Definition and Overview
Atherosclerosis is a progressive arterial disease caused by a plaque buildup resulting in a narrowed blood stream. Its actual cause remains unknown, although there are strong theories and several risk factors.
The disease is serious in the long term since it significantly increases the risk of cardiovascular disease (CVD), as well as stroke and heart attack. It can also occur in other major arteries affecting other organs such as kidneys (renal), legs (peripheral), and the brain (cerebral).
Depending on the severity of the condition, it may result in very subtle to severe symptoms, including difficulty in breathing and heart attack. Fortunately, many tests are available to accurately diagnose the disease, and interventions are aplenty allowing the patient to continue to live a normal life despite their condition.
Causes of Condition
Many people believe that atherosclerosis is caused by high levels of low-density lipoprotein (LDL) cholesterol, also known as “bad cholesterol.” Cholesterol, in general, is essential to life since it helps create vitamin D and hormones.
The cholesterol molecules circulate around the body inside lipoproteins, which is composed of fat on its internal side and protein as its external layer. Bad cholesterol “sticks” to the arteries while the good ones go back to the liver where they are synthesized and eventually eliminated by the body.
In truth, however, the actual reason for atherosclerosis remains unclear. Nevertheless, it occurs when the arteries are damaged.
When an artery is damaged, cholesterol can get into the walls of the arteries and attach itself there. The body’s immune system identifies the deposit as a “threat” and goes out to repair the artery’s damage. In turn, a blood clot forms. This blood clot can become a serious blockage to the blood flow. In certain cases, the clot can detach itself and travel to other parts of the body, a condition known as embolism. The plaque can also rupture, which may then lead to stroke or heart attack.
Some of the risk factors associated with atherosclerosis are:
- Sedentary lifestyle or lack of physical activity
- Unhealthy diet, especially eating food known for too much fat or cholesterol
- Family history
- High triglycerides
- Smoking and excessive alcohol intake
- Preexisting conditions such as heart disease, diabetes, and chronic kidney disease
- A history of stroke or heart attack
- High blood pressure
- Insulin resistance
- Age (the disease tends to progress a lot faster among older people)
- Inflammation, which may be indicated by high levels of CRP (C-reactive protein)
Note that these are only risk factors, which means having them doesn’t necessarily mean you will automatically develop atherosclerosis. However, your chances of developing the disease are much higher than the general population or those who don’t have them.
- Angina (tightening or squeezing of the chest)
- Unexplained fatigue
- Shortness of breath
- Difficulty in breathing
- Abnormal rhythm of the heart (arrhythmia)
- Numbness in the extremities
- Loss of appetite
- Edema (collection of water in the body’s cavities)
- Changes in urination
The symptoms can vary depending on where atherosclerosis is developing. However, there are cases wherein the condition doesn’t have any symptom in its earliest stages, such as in renal disease.
The buildup of plaque can begin in childhood. In fact, many studies have already linked high childhood obesity rate to early CVD and atherosclerosis.
As the disease progresses and remains untreated, patients may develop a heart attack where the following are experienced:
- Shortness of breath
- Unexplained fatigue that lasts for days
- Upper body discomfort, especially around the chest area
- Cold sweat
- Nausea and vomiting
It’s also possible to experience a stroke once the arteries burst, which will lead to the following symptoms:
- Drooping of the face
- Difficulty of speech
- Weakness or numbness of the arm
- Confusion or disorientation
- Loss of balance
- Blurry vision
- Fainting spell
Who to See and Treatments Available
Atherosclerosis remains to be a common serious health problem, but it is now easy to manage and prevent.
Patients who experience the symptoms listed above are advised to consult their family doctor who may then refer them to a specialist depending on the location of atherosclerosis. It could be a cardiologist (if it affects the heart), a nephrologist (if the kidneys are the ones affected), or a vascular doctor (if the condition has affected the blood vessels).
Different tests are performed to diagnose the condition and to assess its extent. These include:
- Blood tests to measure levels of cholesterol and triglycerides, sugar, and blood proteins
- Physical exam to assess blood pressure and blood flow
- Urinalysis to determine kidney problems
- Chest X-ray to know the size of the heart and the condition of the chest
- Electrocardiogram (EKG) to assess the heart’s electrical activity
- Imaging tests like CT scan to get a more detailed picture of the possibly affected organs and arteriogram to view the structure of the arteries
- Stress test to determine if the heart is overworked
One of the most important steps to reduce or stop atherosclerosis is a lifestyle change. These include:
- Maintaining a healthy weight
- Eating a balanced diet rich in vitamins and minerals, moderate in good fats and protein, enough sodium, and almost no artificial sugar
- Managing stress
- Increasing physical activity
- Quitting smoking and alcohol
Other treatment methods are meant to manage the symptoms and lower the risk factors. For example, statins are used to reduce the level of bad cholesterol while anti-coagulants or blood thinners prevent the formation of blood clots.
When necessary, surgical interventions are performed. These include coronary angioplasty and stenting, where a catheter is inserted to introduce a balloon. The balloon, when expanded, pushes the plaque deposits to the side, clearing the blood’s pathway. A stent is attached to keep the arteries open.
Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 47.
Libby P. The vascular biology of atherosclerosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 43.
Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 70.