Atherosclerosis (arteriosclerosis – hardening of the arteries)
Reviewed by Dr Neal Uren, consultant cardiologist/© NetDoctor/
What is atherosclerosis?
Atherosclerosis develops slowly over 20 years, resulting in constricted arteries with low elasticity.
Atherosclerosis refers to the build up of plaque in the walls of the arteries leading to a reduction in the caliber of the vessel. The narrowing does not occur suddenly but builds up over several years where cholesterol, fat and the smooth muscle cells lining the blood vessels have been transformed into a thickened, and sometimes calcified, mass.
The result is that the arteries become constricted, their elasticity disappears and the volume of blood able to travel through them at any given time is reduced.
What are the symptoms of atherosclerosis?
In the brain, the presence of vulnerable plaque in arteries can lead to a blood clot (thrombus), thus cutting off the supply of oxygen to an area of brain. The results of this depend on the area and amount of damaged brain tissue – for example paralysis, typically affecting only one side of the body, can occur.
A brain artery affected by atherosclerosis may also rupture (hemorrhage), usually in someone who also has high blood pressure, and can potentially cause considerable brain damage. Both these events are known as strokes.
In the heart, it can be seen as angina, coronary thrombosis or reduced heart function (heart failure) due to damage done to the heart muscle from vessel occlusion.
In the aorta, atherosclerosis can lead to the development of aneurysmal dilation of the thorax and abdomen – in other words a ballooning of a segment of this vessel, which is then at risk of a rupture.
In the kidneys, atherosclerosis can lead to high blood pressure and renal failure.
Leg pains can also be experienced due to atherosclerosis in the main and smaller arteries to the lower limbs. In extreme cases, this might mean amputation of the leg due to an insufficient blood supply.
Atherosclerosis affects a lot of people. It can affect individuals in their 20s and increases with age. The exact cause is unknown but several risk factors leading to atherosclerosis have been identified:
- a family history of atherosclerosis
- diabetes Type 1 and Type 2
- hypertension (high blood pressure)
- high content of cholesterol in the blood
- being of the male gender
- excess weight.
How can the doctor help?
Currently, there is no medication available to cure atherosclerosis. Nor are there any drugs that can make constricted arteries regain their elasticity.
Some patients benefit from cholesterol-lowering medicine that reduces the progression of disease and the likelihood of plaque rupture. Often medicine preventing thrombosis (blood clotting) is also given, such as acetylsalicylic acid (aspirin).
The effects of atherosclerosis in the coronary arteries (those which supply blood to the heart muscle) can be treated by medication and surgery.
Medication reduces the amount of work that the heart performs, lowering pressure on the heart and improving pumping ability.
Atherosclerotic disease of the arteries in the neck (carotids) to the kidneys (renal) and to the limbs can potentially also be treated by techniques which introduce devices through the skin into accessible arteries, which are guided on to the diseased areas.
The surgical methods include:
- balloon dilation or PTCA (percutaneous transluminal coronary angioplasty).
A balloon is passed through the coronary arteries to the constricted parts where it is expanded to enlarge the blood vessels and improve the flow of blood. A superior, long-term result can be achieved by deployment of a metal stent.
- cleaning of the artery (endarterectomy).
The plaque is scraped away from inside the arteries at the time of surgery. This operation is specifically used in the treatment of the carotid arteries and is rarely done in other arteries.
- bypass operation.
The surgical insertion of a new blood vessel or vein graft around the constricted artery from the aorta.
What can be done to prevent atherosclerosis?
- Stop smoking. Your doctor or pharmacist will be able to provide advice and information on smoking cessation products and techniques.
- Eat a varied healthy diet, full of greens, fibre and, of course, low-fat products. Avoid saturated fats found in red meat like pork and beef.
- Exercise more.
- Lose weight, if overweight.
If you suffer from diabetes Type 1 or Type 2 or high blood pressure, ensure that treatment is maintained.
Based on a text by Dr Sabine Gill, Dr Carl J Brandt and Dr Steen Dalby Kristensen, consultant