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Atherosclerosis

Definition

Atherosclerosis is a condition in which fatty material is deposited along the walls of arteries. This fatty material thickens, hardens, and may eventually block the arteries.

Atherosclerosis is just one of several types of "arterio"-sclerosis, which is characterized by thickening and hardening of artery walls, but the two terms are often used to mean the same thing.

Causes, incidence, and risk factors

Atherosclerosis is a common disorder of the arteries. Fat, cholesterol, and other substances accumulate in the walls of arteries and form "atheromas" or plaques.

Eventually, this fatty tissue can erode the wall of the artery, diminish its elasticity (stretchiness) and interfere with blood flow. Plaques can also rupture, causing debris to migrate downstream within an artery. This is a common cause of heart attack and stroke.

Clots can also form around the plaque deposits, further interfering with blood flow and posing added danger if they break off and travel to the heart, lungs, or brain. Many physicians now suspect that there is an immune system component to the problem (inflammation may help cause atherosclerosis).

When blood flow in the arteries to heart muscle becomes severely restricted, it leads to symptoms like chest pain.

Risk factors include smoking, diabetes, obesity, high blood cholesterol, a diet high in fats, and having a personal or family history of heart disease. Cerebrovascular disease, peripheral vascular disease, high blood pressure, and kidney disease involving dialysis are also disorders that may be associated with atherosclerosis.

Symptoms

Atherosclerosis often shows no symptoms until flow within a blood vessel has become seriously compromised. Typical symptoms of atherosclerosis include chest pain when a coronary artery is involved, or leg pain when a leg artery is involved. Sometimes symptoms occur only with exertion. In some people, however, they may occur at rest.

Signs and tests

Atherosclerosis may not be diagnosed until symptoms develop. Prior to complications, atherosclerosis may be noted by the presence of a "bruit" (a whooshing or blowing sound heard over the artery with a stethoscope). The affected area may have a decreased pulse.

Tests that indicate atherosclerosis (or complications) include:

An abnormal difference between the blood pressure of the ankle and arm (ankle/brachial index, or ABI)
Doppler study of the affected area
Ultrasonic Duplex scanning
CT scan of the affected area
Magnetic resonance arteriography (MRA)
Arteriography of the affected area
Intravascular ultrasound (IVUS) of the affected vessels
Cardiac stress testing

Treatment

To some extent, the body will protect itself by forming new blood vessels around the affected area. This is called developing "collaterals."

Medications may be recommended to reduce fats and cholesterol in your blood; a low-fat diet, weight loss, and exercise are also usually suggested. Control of high blood pressure is also important.

Medications include cholestyramine, colestipol, nicotinic acid, gemfibrozil, probucol, atorvastatin, lovastatin, and others. Aspirin, ticlopidine, and clopidogrel (inhibitors of platelet clumping) or anti-coagulants may be used to reduce the risk of clot formation.

Balloon angioplasty uses a balloon-tipped catheter to flatten plaque and increase the blood flow past the deposits. The technique is used to open the arteries of the heart and other arteries in the body. Another widely used technique is stenting, which consists of implanting a small metal device inside the artery (usually following angioplasty) to keep the artery open.

Surgically removing deposits (endarterectomy) may be recommended in some cases. A bypass graft is the most invasive procedure. It uses a normal artery or vein from the patient to create a bridge that bypasses the blocked section of the artery.

Expectations (prognosis)

The outcome varies. All people begin to develop some degree of atherosclerosis as they age, and in some people, it leads to complications. Heart attack and stroke are potentially fatal complications of atherosclerosis.

Complications

Coronary artery disease -- the blood supply to the heart is insufficient due to atherosclerosis/plaque in the arteries to the heart; a symptom is angina (chest pain)
Heart attack
Transient ischemic attack (TIA) or stroke
Insufficient blood supply to the limbs (mainly the legs and feet) due to obstruction (claudication)
Damage to organs
Atherosclerosis and obstruction of bypass grafts

Calling your health care provider

Call for an appointment with your health care provider if you are at risk for atherosclerosis, particularly if symptoms of complications occur.

Consult with your physician before starting an exercise regimen if you have been diagnosed with coronary artery disease, or if you have previously suffered a heart attack.

Prevention

Follow your doctor's recommendations for preventing plaque buildup, which may include a low-fat, low-cholesterol, and low-salt diet. Follow your doctor's recommendations for treatment and control of hypertension (high blood pressure), diabetes and other diseases.

Lose weight if you are overweight, and stop smoking if you smoke. Get regular exercise to improve the fitness of your heart and circulation.