Atherosclerosis (ath"er-o-skleh-RO'sis) comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). It's the name of the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque. It usually affects large and medium-sized arteries. Some hardening of arteries often occurs when people grow older.
Plaques can grow large enough to significantly reduce the blood's flow through an artery. But most of the damage occurs when they become fragile and rupture. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. If either happens and blocks a blood vessel that feeds the heart, it causes a heart attack. If it blocks a blood vessel that feeds the brain, it causes a stroke. And if blood supply to the arms or legs is reduced, it can cause difficulty walking and eventually lead to gangrene.
How Does Atherosclerosis Start?
Atherosclerosis is a slow, complex disease that typically starts in childhood and often progresses when people grow older. In some people it progresses rapidly, even in their third decade. Many scientists think it begins with damage to the innermost layer of the artery. This layer is called the endothelium (en"do-THE'le-um). Causes of damage to the arterial wall include:
- High blood cholesterol (especially LDL or "bad" cholesterol over 100 mg/dL)
- Cigarette smoking and exposure to tobacco smoke
- High blood pressure
- Diabetes mellitus
- Physical inactivity
Tobacco smoke greatly worsens atherosclerosis and speeds its growth in the coronary arteries, the aorta and arteries in the legs. (The coronary arteries bring blood to the heart muscle; the aorta is the large vessel that the heart pumps blood through to the body.)
Because of the damage to the endothelium, fats, cholesterol, platelets, cellular waste products, calcium and other substances are deposited in the artery wall. These may stimulate artery wall cells to produce other substances that result in further buildup of cells.
These cells and surrounding material thicken the endothelium significantly. The artery's diameter shrinks and blood flow decreases, reducing the oxygen supply. Often a blood clot forms near this plaque and blocks the artery, stopping the blood flow.
Symptoms of Atherosclerosis
Unfortunately, atherosclerosis produces no symptoms until the damage to the arteries is severe enough to restrict blood flow.
- Restriction of blood flow to the heart muscle due to atherosclerosis can cause angina pectoris or a myocardial infarction (a heart attack).
- Restriction of blood flow to the muscles of the legs causes intermittent claudication
(pains in the legs brought about by walking and relieved by rest).
- Narrowing of the arteries supplying blood to the brain may cause transient ischemic attacks (symptoms and signs of a stroke lasting less than 24 hours) and episodes of dizziness, or ultimately, to a stroke itself.
Treatment of Atherosclerosis
Medication is unsatisfactory for treating atherosclerosis, since the damage has already
- Anticoagulant drugs have been used to try to minimize secondary clotting and
- Vasodilator drugs are helpful in providing symptom relief, but are of no curative value.
Surgical treatment is available for those unresponsive to medical treatment or in
certain high-risk situations.
- Balloon angioplasty can open up narrowed vessels and promote an improved
- The blood supply to the heart can also be restored by coronary artery bypass surgery.
Large atheromatous and calcified arterial obstruction can be removed by endartectomy, and entire segments of diseased peripheral vessels can be replaced by woven plastic tube grafts.
What Does Research Show?
Males and people with a family history of premature cardiovascular disease have an increased risk of atherosclerosis. These risk factors can't be controlled.
Research suggests that inflammation in the circulating blood may play an important role in triggering heart attacks and strokes. Inflammation is the body's response to injury, and blood clotting is often part of that response. Blood clots, as described above, can slow down or stop blood flow in the arteries.
Atherosclerosis is responsible for more deaths in the U.S. than any other condition. Atherosclerotic heart disease, involving the coronary arteries (coronary heart disease), is the most common cause of death, accounting for one-third of all deaths. Atherosclerotic interference with blood supply to the brain (stroke) is the third most common cause of death after cancer.
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