What is atherosclerosis?
Atherosclerosis is an inflammatory process in which cholesterol accumulates on the walls of the arteries and forms "fatty plaques." These plaques gradually cause the blood vessels to narrow. In addition, a more dangerous process can occur, where the artery becomes completely blocked at once.
Complete occlusion or blockage of the artery prevents the flow of oxygenated blood to organs such as the heart, brain, and legs. This condition of inadequate oxygen supply is called ischemia.
As mentioned, the blood vessels can become partially or completely blocked. Complete blockage due to the rupture of the fatty plaque can lead to a stroke or heart attack, while partial blockage can cause chest pain (angina) or temporary brain dysfunction.
Important facts about atherosclerosis:
• Atherosclerosis is the main cause of heart and vascular diseases - the number 1 cause of death worldwide.
• The atherosclerotic process is chronic and often asymptomatic, developing over many years until a critical blockage of the blood vessels and oxygen deprivation occur. Hence, many people may experience a heart attack or stroke seemingly out of good health.
What are the risk factors for atherosclerosis?
Several major risk factors influence the likelihood of developing atherosclerosis:
• High LDL-C (bad cholesterol)
• Low HDL-C (good cholesterol)
• Smoking
• High blood pressure
• Diabetes
• Obesity
• Family history
• Previous cardiovascular events
A combination of these risk factors significantly increases the risk of atherosclerosis progression.
It is essential to remember that people who have already experienced a heart attack or stroke are at a higher risk of developing another event if their risk factors are not well managed.
What does atherosclerosis cause?
Atherosclerosis can lead to the following complications:
1. The narrowing of blood vessels supplying oxygen to the heart can cause a condition called angina pectoris, characterized mainly by chest pain.
2. Complete blockage of blood vessels supplying oxygen to the heart can lead to a heart attack, while a blood clot reaching the brain can cause a stroke and, in some cases, even death.
3. Weakness and enlargement of the inner artery wall can lead to the formation of an aneurysm, which is a bulge in the artery wall. The rupture of an aneurysm can cause severe internal bleeding.
Location of the disease Initial symptoms Emergency conditions
Arteries supplying blood to the lower limbs Leg pain during walking and at rest Ulceration, ischemia, infection, gangrene (chronic wound), amputation
Arteries supplying blood to the heart Chest pain Angina, heart attack, death
Arteries supplying blood to the brain (carotid arteries) Temporary loss of vision, transient ischemic attack (TIA) Stroke
It is essential to remember that the absence of initial symptoms does not necessarily indicate the absence of atherosclerosis.
How is atherosclerosis diagnosed?
Atherosclerosis can be diagnosed through the following tests:
1. Medical examination: This includes a family history assessment, risk factor evaluation, and physical examination.
2. Non-invasive tests: Doppler ultrasound measures blood flow based on the sound of blood movement (used for arteries in the legs and carotid arteries), and a stress test that includes ultrasound mapping during exertion.
3. Invasive tests: Angiography involves inserting a catheter into the blood vessels and taking X-ray images after injecting a contrast dye or performing CT angiography of the heart.
Methods of Treatment
Treatment methods for atherosclerosis can be divided into several categories:
1. Non-pharmacological treatment or lifestyle changes (explained below).
2. Pharmacological treatment targeting risk factors (explained below).
3. Non-surgical minimally invasive procedures: Angioplasty is a procedure where a catheter is inserted through the skin into the blood vessel. When the catheter reaches the affected area, a balloon at its tip is inflated, expanding the narrowed artery. Stents, small mesh tubes, are often inserted to prevent recurrent narrowing.
4. Surgical intervention: Bypass surgery involves creating a bypass around the affected artery or opening the artery and removing the plaque.
Lifestyle Changes
Regular physical activity: Regular physical activity reduces the risk of cardiovascular diseases. It is recommended to engage in physical activity five times a week, for 30 minutes each time. Walking is a readily available and beneficial exercise for most individuals.
Healthy diet: A diet rich in whole grains, vegetables, fruits, and healthy fats (such as olive oil) is essential. It is advised to reduce the intake of red meat, high-fat dairy products (with fat content over 5%), sweets, cakes, cookies, and other sugary items.
Weight management: Maintaining a healthy body weight helps lower blood pressure, triglyceride levels, and blood sugar.
It's important to remember that lifestyle changes are an effective and safe preventive treatment for atherosclerosis. This treatment approach is also cost-effective but requires determination, persistence, and appropriate education.
Pharmacological Treatment for Risk Factors
High blood pressure: High blood pressure is when there is higher-than-normal pressure in the blood vessels. It can lead to damage in blood vessels, which may worsen atherosclerosis. Blood pressure is measured by two values: systolic (the higher value during heart contractions) and diastolic (the lower value when the heart is at rest). High blood pressure is defined as values above 140/90 mmHg. Recently, values between 130-140 mmHg systolic and 80-90 mmHg diastolic have also been considered as "pre-hypertension" that requires closer monitoring and sometimes pharmacological treatment, especially in individuals with risk factors like diabetes.
Cholesterol: Cholesterol is a vital substance for the body, but high levels of certain types of cholesterol can harm blood vessels. Smoking or high blood pressure damages the inner lining of arteries, allowing cholesterol to accumulate within the blood vessel walls, leading to the formation of plaques and atherosclerosis.
Treatment for high cholesterol involves a group of medications called statins, which lower cholesterol levels in the body. Statins work by inhibiting the enzyme responsible for cholesterol production. Statins are considered safe for treatment, with minimal side effects. Different statins have varying degrees of LDL-C (bad cholesterol) reduction, with Crestor being considered the most effective.
Diabetes: Diabetes is a condition where there are high blood sugar levels. It can cause damage to both large and small blood vessels and worsen atherosclerosis. People with diabetes have a 2-4 times higher risk of atherosclerosis complications, including heart attacks and strokes. The diabetes treatment is varied and can range from oral medications to insulin injections. People with diabetes should aim for glucose levels before fasting and before meals to be around 100-120 mg/dL, and levels less than 140 mg/dL two hours after meals. Another important measure is the HbA1c level, which represents glucose balance over the past three months and should be less than 7%.
Summary
• Atherosclerosis affects all blood vessels in the body.
• Various risk factors accelerate its progression.
• Atherosclerosis has severe and wide-ranging implications, affecting vital organs such as the brain and heart.
• Early diagnosis and proper treatment of atherosclerosis and its risk factors can prevent dangerous consequences and lead to healthier and longer lives.