Arteriosclerosis

Overview

Clogged plumbing

Arteriosclerosis, the condition often called hardening of the arteries, is a general term for several conditions in which the wall of an artery becomes thicker and less elastic than usual. The most common form of arteriosclerosis is atherosclerosis in which fatty material — predominantly cholesterol — accumulates on artery walls. Your doctor may refer to arteriosclerosis as vascular disease.

Atherosclerosis affects large and medium-sized arteries and is a slow, progressive disease that may start in childhood. In some people, this disease progresses rapidly in their 30s, while others don't have any problems until they reach their 50s or 60s. Collectively, the effects of atherosclerosis on the brain, heart, kidneys, and other vital organs are the leading cause of death and disease in the United States and most western countries. While it can occur anywhere in the body, atherosclerosis is especially common in the arteries leading to the heart and brain and can lead to heart attack or stroke.

Detailed Description

To some extent, arteriosclerosis is a natural part of aging, but a number of lifestyle choices can dramatically affect the onset and severity.

In atherosclerosis, for example, fatty substances — cholesterol, cellular waste products, calcium, and fibrin (a clotting material in the blood) — deposit on the inner lining of an artery. The innermost layer of the artery becomes thickened by these accumulating cells and surrounding material. The resulting build-up, called plaques or atheromas, over time may partially block the blood's flow through an artery, thus decreasing the oxygen supply reaching your internal organs. Affected arteries lose their elasticity and narrow as the plaque deposits grow. Coronary atherosclerosis is the cause of coronary artery disease. People with coronary artery disease (narrowed coronary arteries) may experience angina pectoris (chest pain) or discomfort caused by insufficient oxygen supply to the heart muscle.

In time, the plaques also collect calcium deposits, causing the plaques to become brittle, and increasing the likelihood of rupturing. When a rupture occurs, blood may flow in and make the plaque larger so that it narrows the artery even more. A ruptured plaque may trigger the formation of a blood clot (thrombus). The clot may further narrow or even block the artery, or it may detach and float freely in the blood until it gets stuck in a small vessel. The end result is usually serious. Blockage of the arteries supplying blood to the heart can cause heart attack. Blockage of the arteries supplying blood to the brain can cause stroke. Blockage of the arteries supplying blood to the extremities can cause gangrene.

Symptoms often don't appear until the atherosclerosis reaches an advanced stage, at which point it becomes harder to treat. The best approach is prevention — avoiding the numerous risk factors under your control, including diet, smoking, and exercise.

How Common Is Arteriosclerosis?

Arteriosclerosis is very common in the United States. According to the Centers for Disease Control (CDC), cardiovascular disease, principally heart disease and stroke, accounts for 42% of all deaths nationwide, for both men and women among all racial and ethnic groups. The CDC estimates that one in four Americans has cardiovascular disease.

Conventional Treatment

Goals of Treatment

The immediate goal in treating arteriosclerosis is to halt or at least slow its progress. Your doctor may prescribe medications to help lower cholesterol levels if diet modifications and other lifestyle approaches fail. Drug therapy can also help control high blood pressure and diabetes, two other risk factors.

Lifestyle changes — diet, exercise, and smoking cessation — are critical. The progress of artery hardening can be delayed with treatment. Over time, the size of plaque may decrease. Certain medications are effective in lowering cholesterol levels and slowing the progress of plaque deposits. When medications don't work, surgery is also an option.

Treatment Overview

Once you're diagnosed with arteriosclerosis, your doctor will begin monitoring your overall health status, keeping a close watch on your blood pressure and your cholesterol and triglyceride levels. Your doctor can direct you to helpful resources for dietary counseling and smoking cessation if necessary.

The following treatments are general measures that address the risk factors of arteriosclerosis:

• Aerobic exercise, 30 to 45 minutes, at least three times a week
• Weight loss, if needed, to reach and maintain normal body weight
• Low-fat, low-cholesterol, high-fiber diet
• Correction and control of abnormal blood-cholesterol levels
• Smoking cessation
• Maintenance of normal blood pressure and normal blood sugar levels
• Stress reduction

Drug Therapy

Drugs most commonly prescribed to treat the causes
Crestor
Cholesterol-lowering agents
Pravachol
Mevacor
buy Atorvastatin
Zocor
Fibric acid derivatives
Lopid
Blood-pressure lowering agents that may include diuretics, beta-blockers, calcium-channel blockers, ACE inhibitors, vasodilators, and others

Procedures

When other treatment methods are inadequate, several invasive procedures are available.

• Angioplasty: A catheter with a balloon tip is inserted into a narrowed artery and then inflated, widening the artery by cracking plaques. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque. Angioplasty is most commonly performed on arteries leading to the heart, the kidneys, and vessels in the lower leg.
• Bypass surgery: A section of vein or artery is removed from elsewhere in the body and reconnected to detour blood around the diseased vessel. Coronary bypass surgery is the most common type of bypass, but it's also done in blood vessels in the legs.
• Endarterectomy: The clogged vessel is opened up and the fatty deposits are removed. This procedure is most commonly done on the carotid artery in the neck.

New Treatments in Development

• Gene therapy: In this experimental procedure, genes that direct the growth of new blood vessels are surgically inserted into the blocked artery. This should encourage formation of a natural bypass around the blockage.
• Transmyocardial revascularization: a laser cuts a series of channels in the heart muscle to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle. This is a new procedure and still considered experimental.

Appropriate Healthcare Setting

People with arteriosclerosis do not require hospitalization unless sudden acute complications occur — such as severe angina, transient ischemic attacks, heart attack, or stroke. In those cases, inpatient hospitalization is necessary.

Healthcare Professionals Who May Be Involved in Treatment
Many health professionals and cardiac specialists participate in managing this disorder:

• Family physicians
• Internists
• Geriatricians
• Cardiologists
• Critical care physicians
• Radiologists
• Thoracic surgeons
• Cardiac surgeons

Activity & Diet Recommendations

Exercise is an important component of treating arteriosclerosis and is especially helpful in preventing development of heart disease. A program of aerobic exercise can improve circulation, reduce cholesterol, and control obesity and diabetes, among other factors contributing to arteriosclerosis.

The connection between diet and vascular disease is well-established and many experts recommend a low-fat, high-fiber diet for patients with arteriosclerosis. Here are some general guidelines:

• Avoid foods high in saturated fats, such as meats, eggs, cheeses, and other dairy products
• Eat plenty of whole grains, breads, and cereals instead of white and refined grains
• Eat lots of fresh fruits and vegetables with meals and as snacks
• Eat legumes such as beans, peas, and lentils in soups and salads

Monitoring the Condition

Keep a close watch on your cholesterol and triglyceride levels. Stick to your exercise and diet programs.

Possible Complications

Untreated arteriosclerosis can cause serious complications:

• Angina pectoris and unstable angina
• Coronary artery disease
• Heart attack
• Congestive heart failure
• Stroke or transient ischemic attack (TIA)
• Gangrene

Quality of Life

Depending on the severity and stage of arteriosclerosis, available treatments range from lifestyle adjustments to major surgery. Which treatment is right for you depends on your individual situation. Making lifestyle changes, like improving your diet, quitting smoking, gradually increasing exercise, and reducing stress, can improve your overall quality of life and reduce your risk of the serious consequences of arteriosclerosis, such as a heart attack or stroke.

Considerations for Women

Women over age 35 who are on birth control pills and smoke are at an increased risk of developing arteriosclerosis. Estrogen replacement therapy for postmenopausal women with arteriosclerosis may decrease your chances of experiencing angina. Talk to your doctor about whether this option is right for you.

Considerations for Older People

Older people are particularly at risk for coronary artery disease because the effects of risk factors such as high blood pressure build up over time. The arteries also become thicker and lose their elasticity with age. Older people may also be more susceptible to side effects of medication. Talk to your doctor about any drugs you're currently taking.

Considerations for Children and Adolescents

Coronary artery disease doesn't develop overnight. Fatty streaks and deposits can begin forming in children as young as three years old. Establishing healthy habits in childhood such as eating right and exercising can prevent serious health consequences in adulthood.