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Atherosclerosis is a condition in which the artery walls thicken and get blocked due to accumulation and deposition of white blood cells (WBCs) and fatty substances like cholesterol on them. It is a major risk factor for various conditions like coronary artery disease, stroke, heart attack and peripheral artery disease.
An atheroma or plaque is an accumulation of macrophages, cholesterol, fatty acid, calcium and fibrous connective tissue along the arteries. It narrows the arteries, reduces the elasticity of its walls, restricts blood flow to organs and hampers their functioning.
Causes And Risk Factors
When LDL or bad cholesterol level increases in blood it crosses the endothelium and enters the wall of the artery. This leads to an inflammatory response of WBCs in the arterial walls. Over years, the chronic inflammatory response accumulates dead cell remnants and fatty substances along with calcium and other crystallized materials to become a plaque.
The exact cause is unknown. The risk of developing atherosclerosis increases with age. According to researchers, high blood levels of C-reactive protein (CRP) might also increase the risk.1 Certain health conditions that increase the risk are:
Other factors that may increase the risk include:
- Smoking – damages walls of arteries, increases blood pressure and reduces good cholesterol (HDL) levels
- Excessive alcohol intake – raises blood cholesterol level and blood pressure
- Physical inactivity
- Unhealthy eating habits
- Sleep disorders
Atherosclerosis is a silent condition. It is asymptomatic in its early stages. Symptoms start to appear when blood flow in the arteries is disturbed and the organs and tissues are deprived of blood supply due to plaque. Some of the signs and symptoms that may be seen are:
- Chest pain – indicates the possibility of heart attack due to blockage of coronary arteries
- Sudden numbness or weak and dizzy feeling – indicates the possibility of stroke due to blockage of the blood vessels supplying the brain (carotid arteries)
- Pain while walking – indicates the possibility of peripheral arterial disease due to blockage of arteries that supply blood to the limbs
- Erectile dysfunction in men due to hardening of the arteries
Weak pulse, lowered blood pressure, poor wound healing may indicate atherosclerosis. Following tests may be recommended to aid in diagnosing atherosclerosis:
- Blood Test – detects the levels of cholesterol, fats and sugar in the blood
- ECG (Electrocardiogram) – detects the electrical activity and rhythmic pattern of the heart
- Echocardiography– to test heart functioning
- CT scan – shows thickening and narrowing of arteries.
- Intravascular ultrasound (IVUS) – visualizes the inner wall of blood vessels
- Chest X-ray -analyzes the structures of heart and blood vessels and detects signs of heart failure.
- Ankle-brachial index – an abnormal index may indicate peripheral vascular
- Cholesterol lowering drugs containing statins and fibrates- Statin has been shown to slow progression or cause regression of atherosclerosis, and protect against acute cardiac events.
- Anti-platelet drugs – to reduce the chances of blood clot and further narrowing of arteries
- Anticoagulants – to prevent clot formation
- Beta blockers, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers – to control blood pressure and slow down the progression of atherosclerosis
Surgery is considered in case of severe symptoms or malfunctioning of an organ. Some of the surgical procedures are:
- Angioplasty – involves widening the blocked arteries with the help of a balloon that forces expansion of the plaque and the surrounding muscular wall of the artery
- Bypass surgery – a healthy blood vessel from a different part of the body is grafted to bypass the blockage in the narrowed artery
- Thrombolytic therapy – a clot-dissolving drug is directly inserted into an artery at the site blocked by blood clot
- Endarterectomy – fat deposits are surgically removed from the walls
Atherosclerosis is a slow disease. It takes a long time to progress and cause complications. Plaque formation may start during childhood and may advance rapidly during 30s. It may also not pose a threat until 50s or 60s. Plaque, once formed, can progress in different ways – it can grow slowly within the artery and cause significant blockages or it can rupture suddenly and cause blood clot inside the artery.
Over the years, atherosclerosis may lead to development of diseases like:
- Coronary Artery Disease – the blood vessels that supply oxygen and various nutrients through blood to the heart are blocked, which in turn reduces the flow of blood to the heart. Over the time, when the blood flow is reduced drastically the main symptoms like chest pain (angina) and breathlessness are seen. Complete blockage of the artery leads to a heart attack.
- Stroke – due to complete blockage of an artery inside or leading to the brain.
- Peripheral Artery Disease – caused due to narrowing or blockage of blood vessels supplying blood to the limbs leading to poor circulation.
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1. Devaraj S, Singh U, Jialal I. The evolving role of C-reactive protein in atherothrombosis. Clin Chem. 2009 Feb;55(2):229-38. doi: 10.1373/clinchem.2008.108886. Epub 2008 Dec 18. Review. PubMed PMID: 19095731; PubMed Central PMCID: PMC2662846.
2. Frisinghelli A, Mafrici A. Regression or reduction in progression of atherosclerosis, and avoidance of coronary events, with lovastatin in patients with or at high risk of cardiovascular disease: a review. Clin Drug Investig. 2007;27(9):591-604. Review. PubMed PMID: 17705568.