Atherosclerosis:
Atherosclerosis is a slow, complex disease in which fatty substances, cholesterol, cellular waste products, calcium, and other substances build up in the inner lining of an artery. This buildup is called plaque. Atherosclerosis is derived from the Greek words athero (meaning gruel or paste) and sclerosis (meaning hardness). The effects of atherosclerosis differ depending upon which arteries in the body narrow and become clogged with plaque. For example, plaque buildup in the vessels that supply the heart with oxygen-rich blood may cause chest pain and lead to a heart attack while plaque buildup in the arteries that supply blood to the brain may result in a stroke.
According to the Centers for Disease Control, heart disease is the leading cause of illness and death in the United States and most other Western countries. Close to one million deaths per year in the United States alone are attributable to heart disease, double the number of deaths from cancer. Because atherosclerosis is highly preventable and the risk factors are well-documented, preventive measures such as lowering blood pressure and LDL ("bad") cholesterol levels, smoking cessation, losing weight, and increasing physical activity should be followed.
Signs and Symptoms
Atherosclerosis shows no symptoms until a significant percentage (40%) of a vessel becomes obstructed with plaque and a complication occurs. Symptoms vary depending upon which arteries in the body narrow and become clogged with plaque.
Coronary Artery Disorder (CAD)
CAD is caused by plaque buildup in the vessels that supply the heart with oxygen-rich blood. When the tissues of the heart begin to become deprived of oxygen (ischemia), chest pain (angina) occurs. If the artery becomes completely blocked, cells in the heart begin to die and a heart attack may occur. Symptoms of CAD are usually triggered by physical exercise, sexual activity, exposure to cold weather, anger, or stress. The most common symptoms of CAD include:
- Chest pain (generally a heavy, squeezing, or crushing sensation with possible burning or stabbing pains)
- Abdominal, neck, back, jaw, or shoulder/arm pain
- Nausea and vomiting
- Unexplainable fatigue and/or extreme fatigue after physical activity
- Weakness
- Perspiration
- Shortness of breath
- Depression and/or anxiety
Cerebrovascular Disorder
Cerebrovascular disease is caused by plaque buildup in the arteries that supply the brain with oxygen-rich blood. Cerebrovascular disease causes transient ischemic attack (a sudden loss of brain function with complete recovery within 24 hours) and stroke. Symptoms may include:
- Weakness or paralysis on one side of the body
- Garbled speech and/or inability to comprehend speech
- Loss of vision in one eye
- Paralysis of facial muscles
- Muscle weakness
- Impaired senses
- Stupor
- Poor coordination
- Involuntary, jerky movements on one side of the body
- Rapid, repititious, involuntary eye movement
- Vertigo
Peripheral Artery Disorder
Peripheral artery disease is caused by plaque buildup in the arteries that supply the extremities of the body (such as the hands and feet) with oxygen-rich blood. Symptoms may include:
- Pain, aching, cramps, numbness or sense of fatigue in the muscles of the lower extremities
- Diminished pulses in the extremities
- Decreased muscle mass
- "Bruits" (blowing sounds physicians hear with a stethoscope that indicates turbulence in blood flow)
- Hair loss
- Thickened nails
- Smooth, shiny skin surface
- Skin that is cold to the touch
- Gangrene
Causes
Many researchers believe that atherosclerosis is caused by damage to the innermost layer of the artery known as the endothelium. High blood pressure, elevated LDL ("bad") cholesterol, an abnormal accumulation of homocysteine (an amino acid produced by the human body), tobacco smoke, diabetes, hormonal changes following menopause, and infection are all thought to contribute to endothelial damage. Once the endothelium is damaged, it becomes easier for fats, cholesterol, cellular waste products, calcium, and other substances to become deposited in the artery wall. This buildup thickens the endothelium significantly. As a result, the diameter of the artery shrinks, blood flow decreases, and oxygen supply is dramatically reduced. Blood clots may also form on top of the plaque or damaged endothelium, thereby blocking the artery, and completely cutting off blood supply.
Because many people do not have the classic risk factors of atherosclerosis (such as cigarette smoking and high blood pressure), it is possible that there may be other contributing factors or causes of atherosclerosis, such as inflammation from an infection or autoimmune disease.
Risk Factors
- Male gender
- Lowered levels of the hormone estrogen following menopause
- Older age
- High blood pressure
- High LDL ("bad") cholesterol and/or high triglycerides
- Elevated homocysteine levels
- Low HDL ("good") cholesterol
- Family history of atherosclerosis (which may be related to learned behavior rather than genetic factors)
- Cigarette smoking and regular exposure to second-hand smoke
- Diabetes mellitus
- Insulin resistance
- Obesity, particularly in the abdominal region
- Sedentary lifestyle
- Diets high in saturated fat and trans fatty acids
- Stress
- Depression
Diagnosis
A healthcare practitioner can determine your risk for heart disease by conducting a variety of tests. Blood tests detect elevated levels of cholesterol, homocysteine, and blood clotting factors. A stress test (otherwise known as an exercise tolerance test) monitors heart rate and blood pressure while an individual walks on a treadmill or rides a stationary bicycle. An electrocardiogram (ECG) is used during a stress test to measure and record the electrical activity of the heart. ECGs can detect abnormal heart rhythms, scar formation in the heart muscle from a prior heart attack, and areas of decreased blood flow when the heart is strained (as with physical activity). Advanced imaging techniques used during a stress test (such as an ultrasound) can determine precise areas of decreased blood flow to the heart. Angiograms (or angiography) can reveal arterial damage and plaque buildup.
Preventive Care
Making careful lifestyle choices is an important first step in preventing atherosclerosis. Some healthy habits include:
- Achieving and maintaining normal weight
- Controlling high blood pressure, high cholesterol, diabetes, and other disorders that may contribute to the buildup of plaque in arteries
- Avoiding cigarette smoking and second-hand smoke
- Eating a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fiber, fruits, and vegetables
- Exercising 3 hours per week or more (such as 30 minutes per day, 6 days per week)
- Reducing stress
Treatment Approach
Atherosclerosis shows no symptoms until a complication (such as chest pain or a heart attack) occurs. For this reason, lifestyle choices such as achieving and maintaining a normal weight, lowering blood pressure and cholesterol, exercising regularly, quitting smoking, and reducing stress, are all important steps in preventing atherosclerosis. Once a complication occurs, however, surgery and other Procedures may be required to remove plaque from clogged arteries or to create a detour around a blocked artery. Medications are often prescribed to lower cholesterol or blood pressure and to prevent an initial or recurrent complication. Healthy diets designed to lower cholesterol, blood pressure, and excess body weight are essential in the treatment of atherosclerosis. Nutrition and dietary supplements, such as vitamin E, omega-3 fatty acids, and folate (vitamin B9) may be effective when used in addition to certain medications. Herbs, such as hawthorn, have also shown promise in lowering cholesterol levels and reducing the risk of heart disease.
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