are asked. A doctor specializes in heart diseases (cardiologist) may be recommended.
Depending on physical exam, other suggested tests are:
- Blood tests: Usually done to check blood sugar and cholesterol levels.
High levels of blood sugar and cholesterol – increased risk of atherosclerosis.
C-reactive protein (CRP) test – to check for inflammation of the arteries. - Electrocardiogram (ECG): Quick and painless test procedure to measure the electrical activity of the heart.
Sensors (electrodes) are attached to the chest, wires connect the sensors to a machine, displaying or printing the results.
ECG helps to determine if blood flow to the heart has been reduced. - Exercise stress test: The heart rate while walking on a treadmill or riding a stationary bike is monitored. Because exercise makes the heart pump harder and faster than it does during most daily activities, an exercise stress test may show heart problems that are otherwise missed. If exercising is not possible, then medication mimicking the effect of exercise on heart is given.
- Echocardiogram (2D echo): Sound waves are used to show blood flow through the heart.
- Doppler ultrasound: A special ultrasound device (Doppler ultrasound) is done to measure the blood pressure at various points along the arm or leg. These measurements show the speed of blood flow in arteries.
- Ankle-brachial index (ABI): The test is done to compare the blood pressure in the ankle with that in the arm.
- Cardiac catheterization and angiogram: To check if coronary arteries are narrowed or blocked. A dye is inserted in a blood vessel through a long, thin flexible tube (catheter), and guided to the heart and flows through the catheter to arteries in the heart. This dye provides a clearer picture on images taken during the test.
- Coronary calcium scan (heart scan): Using computerized tomography (CT) imaging, detailed pictures of the heart are taken to show calcium deposits in the artery walls. In presence of calcium a higher score is obtained which indicates a higher the risk of heart disease.
- Other imaging tests: Magnetic resonance angiography (MRA) or positron emission tomography (PET) is done to show hardening and narrowing of large arteries, as well as aneurysms.
What are the treatment options for Atherosclerosis?
- Medications: Drugs for high cholesterol and high blood pressure are prescribed to slow progression and halt atherosclerosis. Blood thinner (antiplatelet medicines like aspirin), may be given to help prevent clots.
- Invasive techniques to open blockages from atherosclerosis or bypass them are as follows:
- Angiography, Angioplasty and stenting: To help open a clogged or blocked artery, a thin tube into an artery in your leg or arm to get to diseased arteries to check for blockages. Angioplasty (using a catheter with a balloon tip) and stenting is used to open a blocked artery.
- Bypass surgery: Doctor takes a healthy blood vessel and uses it to go around a blocked segment.
- Endarterectomy: The doctor removes plaque and restore blood flow from narrowed arteries and if it is done on arteries in the neck, its called a carotid endarterectomy.
- Fibrinolytic therapy: A drug dissolve the blood clot is prescribed.
- Lifestyle and home remedies: Certain lifestyle changes may help in keeping the arteries healthy and slow atherosclerosis. Following are the heart-healthy tips:
- Don’t smoke: Smoking is a major risk factor for coronary artery disease and nicotine tightens blood vessels and forces the heart to work harder.
- Exercising regularly: Regular exercise improves blood flow, lowers blood pressure. At least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of the two is a must. This includes –
- taking the stairs instead of the elevator,
- walking around the block during the lunch hour, or
- do some situps or pushups while watching television.
- Maintain a healthy weight: Losing even a small amount of weight decreases the risk of atherosclerosis.
- Eat healthy foods: A heart-healthy diet full of fruits, vegetables and whole grains — and low in refined carbohydrates, sugars, saturated fat and sodium is recommended.
- Substitute whole-grain bread in place of white bread.
- Grab an apple, a banana or carrot sticks as a snack.
- Read nutrition labels to check the amount of salt and fat and avoid packaged food wherever possible.
- Use monounsaturated fats, such as olive oil.
- Reduce or avoid sugar and sugar substitutes.
- Manage stress: Work towards reducing emotional stress. Relaxation techniques, such as yoga or deep breathing, also may be helpful.
Can Atherosclerosis be prevented?
The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These are:
- Quitting smoking
- Eating healthy foods
- Exercising regularly
- Maintaining a healthy weight
- Checking and maintaining a healthy blood pressure
- Checking and maintaining healthy cholesterol and blood sugar levels
References
- Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, Moran AE. Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. Arch Med Res. 2015 Jul;46(5):328-38.
- Arteriosclerosis / atherosclerosis. Mayo Clinic. March 2024. https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/diagnosis-treatment/drc-20350575
- Atherosclerosis: Symptoms, Causes, and Prevention. WebMD. March 2024. https://www.webmd.com/heart-disease/what-is-atherosclerosis
