Introduction to Atherosclerosis

Atherosclerosis is a chronic, progressive disease in which fatty deposits, known as atheroma or plaque, build up within the walls of arteries. These deposits can restrict or block blood flow, leading to severe health complications such as heart attacks, strokes, and peripheral artery disease.

How Atherosclerosis Develops

1. Plaque Build-up: Cholesterol, fats, blood cells, and other substances accumulate inside the artery walls, forming plaque. This process can begin as early as childhood.
2. Artery Narrowing: As plaque continues to build up, arteries narrow, reducing blood flow.
3. Reduced Blood Flow: The narrowing restricts oxygen-rich blood from reaching organs and tissues.
4. Complications: Plaques may rupture, leading to the formation of blood clots that can completely block the artery, causing severe complications such as heart attacks or strokes.

Types of Atherosclerosis Based on Affected Arteries

• Coronary Artery Disease (CAD): Plaque build-up in the heart’s arteries, leading to conditions like angina or heart attacks.
• Peripheral Artery Disease (PAD): Affects the arteries in the legs and arms, reducing blood flow to the limbs.
• Carotid Artery Disease: Involves plaque build-up in the neck arteries, potentially leading to strokes.
• Renal Artery Stenosis: Affects the arteries supplying blood to the kidneys, which may result in kidney failure.
• Vertebral Artery Disease: Plaque build-up in the arteries supplying the brain’s back, affecting vital functions.
• Mesenteric Artery Ischaemia: Involves plaque build-up in the arteries of the intestines, causing digestive issues.

Symptoms of Atherosclerosis

Atherosclerosis is often asymptomatic in its early stages. Symptoms generally appear once an artery becomes significantly narrowed or blocked, varying depending on the affected area:

• Heart (CAD): Chest pain (angina), shortness of breath, or heart palpitations.
• Brain (Carotid Artery Disease): Sudden numbness, speech difficulties, or vision problems.
• Legs and Feet (PAD): Leg pain when walking, cool skin, and slow-healing sores.
• Kidneys (Renal Artery Stenosis): High blood pressure, changes in urination, or swelling.
• Digestive System (Mesenteric Ischaemia): Abdominal pain after eating, bloating, or weight loss.

Risk Factors for Atherosclerosis

Non-Modifiable Risk Factors:

• Age: Risk increases with age, particularly after 45 for men and 55 for women.
• Family History: A family history of early heart disease increases risk.
• Ethnicity: Black Africans, African Caribbeans, and South Asians are at higher risk.

Modifiable Risk Factors:

• Diet: High in saturated fats, cholesterol, and sodium.
• Lack of Exercise: Physical inactivity increases risk.
• Obesity: Associated with higher risk.
• Smoking: A major risk factor for atherosclerosis.
• Diabetes: Increases the likelihood of developing atherosclerosis.
• High Blood Pressure: Prolonged high blood pressure can damage arteries.
• High Cholesterol: Elevated LDL cholesterol contributes to plaque build-up.
• Inflammation: Diseases like arthritis, lupus, or inflammatory bowel disease can contribute to inflammation and plaque build-up.
• Alcohol: Excessive consumption raises risk.

Diagnosis of Atherosclerosis

• Medical History & Physical Exam: Doctors assess risk factors, check blood flow, and listen for abnormal sounds in the arteries.
• Blood Tests: Assess cholesterol and overall health.
• Imaging Tests: Include ECG, echocardiogram, stress tests, angiography, and others to assess blood flow and plaque build-up.
• Ankle-Brachial Index: Compares blood pressure in the arms and legs to check for peripheral artery disease.

Treatment of Atherosclerosis

Treatment aims to slow plaque build-up, prevent complications, and improve blood flow.

1. Lifestyle Modifications:
   • Quit smoking.
   • Follow a heart-healthy diet low in saturated fats.
   • Engage in regular physical activity.
   • Manage stress.
2. Medications:
   • Statins: To lower cholesterol.
   • Blood Pressure Medications: To control high blood pressure.
   • Antiplatelet Medications: To prevent blood clots.
3. Procedures & Surgeries:
   • Angioplasty and Stent Placement: Opens blocked arteries.
   • Atherectomy: Removes plaque from arteries.
   • Coronary Artery Bypass Grafting (CABG): Bypasses blocked arteries.
   • Carotid Endarterectomy: Removes plaque from carotid arteries.

Prevention of Atherosclerosis

Preventive measures are similar to treatment strategies:

• Adopt a heart-healthy diet.
• Exercise regularly.
• Maintain a healthy weight.
• Stop smoking.
• Manage blood pressure and cholesterol levels.
• Control diabetes if present.

Living with Atherosclerosis

Atherosclerosis is a chronic condition requiring lifelong management. Early diagnosis and consistent treatment can help individuals live full, active lives. Lifestyle modifications are essential to slow disease progression and prevent complications.

References

1. Mayo Clinic. (n.d.). Atherosclerosis Overview
2. National Heart, Lung, and Blood Institute. (n.d.). Atherosclerosis
3. Cleveland Clinic. (n.d.). Atherosclerosis
4. British Heart Foundation. (n.d.). Atherosclerosis