Heart & Vascular Arteriosclerosis / atherosclerosis

Arteries are blood vessels
that carry oxygen and nutrients from your heart to the rest of your
body. Healthy arteries are flexible, strong and elastic. Over time,
however, too much pressure in your arteries can make the walls thick and
stiff — sometimes restricting blood flow to your organs and tissues.
This process is called arteriosclerosis, or hardening of the arteries.

Atherosclerosis is a specific type of arteriosclerosis, but the terms
are sometimes used interchangeably. Atherosclerosis refers to the
buildup of fats in and on your artery walls (plaques), which can
restrict blood flow. These plaques can also burst, causing a blood clot.
Although atherosclerosis is often considered a heart problem, it can
affect arteries anywhere in your body. Atherosclerosis is a preventable
and treatable condition.

Symptoms

Atherosclerosis develops gradually. Mild atherosclerosis usually doesn't have any symptoms.

You usually won't have atherosclerosis symptoms until an artery is so
narrowed or clogged that it can't supply adequate blood to your organs
and tissues. Sometimes a blood clot completely blocks blood flow, or
even breaks apart and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:

* If you have atherosclerosis in your heart arteries, you may have
symptoms similar to those of a heart attack, such as chest pain
(angina).
* If you have atherosclerosis in the arteries leading to your brain,
you may have signs and symptoms such as sudden numbness or weakness in
your arms or legs, difficulty speaking or slurred speech, or drooping
muscles in your face. These are signs of a transient ischemic attack
(TIA) — which, if left untreated — may progress to a stroke.
* If you have atherosclerosis in the arteries in your arms and legs,
you may have symptoms of peripheral artery disease, such as leg pain
when walking (intermittent claudication).

Sometimes atherosclerosis causes erectile dysfunction in men.

When to see a doctor
If you think you have atherosclerosis — or risk factors for hardening of
the arteries — talk to your doctor. Also pay attention to early
symptoms of inadequate blood flow, such as chest pain (angina), leg pain
or numbness. Early diagnosis and treatment can stop atherosclerosis
from worsening and prevent a medical emergency.

Causes

Atherosclerosis is a slow, progressive disease that may begin as early
as childhood. Although the exact cause is unknown, atherosclerosis may
start with damage or injury to the inner layer of an artery. The damage
may be caused by:

* High blood pressure
* High cholesterol, often from getting too much cholesterol in your diet
* Smoking and other sources of nicotine
* Diabetes

Once the inner wall of an artery is damaged, blood cells called
platelets often clump at the injury site to try to repair the artery,
leading to inflammation. Over time, fatty deposits (plaques) made of
cholesterol and other cellular waste products also build up at the
injury and harden, narrowing your arteries. The organs and tissues
connected to the blocked arteries then don't receive enough blood to
function properly.

Eventually pieces of the fatty deposits may rupture and enter your
bloodstream. This can cause a blood clot to form and damage your organs,
such as in a heart attack. A blood clot can also travel to other parts
of your body and partially or totally block blood flow to another organ.

Risk factors

Hardening of the arteries occurs over time. In addition to simply
getting older, factors that increase the risk of atherosclerosis
include:

* High blood pressure
* High cholesterol
* Diabetes
* Obesity
* Smoking
* A family history of aneurysm or early heart disease

Complications

The complications of atherosclerosis depend on the location of the blocked arteries. For example:

* Coronary artery disease. When atherosclerosis narrows the arteries
close to your heart, you may develop coronary artery disease, which can
cause chest pain (angina) or a heart attack.
* Carotid artery disease. When atherosclerosis narrows the arteries
close to your brain, you may develop carotid artery disease, which can
cause a transient ischemic attack (TIA) or stroke.
* Peripheral artery disease. When atherosclerosis narrows the
arteries in your arms or legs, you may develop circulation problems in
your arms and legs called peripheral artery disease. This can make you
less sensitive to heat and cold, increasing your risk of burns or
frostbite. In rare cases, poor circulation in your arms or legs can
cause tissue death (gangrene).
* Aneurysms. Atherosclerosis can also cause aneurysms, a serious
complication that can occur anywhere in your body. An aneurysm is a
bulge in the wall of your artery. Pain and throbbing in the area of an
aneurysm is a common symptom. If an aneurysm bursts, you may face
life-threatening internal bleeding. Although this is usually a sudden,
catastrophic event, a slow leak is possible. If a blood clot within an
aneurysm dislodges, it may block an artery at some distant point.

Preparing for your appointment

If you think you may have atherosclerosis, or are worried about having
atherosclerosis because of a strong family history of heart disease,
make an appointment with your family doctor to have your cholesterol
level checked.

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be prepared for your appointment.
Here's some information to help you get ready for your appointment, and
what to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet. Many blood tests, including
cholesterol, other blood fat and blood sugar tests, require that you
fast beforehand.
* Write down any symptoms you're experiencing. Atherosclerosis
seldom has symptoms, but it is a risk factor for heart disease. Letting
your doctor know if you have symptoms like chest pains or shortness of
breath can help your doctor decide how aggressively your atherosclerosis
needs to be treated.
* Write down key personal information, including a family history of
high cholesterol, heart disease, stroke, high blood pressure or
diabetes, and any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Be prepared to discuss your diet and exercise habits. If you don't
already follow a diet or exercise routine, be ready to talk to your
doctor about any challenges you might face in getting started.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
atherosclerosis, some basic questions to ask your doctor include:

* What kinds of tests will I need?
* What's the best treatment?
* What foods should I eat or avoid?
* What's an appropriate level of physical activity?
* How often do I need a cholesterol test?
* What are the alternatives to the primary approach that you're suggesting?
* I have other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me?
* What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* Do you have a family history of high cholesterol, high blood pressure or heart disease?
* What are your diet and exercise habits like?
* Do you smoke?
* Have you had a cholesterol test before? If so, when was your last test? What were your cholesterol levels?
* Do you have any discomfort in your chest or pain in your legs with walking or at rest?
* Have you had a stroke or any unexplained numbness, tingling, or weakness of one side of your body or difficulty speaking?

What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting
smoking, eating healthy foods and becoming more physically active.
These are primary lines of defense against atherosclerosis and its
complications, including heart attack and stroke.

Tests and diagnosis

Your doctor may find signs of narrowed, enlarged or hardened arteries during a physical exam. These include:

* A weak or absent pulse below the narrowed area of your artery
* Decreased blood pressure in an affected limb
* Whooshing sounds (bruits) over your arteries, heard with a stethoscope
* Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
* Evidence of poor wound healing in the area where your blood flow is restricted

Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

* Blood tests. Lab tests can detect increased levels of cholesterol
and blood sugar that may increase the risk of atherosclerosis. You'll
need to go without eating or drinking anything but water for nine to 12
hours before your blood test. Your doctor should tell you ahead of time
if this test will be performed during your visit.
* Doppler ultrasound. Your doctor may use a special ultrasound
device (Doppler ultrasound) to measure your blood pressure at various
points along your arm or leg. These measurements can help your doctor
gauge the degree of any blockages, as well as the speed of blood flow in
your arteries.
* Ankle-brachial index. This test can tell if you have
atherosclerosis in the arteries in your legs and feet. Your doctor may
compare the blood pressure in your ankle with the blood pressure in your
arm. This is known as the ankle-brachial index. An abnormal difference
may indicate peripheral vascular disease, which is usually caused by
atherosclerosis.
* Electrocardiogram (ECG). An electrocardiogram records electrical
signals as they travel through your heart. An ECG can often reveal
evidence of a previous heart attack or one that's in progress. If your
signs and symptoms occur most often during exercise, your doctor may ask
you to walk on a treadmill or ride a stationary bike during an ECG.
* Stress test. A stress test, also called an exercise stress test,
is used to gather information about how well your heart works during
physical activity. Because exercise makes your heart pump harder and
faster than it does during most daily activities, an exercise stress
test can reveal problems within your heart that might not be noticeable
otherwise. An exercise stress test usually involves walking on a
treadmill or riding a stationary bike while your heart rhythm, blood
pressure and breathing are monitored.
* Cardiac catheterization and angiogram. This test can show if your
coronary arteries are narrowed or blocked. A liquid dye is injected into
the arteries of your heart through a long, thin tube (catheter) that's
fed through an artery, usually in your leg, to the arteries in your
heart. As the dye fills your arteries, the arteries become visible on
X-ray, revealing areas of blockage.
* Other imaging tests. Your doctor may use ultrasound, a
computerized tomography (CT) scan or a magnetic resonance angiogram
(MRA) to study your arteries. These tests can often show hardening and
narrowing of large arteries, as well as aneurysms and calcium deposits
in the artery walls.

Treatments and drugs

Lifestyle changes, such as eating a healthy diet and exercising, are
often the best treatment for atherosclerosis. But sometimes, medication
or surgical procedures may be recommended as well.

Various drugs can slow — or sometimes even reverse — the effects of atherosclerosis. Here are some common choices:

* Cholesterol medications. Aggressively lowering your low-density
lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or
even reverse the buildup of fatty deposits in your arteries. Boosting
your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol,
may help, too. Your doctor can choose from a range of cholesterol
medications, including drugs known as statins and fibrates.
* Anti-platelet medications. Your doctor may prescribe anti-platelet
medications, such as aspirin, to reduce the likelihood that platelets
will clump in narrowed arteries, form a blood clot and cause further
blockage.
* Beta blocker medications. These medications are commonly used for
coronary artery disease. They lower your heart rate and blood pressure,
reducing the demand on your heart and often relieve symptoms of chest
pain. Beta blockers reduce the risk of heart attacks and heart rhythm
problems.
* Angiotensin-converting enzyme (ACE) inhibitors. These medications
can help slow the progression of atherosclerosis by lowering blood
pressure and producing other beneficial effects on the heart arteries.
ACE inhibitors can also reduce the risk of recurrent heart attacks.
* Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina.
* Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.
* Other medications. Your doctor may suggest certain medications to
control specific risk factors for atherosclerosis, such as diabetes.
Sometimes specific medications to treat symptoms of atherosclerosis,
such as leg pain during exercise, are prescribed.

Sometimes more aggressive treatment is needed. If you have severe
symptoms or a blockage that threatens muscle or skin tissue survival,
you may be a candidate for one of the following surgical procedures:

* Angioplasty. In this procedure, your doctor inserts a long, thin
tube (catheter) into the blocked or narrowed part of your artery. A
second catheter with a deflated balloon on its tip is then passed
through the catheter to the narrowed area. The balloon is then inflated,
compressing the deposits against your artery walls. A mesh tube (stent)
is usually left in the artery to help keep the artery open.
* Endarterectomy. In some cases, fatty deposits must be surgically
removed from the walls of a narrowed artery. When the procedure is done
on arteries in the neck (the carotid arteries), it's known as carotid
endarterectomy.
* Thrombolytic therapy. If you have an artery that's blocked by a
blood clot, your doctor may insert a clot-dissolving drug into your
artery at the point of the clot to break it up.
* Bypass surgery. Your doctor may create a graft bypass using a
vessel from another part of your body or a tube made of synthetic
fabric. This allows blood to flow around the blocked or narrowed artery.

Lifestyle and home remedies

Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

* Stop smoking. Smoking damages your arteries. If you smoke,
quitting is the best way to halt the progression of atherosclerosis and
reduce your risk of complications.
* Exercise most days of the week. Regular exercise can condition
your muscles to use oxygen more efficiently. Physical activity can also
improve circulation and promote development of new blood vessels that
form a natural bypass around obstructions (collateral vessels). Exercise
helps lower blood pressure and reduce your risk of diabetes. Ideally,
you should exercise 30 to 60 minutes most days of the week. If you can't
fit it all in one session, try breaking it up into 10-minute intervals.
You can take the stairs instead of the elevator, walk around the block
during your lunch hour, or do some sit-ups or push-ups while watching
television.
* Eat healthy foods. A heart-healthy diet based on fruits,
vegetables and whole grains — and low in saturated fat, cholesterol and
sodium — can help you control your weight, blood pressure, cholesterol
and blood sugar. Try substituting whole-grain bread in place of white
bread, grabbing an apple, a banana or carrot sticks as a snack, and
reading nutrition labels to control the amount of salt and fat you eat.
* Lose extra pounds and maintain a healthy weight. If you're
overweight, losing as few as 5 to 10 pounds can help reduce your risk of
high blood pressure and high cholesterol, two of the major risk factors
for developing atherosclerosis. Losing weight helps reduce your risk of
diabetes or control your condition if you already have diabetes.
* Manage stress. Reduce stress as much as possible. Practice healthy
techniques for managing stress, such as muscle relaxation and deep
breathing.

If you have high cholesterol, high blood pressure, diabetes or another
chronic disease, work with your doctor to manage the condition and
promote overall health.

Alternative medicine

It's thought that some foods and herbal supplements can help reduce your
high cholesterol level and high blood pressure, two major risk factors
for developing atherosclerosis. With your doctor's OK, consider these
supplements and products:

* Alpha-lineolic acid (ALA)
* Artichoke
* Barley
* Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
* Blond psyllium (found in seed husk and products such as Metamucil)
* Calcium
* Cocoa
* Cod liver oil
* Coenzyme Q10
* Garlic
* Oat bran (found in oatmeal and whole oats)
* Omega-3 fatty acids
* Sitostanol (found in oral supplements and some margarines, such as Benecol)

Talk to your doctor before adding any of these supplements to your
atherosclerosis treatment. Some supplements can interact with
medications, causing harmful side effects.

You can also practice relaxation techniques, such as yoga or deep
breathing, to help you relax and reduce your stress level. These
practices can temporarily reduce your blood pressure, reducing your risk
of developing atherosclerosis.

Prevention

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These include:

* Quitting smoking
* Eating healthy foods
* Exercising regularly
* Maintaining a healthy weight
* Drinking alcohol in moderation, if at all

Just remember to make changes one step at a time, and keep in mind what
lifestyle changes are manageable for you in the long run.

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