What is Atherosclerosis?

Atherosclerosis is a narrowing and hardening of the arteries which understandably receives a large amount of bad press. This silent disease progressively puts the patient at risk by blocking the arteries and making blood flow dangerously sluggish.

This thickening of the arteries is the cause for cardiovascular disease and more precisely strokes, peripheral vascular disease and heart attacks. In 2005 more than 800,000 Americans died from cardiovascular disease, making it the number one killer in America.

Who will develop the disease and why and what is the exact progression of atherosclerosis?

Read on to find out more about the number one killer in the US and just how it can be both treated and prevented.

What is the underlying cause of Atherosclerosis?

Blood is carried from the heart and circulated around the human body by blood vessels that are called arteries. These vessels have a thin inner coating known as an endothelium lining. This lining of cells keeps the arteries healthy and promotes a smooth flow of blood through the vessels.The onset of Atherosclerosis is when this delicate lining of the arteries becomes damaged by various causes such as smoking or high blood pressure. Plaque then forms on the arteries as cholesterol, narrowing the walls.

Invasion of cholesterol: LDL, or bad cholesterol as it is also known begins to cross the already damaged endothelium, the cholesterol entering the wall of the arteries.

Formation of plaque: Your bodies defense mechanism allows for the influx of white blood cells which will try to digest the bad cholesterol. Overtime however the cells and the accumulated cholesterol will harden and restrict the already damaged walls of the arteries with plaque. Patients who have accumulated plaque in the arteries are at far greater risk of suffering a stroke.

The silent disease if generally left undetected until at least middle age. Once there is substantial narrowing due to a build up of plaque, the blood cells choke and the patient will experience pain. Blood clots can also form and then proceed to rupture at any point inside of the arteries.

Atherosclerosis and plaque formation and progression:

The plaque that forms on the walls of the arteries in Atherosclerosis can behave in different ways. When the plaque remains within the confines of the artery wall, it will grow to a certain size and then cease to grow further. This type of plaque may go undetected as there is not sufficient growth to impede blood flow through the vessels.

Plaque can also grow into the path of the blood, this eventually restricting the flow. After time these blockages will become significant enough to cause pain for the sufferer. The patient will feel pain to the legs or chest after exercise or only moderate exertion. The worst outcome for plaque formation in the arteries is when blood clots form due the plaque rupturing. If this rupturing occurs in the heart the result is a heart attack; in the brain the patient will suffer a stroke.

There are three main different diseases that are caused by the plaque that is present in atherosclerosis:

Coronary artery disease: angina, which is distinguished by a painful chest when the patient exercise or exerts is caused by motionless plaques which have formed in the arteries of the heart. In this instance, blood clots may rupture, causing muscles within the heart to die. This is known as a myocardial infarction, or more commonly a heart attack.

Cerebrovascular disease: In this instance, strokes are caused by the rupturing of the blood vessels in the brain as a direct consequence of the build up of plaque. Permanent brain damage is common within stroke patients. When the blockages are still temporary within the arteries, the sufferer may experience transient attacks known as TIAs where no brain injury occurs.

Peripheral artery disease: Plaque causes a narrowing of the arteries in the legs resulting in poor or restricted circulation. The patient will find walking painful and wounds will take longer than normal to heal. In the most severe cases, amputation of the leg will be required.

Who is susceptible to atherosclerosis?

In actual fact, it is easier to identify the low risk categories for atherosclerosis—

The onset if the disease is early but lies undetected; autopsies of American solider killed in Vietnam showed that almost three quarters were already showing early signs if the disease.Of these, none were showing any symptoms and the arteries were not significantly narrowed. This early stage of atherosclerosis is only detectable with specialist techniques.

Once you reach forty years of age, even if you are in general good health, you have a 50% chance of developing the disease within your lifetime, the risk increasing greatly with age. Of adults over 60 years of age, nearly all will show some signs of the disease, even if they have no symptoms to note.

The good news is that in the last thirty years, there has been a 25% drop in the death rate from the disease, this being due to both improved treatments as well as a healthier lifestyle. Once an artery has become blocked, it will normally stay that way. However, medicines are now available that will slow down or even stop the growth when accompanied with a healthy living plan. Blockages can now also be shrunk with aggressive treatment in high risk patients.

Changes to lifestyle: You can slow down or stop atherosclerosis from developing by changing your lifestyle, this meaning stopping smoking, eating healthily and exercising. Once a blockage has been formed, lifestyle changes will not be able to remove it, but it will lower the risk of stroke or heart attack.

There are also techniques now available that will open up or divert round blockages caused by atherosclerosis.

Stenting and angiography: The most common procedure here is cardiac catheterization with angiography. The damaged arteries can be accessed by inserting a tube in the leg or arm of the patient. Blocked arteries will be identified using an x-ray screen. The blocked arteries can then be opened up using catheters in a process known as an angioplasty. Symptoms can also be reduced using stenting, but the treatment cannot prevent further heart attacks occurring.

Heart bypass: A blocked segment of the heart can be bypassed by using a vessel from a healthy arm or leg, the healthy vessel being harvested.

There are always complications and risks associated with these types of procedure, the procedures usually being used on patients with advanced atherosclerosis which is limiting their quality of life.

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