Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside arteries. Arteries are blood vessels that carry oxygen-rich blood to heart and other parts of your body.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows arteries. This limits the flow of oxygen-rich blood to organs and other parts of your body.

Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Causes:

The exact cause of atherosclerosis isn't known. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age.

Atherosclerosis may start when certain factors damage the inner layers of the arteries. These factors include:

Smoking
High amounts of certain fats and cholesterol in the blood
High blood pressure
High amounts of sugar in the blood due to insulin resistance or diabetes

Risk Factors:

The exact cause of atherosclerosis is not clear but certain traits, conditions, or habits may raise risk for the disease. These conditions are known as risk factors. The more risk factors you have, the more likely it is that you'll develop atherosclerosis.

Major Risk Factors

Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called "bad" cholesterol) and low HDL cholesterol (sometimes called "good" cholesterol).
High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)
Smoking. Smoking can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't allow enough oxygen to reach body tissues.
Insulin resistance. This condition occurs if the body can't use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used as an energy source. Insulin resistance may lead to diabetes.
Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly.
Overweight or obesity. The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height.
Lack of physical activity. A lack of physical activity can worsen other risk factors for atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight and obesity.
Unhealthy diet. An unhealthy diet can raise your risk for atherosclerosis. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other atherosclerosis risk factors.
Older age. As one gets older, risk for atherosclerosis increases. Genetic or lifestyle factors cause plaque to build up in arteries with ageing. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk increases after the age of 45. In women, the risk increases after the age of 55.
Family history of early heart disease. Your risk for atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.

Signs and Symptoms

Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as heart attack or stroke.

Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected.

Coronary Arteries

The coronary arteries supply oxygen-rich blood to heart. If plaque narrows or blocks these arteries (a disease called coronary heart disease, or CHD), it may lead to angina. Angina is chest pain or discomfort that occurs when heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in chest. Pain may also be felt in shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.

Other symptoms of CHD are shortness of breath and arrhythmias Arrhythmias are problems with the rate or rhythm of the heartbeat.

Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). Symptoms of coronary MVD include angina, shortness of breath, sleep problems, fatigue (tiredness), and lack of energy.

Carotid Arteries

The carotid arteries supply oxygen-rich blood to brain. If plaque narrows or blocks these arteries (a disease called carotid artery disease), one may have symptoms of stroke. These symptoms may include:

Sudden weakness
Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body
Confusion
Trouble speaking or understanding speech
Trouble seeing in one or both eyes
Difficulty in breathing
Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
Loss of consciousness
Sudden and severe headache

Peripheral Arteries

Plaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis (a disease called peripheral artery disease).

If these major arteries are narrowed or blocked, you may have numbness, pain, and sometimes dangerous infections.

Renal Arteries

The renal arteries supply oxygen-rich blood to kidneys. If plaque builds up in these arteries, one may develop chronic kidney disease. Over time, chronic kidney disease causes a slow loss of kidney function.

Early kidney disease often has no signs or symptoms. As the disease gets worse, it can cause tiredness, changes in how you urinate (more often or less often), loss of appetite, nausea (feeling sick to the stomach), swelling in the hands or feet, itchiness or numbness and trouble concentrating.

Diagnosis:

Physical Exam

Physical examination may show weak or absent pulse (e.g. in leg or foot). A weak or absent pulse can be a sign of blocked artery.

Diagnostic Tests

One or more tests may be required to diagnose atherosclerosis. Extent of disease so determined by tests, helps in planning the treatment.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in blood. Abnormal levels may be a sign that you're at risk for atherosclerosis.

ECG (Electrocardiogram)

An ECG can show signs of heart damage caused by CHD. The test also can show signs of a previous or current heart attack.

Chest x- Ray

A chest x- ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.

Ankle/Brachial Index

This test compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. This test can help diagnose P.A.D. write full form of P A D.

Other Tests

Other tests are being studied to see whether they can give a better view of plaque build up in the arteries. Examples of these tests include magnetic resonance imaging (MRI) and positron emission tomography (PET).

Treatment:

Treatments for atherosclerosis may include heart-healthy lifestyle changes, medicines, and medical procedures or surgery. The goals of treatment include:

· Lowering the risk of blood clot forming

· Preventing atherosclerosis-related diseases

· Reducing risk factors in an effort to slow or stop the build up of plaque

· Relieving symptoms

· Widening or bypassing plaque-clogged arteries

Heart-Healthy Lifestyle Changes

Doctor may recommend heart-healthy lifestyle changes if you have atherosclerosis. Heart-healthy lifestyle changes include heart-healthy eating, maintaining a healthy weight, managing stress, physical activity and quitting smoking.

Heart-Healthy Eating

Doctor may recommend heart-healthy eating, which includes:

Fat-free or low-fat dairy products, such as skimmed milk
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
Fruits, such as apples, bananas, oranges, pears, and prunes
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
Vegetables, such as broccoli, cabbage, and carrots
Whole grains, such as oatmeal, brown rice, and corn tortillas

Maintaining a Healthy Weight

Maintaining a healthy weight is important for overall health and can lower risk for coronary heart disease. Knowing body mass index (BMI) helps in finding out a healthy weight in relation to height and give an estimate of total body fat.

A BMI:

Below 18.5 is considered underweight.
Between 18.5 and 24.9 is in the normal range.
Between 25.0 and 29.9 is considered overweight.
A BMI of 30.0 or higher is considered obese.

A general goal is to aim for a BMI of less than 25. Doctor or health care provider can help set an appropriate BMI goal.

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Consider healthy stress-reducing activities, such as:

A stress management program
Meditation
Physical activity
Relaxation therapy
Talking things out with friends or family

Physical Activity:

Regular physical activity can lower many atherosclerosis risk factors, including LDL or “bad” cholesterol, high blood pressure, and excess weight. Physical activity also can lower risk for diabetes and raise HDL or “good” cholesterol, which helps prevent atherosclerosis.

Quitting Smoking

If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise risk for atherosclerosis. Take advice of doctor about programs and products that help in quitting. Also, try to avoid passive smoking. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

Medicines

Sometimes lifestyle changes alone aren’t enough to control cholesterol levels. For example, one may also need statin medications to control or lower cholesterol. By lowering blood cholesterol level, one can decrease chances of having a heart attack or stroke.

Medical Procedures and Surgery

Patients with severe atherosclerosis may require a medical or surgical procedure.

Prevention:

Taking action to control risk factors can help prevent or delay atherosclerosis and related diseases. Risk for atherosclerosis increases with the number of risk factors you have.

One step you can take is to adopt a healthy lifestyle, which can include:

Heart-Healthy Eating. Adopt heart-healthy eating habits, which include eating different fruits and vegetables (including beans and peas), whole grains, lean meat, poultry without skin, seafood, and fat-free or low-fat milk and dairy products. A heart-healthy diet is low in sodium, added sugar, solid fats, and refined grains. Following a heart-healthy diet is an important part of a healthy lifestyle.

Physical Activity. Be as physically active as you can. Physical activity can improve fitness level and health. Ask your doctor what types and amounts of activity are safe for you.

Quit Smoking. If you smoke, quit. Smoking can damage and tighten blood vessels and raise risk for atherosclerosis. Take advice of doctor about programs and products that help in quitting. Also, try to avoid passive smoking.

Weight Control. If overweight or obese, take advice of doctor to create a reasonable weight-loss plan. Proper weight helps in controlling risk factors for atherosclerosis.

References:

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/causes

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/atrisk

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/signs

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/diagnosis

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/treatment

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/prevention