What are the symptoms and causes of atherosclerosis. How does plaque buildup affect arterial health. Can lifestyle changes prevent or slow the progression of atherosclerosis. What are the potential complications of untreated atherosclerosis. How is atherosclerosis diagnosed and treated.

The Fundamentals of Atherosclerosis: A Stealthy Cardiovascular Threat

Atherosclerosis, often referred to as hardening of the arteries, is a progressive cardiovascular condition that develops over a lifetime. This insidious disease is characterized by the accumulation of plaque within the arterial walls, gradually narrowing the blood vessels and impeding blood flow to vital organs and tissues.

The composition of atherosclerotic plaque is complex, consisting of:

• Cholesterol
• Fatty substances
• Cellular waste products
• Calcium
• Fibrin (a blood-clotting protein)

As plaque builds up, it thickens the arterial wall, reducing the vessel’s inner diameter and compromising blood flow. This restriction diminishes the delivery of oxygen and essential nutrients to the body’s tissues, setting the stage for a range of cardiovascular complications.

Distinguishing Atherosclerosis from Arteriosclerosis

While often used interchangeably, atherosclerosis and arteriosclerosis are not identical concepts. Atherosclerosis specifically refers to the buildup of fatty plaques in the arteries, while arteriosclerosis is a broader term encompassing the general hardening and loss of elasticity in arterial walls. Atherosclerosis is, in fact, a subtype of arteriosclerosis.

The Silent Progression: How Atherosclerosis Develops Over Time

Atherosclerosis is a gradual process that can begin in childhood and accelerate with age. The exact cause remains elusive, but researchers have identified several factors that contribute to its development and progression:

1. Endothelial damage: The initial stage often involves injury to the inner lining of the arteries (endothelium).
2. Lipid accumulation: Damaged areas become focal points for cholesterol and other lipids to accumulate.
3. Inflammatory response: The body’s immune system responds to this buildup, leading to chronic inflammation.
4. Plaque formation: Over time, these areas of damage and inflammation develop into atherosclerotic plaques.
5. Arterial narrowing: As plaques grow, they narrow the arterial lumen, restricting blood flow.

Do all individuals develop atherosclerosis at the same rate? No, the progression of atherosclerosis varies significantly among individuals and is influenced by both genetic and lifestyle factors. Some people may develop severe atherosclerosis relatively early in life, while others may have minimal plaque buildup well into old age.

Risk Factors: Unraveling the Contributors to Atherosclerosis

Understanding the risk factors for atherosclerosis is crucial for prevention and early intervention. While some risk factors are beyond our control, many are modifiable through lifestyle changes and medical management.

Non-Modifiable Risk Factors

• Age: The risk of atherosclerosis increases as we get older.
• Gender: Men are generally at higher risk, though women’s risk increases after menopause.
• Family history: Genetic predisposition plays a role in atherosclerosis development.

Modifiable Risk Factors

• High blood cholesterol levels, particularly LDL cholesterol
• Hypertension (high blood pressure)
• Smoking and tobacco use
• Diabetes mellitus
• Obesity
• Physical inactivity
• Poor diet high in saturated fats and processed foods
• Chronic stress

Can addressing modifiable risk factors reverse atherosclerosis? While complete reversal is challenging, aggressive management of risk factors can slow progression and, in some cases, lead to regression of atherosclerotic plaques. This underscores the importance of early intervention and lifestyle modifications in managing cardiovascular health.

The Double Threat: Understanding the Dangers of Atherosclerotic Plaque

Atherosclerotic plaques pose two distinct threats to cardiovascular health:

1. Stenosis: As plaques grow, they narrow the arterial lumen, restricting blood flow to tissues and organs.
2. Plaque rupture: Unstable plaques can rupture, triggering blood clot formation that may completely occlude the artery.

The consequences of these events depend on the location of the affected artery:

• Coronary arteries: May lead to angina or myocardial infarction (heart attack)
• Cerebral arteries: Can cause stroke or transient ischemic attack (TIA)
• Peripheral arteries: May result in peripheral artery disease (PAD) or critical limb ischemia
• Renal arteries: Can contribute to chronic kidney disease

Is it possible for a person to have advanced atherosclerosis without experiencing symptoms? Yes, atherosclerosis can progress silently for years or even decades without causing noticeable symptoms. This is why it’s often referred to as a “silent killer” and underscores the importance of regular cardiovascular check-ups, especially for individuals with known risk factors.

Diagnostic Approaches: Uncovering Hidden Atherosclerosis

Detecting atherosclerosis before it leads to serious cardiovascular events is crucial for effective management. Healthcare providers employ a variety of diagnostic tools and techniques to assess arterial health and identify the presence and extent of atherosclerosis:

Non-Invasive Diagnostic Methods

• Carotid ultrasound: Assesses plaque buildup in the neck arteries
• Ankle-brachial index (ABI): Compares blood pressure in the arms and legs to detect PAD
• Computed tomography (CT) scan: Can reveal calcium deposits in coronary arteries
• Magnetic resonance angiography (MRA): Provides detailed images of arterial structures

Invasive Diagnostic Procedures

• Coronary angiography: Gold standard for assessing coronary artery disease
• Intravascular ultrasound (IVUS): Offers detailed images of arterial walls from within the vessel

How early can atherosclerosis be detected using these methods? Some advanced imaging techniques, such as coronary calcium scoring, can detect the earliest stages of atherosclerosis before it causes significant stenosis or symptoms. However, the appropriateness of screening depends on individual risk factors and should be discussed with a healthcare provider.

Treatment Strategies: Combating Atherosclerosis and Its Complications

Managing atherosclerosis involves a multifaceted approach aimed at slowing disease progression, stabilizing existing plaques, and preventing cardiovascular events. Treatment strategies typically include a combination of lifestyle modifications, medications, and, in some cases, interventional procedures.

Lifestyle Modifications

• Adopting a heart-healthy diet low in saturated fats and rich in fruits, vegetables, and whole grains
• Engaging in regular physical activity
• Quitting smoking and avoiding tobacco products
• Managing stress through relaxation techniques or counseling
• Maintaining a healthy weight

Pharmacological Interventions

• Statins: Lower LDL cholesterol and may help stabilize plaques
• Antiplatelet agents: Reduce the risk of blood clot formation
• Antihypertensive medications: Control blood pressure to reduce arterial stress
• Diabetes medications: Manage blood glucose levels in diabetic patients

Interventional Procedures

• Angioplasty and stenting: Widen narrowed arteries and improve blood flow
• Atherectomy: Removes plaque from arterial walls
• Bypass surgery: Creates alternative routes for blood flow around severely blocked arteries

Can lifestyle changes alone be sufficient to manage atherosclerosis? For individuals with early-stage atherosclerosis or those at moderate risk, aggressive lifestyle modifications may be sufficient to slow or halt disease progression. However, those with advanced disease or multiple risk factors often require a combination of lifestyle changes and medical interventions for optimal management.

Prevention: Strategies for Maintaining Arterial Health

Preventing atherosclerosis, or slowing its progression in its earliest stages, is far more effective than treating advanced disease. A proactive approach to cardiovascular health can significantly reduce the risk of developing atherosclerosis and its complications.

Key Prevention Strategies

1. Regular cardiovascular health screenings, including blood pressure, cholesterol, and diabetes checks
2. Maintaining a balanced, nutrient-rich diet with an emphasis on plant-based foods
3. Engaging in at least 150 minutes of moderate-intensity aerobic exercise per week
4. Avoiding tobacco products and limiting alcohol consumption
5. Managing stress through mindfulness, meditation, or other relaxation techniques
6. Treating underlying conditions such as hypertension, diabetes, and high cholesterol

At what age should individuals start taking preventive measures against atherosclerosis? While it’s never too early to adopt heart-healthy habits, the American Heart Association recommends that adults begin regular cardiovascular risk assessments at age 20. However, for individuals with a family history of early heart disease or other significant risk factors, earlier screening and intervention may be appropriate.

The Future of Atherosclerosis Management: Emerging Therapies and Research Directions

As our understanding of atherosclerosis continues to evolve, researchers are exploring novel approaches to prevent, detect, and treat this complex disease. Several promising avenues of research are currently underway:

Innovative Therapeutic Approaches

• PCSK9 inhibitors: A new class of cholesterol-lowering drugs showing promise in high-risk patients
• Anti-inflammatory therapies: Targeting the inflammatory component of atherosclerosis
• Gene therapy: Exploring genetic modifications to reduce atherosclerosis risk
• Nanoparticle-based treatments: Developing targeted therapies to dissolve or stabilize plaques

Advanced Diagnostic Technologies

• Molecular imaging: Techniques to visualize cellular and molecular processes within atherosclerotic plaques
• Artificial intelligence: Machine learning algorithms to improve risk prediction and treatment planning
• Biomarker discovery: Identifying new blood-based markers for early atherosclerosis detection

How might these emerging therapies change the landscape of atherosclerosis management? These innovative approaches hold the potential to revolutionize atherosclerosis treatment by offering more personalized, targeted interventions. They may allow for earlier detection, more precise risk stratification, and therapies that address the underlying mechanisms of plaque formation and progression rather than just managing symptoms.

As research progresses, the future of atherosclerosis management looks promising, with the potential for more effective prevention strategies and treatments that could significantly reduce the global burden of cardiovascular disease. However, it’s important to note that while these advancements are exciting, maintaining a heart-healthy lifestyle remains the cornerstone of cardiovascular disease prevention and management.

What is Atherosclerosis? | American Heart Association

Atherosclerosis and cholesterol

Plaque (fatty deposits) build up in your arteries is called atherosclerosis. These deposits are made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood). Atherosclerosis is a type of arteriosclerosis. Arteriosclerosis means hardening (sclerosis) of the arteries.

As plaque builds up, the wall of the blood vessel thickens. This narrows the channel within the artery – reducing blood flow. That lessens the amount of oxygen and other nutrients reaching the body.

Watch an animation about atherosclerosis.

Where plaque develops, and the type of artery affected, varies with each person. Plaque may partially or totally block blood flow through large- or medium-sized arteries in the heart, brain, pelvis, legs, arms or kidneys. This can lead to conditions such as:

• Coronary heart disease (plaque in arteries in or leading to the heart)
• Angina (chest pain from reduced blood flow to the heart muscle)
• Carotid artery disease (plaque in neck arteries supplying blood to the brain)
• Peripheral artery disease, or PAD (plaque in arteries of the extremities, especially the legs)
• Chronic kidney disease

Plaque presents a double threat

Plaque itself can pose a risk. A piece of plaque can break off and be carried by the bloodstream until it gets stuck. And plaque that narrows an artery may lead to a blood clot (thrombus) that sticks to the blood vessel’s inner wall.

In either case, the artery can be blocked, cutting off blood flow.

If the blocked artery supplies the heart or brain, a heart attack or stroke occurs. If an artery supplying oxygen to the extremities (often the legs) is blocked, gangrene, or tissue death, can result.

Atherosclerotic cardiovascular disease (ASCVD) involves plaque buildup in arterial walls which includes conditions such as acute coronary syndrome and peripheral artery disease, and can cause a heart attack, stable or unstable angina, stroke, transient ischemic attack (TIA) or aortic aneurysm.

Download Reduce Your Risk of ASCVD (PDF) | Spanish (PDF)

How it starts and how it progresses

Atherosclerosis is a slow, lifelong progression of changes in the blood vessels that may start in childhood and get worse faster as you age.

The cause of atherosclerosis isn’t completely known.

Many scientists believe plaque begins when an artery’s inner lining (called the endothelium) becomes damaged. Four possible causes of such damage are:

• Elevated levels of cholesterol and triglycerides in the blood
• High blood pressure
• Cigarette smoking
• Diabetes

Smoking plays a big role in the progression of atherosclerosis in the aorta (the body’s main artery), coronary arteries and arteries in the legs. Smoking makes fatty deposits more likely to form, and it accelerates the growth of plaque.

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff.

Last Reviewed: Nov 6, 2020

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Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. That limits the flow of oxygen-rich blood to your body.

Atherosclerosis can lead to serious problems, including:

• Coronary artery disease. These arteries supply blood to your heart. When they are blocked, you can suffer angina or a heart attack.
• Carotid artery disease. These arteries supply blood to your brain. When they are blocked you can suffer a stroke.
• Peripheral arterial disease. These arteries are in your arms, legs and pelvis. When they are blocked, you can suffer from numbness, pain and sometimes infections.

Atherosclerosis usually doesn’t cause symptoms until it severely narrows or totally blocks an artery. Many people don’t know they have it until they have a medical emergency.

A physical exam, imaging, and other diagnostic tests can tell if you have it. Medicines can slow the progress of plaque buildup. Your doctor may also recommend procedures such as angioplasty to open the arteries, or surgery on the coronary or carotid arteries. Lifestyle changes can also help. These include following a healthy diet, getting regular exercise, maintaining a healthy weight, quitting smoking, and managing stress.

NIH: National Heart, Lung, and Blood Institute

• What Is Atherosclerosis?

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• Angioplasty: MedlinePlus Health Topic

  (National Library of Medicine)

  Also in Spanish

• Carotid Endarterectomy

  (Cleveland Clinic Foundation)

• Chelation for Coronary Heart Disease

  (National Center for Complementary and Integrative Health)

• Heart-Healthy Diet: Eight Steps to Prevent Heart Disease

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Atherosclerosis and Stroke

  (American Stroke Association)

• Cerebral Arteriosclerosis

  (National Institute of Neurological Disorders and Stroke)

• ClinicalTrials. gov: Arteriosclerosis

  (National Institutes of Health)

• ClinicalTrials.gov: Atherosclerosis

  (National Institutes of Health)

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Peripheral arterial disease – what is it?

25. 10.2019

Atherosclerosis (hardening arteries ) is a disease caused by narrowing and closing of the limbs arteries .

Causes of peripheral arterial disease

Hardening of the arteries begins with minor injuries to the innermost layer of the artery . Various substances accumulate in the area of ​​damage. This deposit in the long run will lead to a narrowing of vessels until the closure of blood vessels .

Many factors contribute to the development of vessel calcification .

Prolonged high blood pressure is one of the most common causes of atherosclerosis because it can lead to injury to the wall of the artery . With diabetes mellitus vascular attacks often occur already at a fairly young age. Age plays a big role. Because with age there is a loss of elasticity vessels , as the elastic fibers disappear and are replaced by “hard” connective tissue. Elevated blood fats increase the risk of hardening arteries because fat is deposited in vessels . Also, smoking harms vessels in the long term.

All arteries of the body can be narrowed by atherosclerotic changes. In peripheral arterial disease, the pelvic and leg arteries are usually affected . One narrowing of arteries is an absolute rarity.

Symptoms

A typical symptom is the so-called “showcase disease”: from a certain walking distance, victims notice pain in their legs which makes them stand. After a short break, the discomfort subsides and the victim continues to work. So that this strange rhythm is not too noticeable, people like to stand in front of shop windows.

The cause of these ailments is the lack of oxygen in the muscles as a result of poor blood circulation. The meaning of pain depends on the location of the narrowing vessels . As a rule, discomfort is always felt below the affected artery .

Course and complications

If the disease progresses, leg pain also occurs at rest. If the artery is completely closed, the deficient tissue dies. The most common location for these dead tissues is toes . Talk about necrosis or gangrene. With dry gangrene, the black area has a mummified appearance, with wet gangrene, on the contrary, tissue breakdown due to bacterial decomposition is used, an unpleasant odor is typical.

Especially in the aorta, the largest artery of our body, over the years a cluster can form, the so-called aneurysm . If the size of this package increases, there is a risk of it breaking.

Fear of acute arterial insufficiency caused by free parts of vascular deposits. They continue to be transported with blood until they get stuck in small vessels and completely clog them.

Clinical pictures with similar symptoms

Discomfort in the legs also occurs with chronic weakness veins , or their result, varicose veins . However, this affects the veins , ie the blood vessels , which transport the blood consumed back to the heart . Arterial disease affects the blood vessels that carry oxygen-rich blood to feet .

Pain in the legs that occurs during exercise can also be a sign of damage to the intervertebral disc .

In the context of nerve damage, polyneuropathy, pain in the leg often occurs.

In severe pain, especially in the big toe , one should think of an acute attack of gout.

Treatment

Above all, avoid risk factors to prevent the progression of arterial disease. This means you need treat high blood pressure , diabetes and elevated blood fats . Give up nicotine. To prevent hardening of the arteries , a balanced and low-fat diet , as well as regular exercise, is important. In the initial stage of peripheral VKA, walking is an important measure: the victim should continue walking until pain appears, and then stop and continue work until discomfort improves. The purpose of this therapy is the promotion of bypass circles in the area of ​​constricted blood vessels . Achievements can be achieved by daily training 1-2 hours. Important: well-fitting and comfortable shoes and careful care of feet . In this way, injuries that heal very slowly due to poor circulation can be avoided. Menopausal baths with cold and warm water can stimulate circulation.

In any case, be sure to come to the reception to doctor to exclude other diseases and not to attribute treatment from unknown sources.

Published in Cardiology Premium Clinic

Publication date: November 2, 2017
Update date: December 01, 2021

What is atherosclerosis and how to detect this disease in advance?

Atherosclerosis is a real executioner of the modern world. According to various data, mortality due to cardiovascular pathology associated with atherosclerosis reaches 85% of the total number of deaths in the world. With the greatest frequency, atherosclerosis affects men older than 45-50 years (3-4 times more often than women), but occurs in younger patients.

Atherosclerosis (translated from the Greek athera-gruel + sklerosis-hardening) is a lesion of the arteries, accompanied by cholesterol deposits in the inner membranes of the vessels, narrowing of their lumen and malnutrition of the blood-supplying organ.

The composition of cholesterol deposits includes those very “bad” fats – cholesterol and some fractions of lipoproteins that enter our bloodstream through food saturated with fatty acids – mainly fatty meat products. Deposits form in the form of atheromatous plaques. The subsequent proliferation of connective tissue in them and the inclusion of calcium lead to deformation and narrowing of the lumen up to blockage of the vessel. All types of cholesterol deposits, starting from the very first, the so-called lipid spots, can be traced with ultrasound.

At the moment, there is no unified theory of the occurrence of this disease. The most famous theory is lipoprotein infiltration, in which there is a primary accumulation of “bad” fats in the vascular wall.

There are opinions that infectious agents (herpes simplex virus, cytomegalovirus, chlamydial infection, etc.), a violation of the protective properties of the endothelium and its mediators, hereditary diseases accompanied by an increase in cholesterol levels, autoimmune causes, mutations of cells of the vascular walls play a role in the development of atherosclerosis. There is also a hormonal theory, according to which an age-related increase in the level of gonadotropic and adrenocorticotropic hormones leads to an increased synthesis of the building material for cholesterol hormones.

Risk factors that aggravate the prognosis of the course and development of atherosclerosis:

– smoking (the most dangerous factor)

– hyperlipoproteinemia (total cholesterol > 5 mmol/l, LDL > 3 mmol/l, Lp(a) > 50 mg/dl)

– arterial hypertension (systolic blood pressure > 140 mm Hg diastolic blood pressure > 90 mm Hg)

– diabetes

– obesity

– sedentary lifestyle (lack of exercise)

– emotional stress

– malnutrition

– hereditary predisposition

– postmenopause

– hyperfibrinogenemia

– homocysteinuria

– hypothyroidism

Which arteries can be affected by atherosclerosis and what does it lead to?

Damage to the arteries of the heart, or coronary arteries, leads to the development of coronary heart disease, which leads to the development of myocardial infarction.

Damage to the arteries of the neck leads to the development of a stroke.

Damage to the arteries that feed the digestive organs (intestines, stomach) leads to the development of ischemia of the digestive organs.

The defeat of the renal arteries leads to a reflex increase in blood pressure, developing renovascular hypertension.

Damage to the arteries of the lower extremities leads to the development of intermittent claudication or the “poster” syndrome, pain in the muscles of the lower leg appears during walking, forcing to stop, supposedly to read advertising posters. And in the last stages, gangrene develops, which can lead to amputation of the limb.

So, atherosclerotic lesion of the arteries is a multifaceted process that affects all organs and systems of our body!

In order to prevent these serious, life-threatening diseases, it is necessary to constantly be monitored by specialist doctors, annually take a minimum range of tests, including lipidogram and coagulogram, follow dietary recommendations and all medical prescriptions.