Atherosclerosis

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Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries. Atherosclerosis is a type of arteriosclerosis. The two terms are often used to mean the same thing.

Causes
Atherosclerosis is a common disorder that specifically affects the medium and large arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Watch this video about:Atherosclerosis Eventually, the plaques can make the artery narrow and less flexible, making it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms. Pieces of plaque can break off and move through the affected artery to smaller blood vessels, blocking them and causing tissue damage or death (embolization). This is a common cause of heart attack and stroke. Blood clots can also form around a tear (fissure) in the plaque leading to blocked blood flow. If the clot moves into an artery in the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism. In some cases, the atherosclerotic plaque is associated with a weakening of the wall of an artery leading to an aneurysm. Risk factors for atherosclerosis include:
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Diabetes Heavy alcohol use High blood pressure High blood cholesterol levels High-fat diet Increasing age Obesity Personal or family history of heart disease Smoking

Atherosclerosis can affect many different organ systems, including the heart, lungs, brain, intestines, kidneys, and limbs (extremities).

Symptoms
Symptoms usually do not occur until blood flow becomes restricted or blocked. See the specific condition for more details on symptoms:
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Abdominal aortic aneurysm Coronary artery disease Kidney disease Mesenteric artery ischemia Peripheral artery disease Renal artery stenosis Hypertension Stroke (cerebrovascular disease) Thoracic aortic aneurysm

Exams and Tests

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery. Tests that may be used to diagnose atherosclerosis or its complications include:
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Ankle/brachial index (ABI) Aortic arteriography (aortic angiography) Arteriography Cardiac stress testing Carotid duplex Coronary artery angiography) CT scan Doppler study Extremity arteriography Intravascular ultrasound (IVUS) Magnetic resonance arteriography (MRA) Mesenteric arteriography Pulmonary angiography Renal arteriography

Treatment
To help prevent atherosclerosis or its complications (such as heart disease and stroke), make the following lifestyle changes:

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Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish. Do not drink more than one or two alcoholic drinks a day. Exercise regularly for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight.

Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family. Have your blood pressure checked more often if you have high blood pressure, heart disease, or you have had a stroke. Talk to your doctor about how often you should have yours checked. Specific recommendations depend on your age and blood pressure readings.
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Everyone should keep their blood pressure below 140/90 mmHg If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure should probably be less than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.

Have your cholesterol checked and treated if it is high. See: High cholesterol and triglycerides
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Adults should have their cholesterol checked every 5 years. If you are being treated for high cholesterol or a family history of cholesterol problems, you will need to have it checked more often. All adults should keep their LDL ("bad") cholesterol levels below 130-160 mg/dL. If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your LDL cholesterol should be lower than 100 mg/dL. Few medications have been found to clear up plaque. Statins and other cholesterollowering drugs can help prevent more plaque from forming.

Your doctor may suggest taking aspirin or another drug called clopidogrel (Plavix) to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your doctor. Talk to your doctor about the safety of hormone replacement therapy for menopause. Guidelines no longer recommend vitamins E or C, antioxidants, or folic acid to prevent heart disease. A number of surgeries are performed to help prevent the complications of atherosclerosis. Some of these are:
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Angioplasty and stent - heart - discharge Angioplasty and stent placement - peripheral arteries Abdominal aortic aneurysm repair - open Coronary artery bypass surgery

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Carotid artery surgery Minimally invasive heart surgery

Outlook (Prognosis)
Everyone starts to develop some amount of atherosclerosis as they grow older. In some people, the condition can cause complications such as a heart attack or stroke.

Possible Complications
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Coronary heart disease Damage to organs (such as the kidneys, brain, liver, and intestines) Heart attack Stroke Too little blood to the legs and feet Transient ischemic attack (TIA)

What Is Atherosclerosis?
Atherosclerosis -- hardening and narrowing of the arteries -- gets a lot of bad press, with good reason. This progressive process silently and slowly blocks arteries, putting blood flow at risk. Atherosclerosis is the usual cause of heart attacks, strokes, and peripheral vascular disease -- what together are called "cardiovascular disease." Cardiovascular disease is the No. 1 killer in America, with more than 800,000 deaths in 2005.
Recommended Related to Heart Disease
Your Arterial Lifeline Atherosclerosis is dangerous because it's so stealthy. This process of narrowing and hardening of the arteries occurs over decades, usually without any symptoms. Heart attacks and strokes caused by atherosclerosis are responsible for hundreds of thousands of deaths each year. But diseases caused by atherosclerosis also lead to chronic pain, kidney failure, blindness, and even impotence. It's time to shine some light on these hidden complications of atherosclerosis -- and to learn how to prevent... Read the Your Arterial Lifeline article > >

How does atherosclerosis develop? Who gets it, and why? Atherosclerosis is a mouthful, but it doesn't need to be a mystery. This deadly process is preventable and treatable. Read on, and get to know your enemy. What Causes Atherosclerosis? First, an Anatomy 101 review: Arteries are blood vessels that carry blood from the heart throughout the body. They're lined by a thin layer of cells called the endothelium. The endothelium works to keep the inside of arteries toned and smooth, which keeps blood flowing. "Atherosclerosis starts when high blood pressure, smoking, or high cholesterol damage the endothelium," says Richard Stein, MD, national spokesperson for the American Heart Association. "At that point, cholesterol plaque formation begins." Cholesterol invasion. Bad cholesterol, or LDL, crosses damaged endothelium. The cholesterol enters the wall of the artery.

Plaque formation. Your white blood cells stream in to digest the LDL cholesterol. Over years, the accumulating mess of cholesterol and cells becomes a plaque in the wall of the artery. "It's a jumble of lipids, or cholesterol, cells, and debris, and it creates a bump on the artery wall," explains Stein. As the process of atherosclerosis continues, "the bump gets bigger." A big enough bump can create a blockage. Atherosclerosis tends to happen throughout the body. "So if you have plaque in your heart, you're at a higher risk for stroke, and vice versa," says Stein. Atherosclerosis usually causes no symptoms until middle or older age. Once narrowings become severe, they choke off blood flow and can cause pain. Blockages can also suddenly rupture, causing blood to clot inside an artery at the site of the rupture. Atherosclerosis and Plaque Attacks Plaques from atherosclerosis can behave in different ways. y y y They can stay within the artery wall. There, the plaque grows to a certain size and stops. "Because they don't block blood flow, these plaques may never cause any symptoms," says Stein. They can grow in a slow, controlled way into the path of blood flow. Eventually, they cause significant blockages. Pain on exertion (in the chest or legs) is the usual symptom. The worst-case scenario: plaques can suddenly rupture, allowing blood to clot inside an artery. In the brain, this causes a stroke; in the heart, a heart attack. The plaques of atherosclerosis cause the three main kinds of cardiovascular disease: y Coronary artery disease: Stable plaques in the heart's arteries cause angina (chest pain on exertion). Sudden plaque rupture and clotting causes heart muscle to die. This is a heart attack, or myocardial infarction. Cerebrovascular disease: Ruptured plaques in the brain's arteries causes strokes, with the potential for permanent brain damage. Temporary blockages in an artery can also cause transient ischemic attacks (TIAs), which are warning signs of stroke; however, there is no brain injury. Peripheral artery disease: Narrowing in the arteries of the legs caused by plaque. Peripheral artery disease causes poor circulation. This causes pain on walking and poor wound healing. Severe disease may lead to amputations.

y Atherosclerosis Prevention Atherosclerosis is progressive, but it's also preventable. For example, nine risk factors are to blame for up to 90% of all heart attacks: y y y y y y y y y Smoking High cholesterol High blood pressure Diabetes Abdominal obesity ("spare tire") Stress Not eating fruits and vegetables Excess alcohol intake (more than one drink for women, one or two drinks for men, per day) Not exercising regularly

You may notice all of these have something in common: You can do something about them! Experts agree that reducing your risk factors leads to a lower risk of cardiovascular disease. For people at moderate or higher risk -- those whove had a heart attack or stroke, or who suffer angina -taking a baby aspirin a day can be important. Aspirin helps prevent clots from forming. Ask your doctor before starting daily aspirin, as it can have side effects. Atherosclerosis Treatment Once a blockage is there, it's generally there to stay. With medication and lifestyle changes, though, plaques may slow or stop growing. They may even shrink slightly with aggressive treatment. y Lifestyle changes: Reducing the lifestyle risk factors that lead to atherosclerosis will slow or stop the process. That means a healthy diet, exercise, and no smoking. These lifestyle changes won't remove blockages, but theyre proven to lower the risk of heart attacks and strokes. Medication:Taking drugs for high cholesterol and high blood pressure will slow and perhaps even halt the progression of atherosclerosis, as well as lower your risk of heart attacks and stroke. Using invasive techniques, doctors can also open up blockages from atherosclerosis, or go around them: y Angiography and stenting: Cardiac catheterization with angiography of the coronary arteries is the most common angiography procedure performed. Using a thin tube inserted into an artery in the leg or arm, doctors can access diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (catheters with balloon tips) and stenting can often open up a blocked artery. Bypass surgery: Surgeons "harvest" a healthy blood vessel (often from the leg or chest). They use the healthy vessel to bypass a segment blocked by atherosclerosis. These procedures involve a risk of complications. They are usually saved for people with significant symptoms or limitations caused by atherosclerosis.