Atherosclerosis

Overview

Atherosclerosis is the gradual formation of plaques in and on the arterial walls made of lipids, cholesterol, and other substances. Atherosclerosis can cause arteries to narrow and obstruct blood flow. Additionally, the continuous force of blood flow may cause plaque erosion or rupture, which will result in the formation of a blood clot.

The arterial wall becomes thicker and harder as plaque accumulates. The early phases of this “hardening of the arteries” are frequently silent. The patient could go a long time without seeing any symptoms. But as the plaque thickens, their artery’s lumen eventually closes off, reducing the amount of space available for blood to flow, which results to less blood reaching the organs or tissues.

Where the blood clot forms determine its impact on the body. For instance, heart attacks can result when obstructions in a coronary artery prevent oxygen-rich blood from reaching the heart. Atherosclerosis can affect arteries elsewhere in the body, despite the fact that it is frequently thought of as a heart condition. Additionally, aneurysms can develop as a result of atherosclerosis weakening the walls of the arteries.

Early diagnosis and treatment can help patients avoid or delay problems associated with atherosclerosis. By adopting a healthy lifestyle, individuals can also prevent atherosclerosis and its complications. Furthermore, making lifestyle changes and receiving appropriate treatment can effectively manage atherosclerosis.

Symptoms

Atherosclerosis symptoms do not appear especially if the condition is mild. Symptoms usually appears when blood vessel is so severely narrowed or blocked that it can no longer adequately provide blood to organs and tissues. Blood flow can occasionally be entirely stopped by a blood clot.

Which arteries are affected determines the symptoms of moderate to severe atherosclerosis. Examples include

• Arteries in the heart: Patient may experience chest pain or pressure (angina). Pain in their back, shoulders, neck, arms, and belly. Shortness or difficulty in breathing.
• Arteries in the brain: Patient may have abrupt numbness or weakness in their arms or legs, trouble speaking or slurring their speech, sudden blindness in one eye, or drooping facial muscles. These indicate a TIA, or transient ischemic attack. An untreated TIA can result in a stroke.
• Arteries in the arms and legs: When the patient is moving around, they experience leg pain (claudication). Affected limbs may experience lower blood pressure or experience claudication, which are signs of peripheral artery disease. This usually goes away when resting.
• Arteries in the kidneys: Patient will experience elevated blood pressure or kidney failure.

If a patient suspects they have atherosclerosis, it is important to seek guidance from a healthcare provider. It is crucial to remain vigilant for any early signs reduced blood flow, such as leg pain, numbness, or chest pain (angina). By obtaining early diagnosis and treatment for atherosclerosis, the risk of experiencing a heart attack, stroke, or other medical emergencies can be minimized. Consulting with a healthcare professional and taking prompt action is key to preventing such complications.

Causes

The precise cause of atherosclerosis is not currently known. This progressive condition can develop over time and may initiate as early as childhood.

Atherosclerosis advances through multiple stages over the years including:

• Endothelial damage and immune response: Endothelial damage is the first step of atherosclerosis. The inner layer (intima) of the arterial wall is covered by a thin layer of cells known as the endothelium. High levels of LDL cholesterol and toxins from tobacco products are just two of the many factors that might harm endothelial cells.
• Fatty streak formation: A “fatty streak” is atherosclerosis’s first visible sign. At the site of endothelium injury, it appears as a yellow streak or patch made of decomposing foam cells. White blood cells called foam cells seek to eliminate invaders by consuming them. In this instance, they eat cholesterol, which makes them appear foamy. The endothelium continues to be harmed by foam cell activity.
• Plaque growth: As debris, including lifeless foam cells, continues to accumulate, the fatty streak progresses into a larger piece of plaque. As time passes, a fibrous cap composed of smooth muscle cells forms over the plaque. This cap prevents fragments of the plaque from detaching and entering the bloodstream. There is less room for blood to pass through when the plaque grows and gradually narrows the lumen of the artery.
• Plaque rupture: A blood clot develops in the artery as a result of plaque rupture or erosion. Plaque rupture occurs when the protective fibrous cap covering the plaque ruptures or breaks open. On the other hand, plaque erosion refers to a condition where the fibrous cap remains intact, but the surrounding endothelial cells around the plaque undergo wear and tear. A blood clot forms as a result of both circumstances. The clot prevents blood flow, which increases the risk of a heart attack or stroke.

The initial damage or injury to the inner layer of an artery can occur due to various potential causes, including:

• Elevated blood pressure
• High cholesterol
• High triglycerides
• Tobacco use or smoking
• Diabetes
• Resistance to insulin
• Obesity
• Inflammation from unknown sources or brought on by conditions such inflammatory bowel disease, lupus, psoriasis, or arthritis.

Risk factors

Atherosclerosis has an extensive list of risk factors. Patients are unable to alter non-modifiable risk variables. In certain circumstances, they could be able to lessen modifiable risk factors, such as particular medical problems and lifestyle choices.

The arteries gradually become harder. Atherosclerosis risk factors include aging. The following are other factors that might increase the risk of atherosclerosis:

• Non-modifiable factors:
  • People who are getting older have higher risk.
  • Male at age of 45 have higher risk in developing the condition. Female at age of 55 are at risk.
  • Family history of early or premature cardiovascular disease.
• Medical conditions:
  • Diabetes
  • Hypertension or high blood pressure
  • Hyperlipidemia or high cholesterol (especially high LDL cholesterol or high levels of lipoprotein)
  • Metabolic syndrome
  • High levels of C-reactive protein (CRP), a marker of inflammation
• Lifestyle factor:
  • Lack of exercise or physical activity
  • Obesity
  • Tobacco use or smoking
  • A diet rich in saturated fat, trans fat, sodium, and sugar.