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Atherosclerosis: Causes, Symptoms & Treatment

Atherosclerosis is a chronic vascular disease in which plaques build up inside artery walls, restricting blood flow. It is the leading cause of heart attack and stroke.

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Things worth knowing about "Atherosclerosis"

Atherosclerosis is a chronic vascular disease in which plaques build up inside artery walls, restricting blood flow. It is the leading cause of heart attack and stroke.

What is Atherosclerosis?

Atherosclerosis is a chronic inflammatory disease of the arteries in which deposits called plaques gradually accumulate within the inner lining (intima) of blood vessel walls. These plaques are composed of fats, cholesterol, calcium, and connective tissue cells. As plaques grow, the inner diameter (lumen) of the artery narrows, blood flow is impeded, and the vessel wall loses its elasticity. Atherosclerosis is the primary underlying cause of heart attack, stroke, and peripheral arterial disease (PAD).

Causes and Risk Factors

Atherosclerosis develops slowly, often beginning in early adulthood. The central mechanism involves damage to the inner vessel wall layer, the endothelium, which triggers an inflammatory response.

Elevated blood lipids (hyperlipidemia): LDL cholesterol in particular promotes plaque formation.
High blood pressure (hypertension): Elevated pressure mechanically damages the endothelium.
Smoking: Toxic substances in tobacco smoke cause oxidative stress and endothelial injury.
Diabetes mellitus: High blood glucose levels promote vascular inflammation.
Physical inactivity and poor diet: Contribute to obesity, hypertension, and dyslipidemia.
Genetic predisposition: A family history significantly increases the risk.
Age and sex: Risk increases with age; men tend to develop atherosclerosis earlier than women.

Symptoms

Atherosclerosis progresses silently for many years. Symptoms only appear when blood flow is significantly restricted or a plaque ruptures and causes a vascular blockage.

Coronary artery disease (CAD): Chest pain (angina pectoris), heart attack
Cerebrovascular disease: Stroke, TIA (transient ischemic attack)
Peripheral arterial disease: Leg pain during walking (claudication)
Renal artery stenosis: High blood pressure, reduced kidney function

Diagnosis

Diagnosis is based on a combination of clinical examination, laboratory tests, and imaging procedures:

Blood tests: Measurement of cholesterol, LDL, HDL, triglycerides, blood glucose, and inflammatory markers (e.g., hsCRP)
ECG and stress ECG: Indicators of coronary blood flow reduction
Ultrasound (Doppler/Duplex): Measurement of vessel wall thickness (intima-media thickness) and flow velocity
Coronary angiography: Imaging of the coronary arteries using contrast agent
CT angiography: Non-invasive imaging of blood vessels

Treatment

Lifestyle Changes

Lifestyle modification is the cornerstone of any treatment strategy:

Healthy, balanced diet (Mediterranean diet)
Regular physical activity (at least 150 minutes of moderate exercise per week)
Smoking cessation
Weight loss in cases of overweight or obesity

Medication

Statins: Lower LDL cholesterol levels and help stabilize plaques
Antihypertensives: Blood pressure-lowering drugs (e.g., ACE inhibitors, beta-blockers)
Antiplatelet agents: E.g., aspirin or clopidogrel to prevent vascular occlusion
PCSK9 inhibitors: Modern drugs for significant LDL reduction

Interventional and Surgical Therapy

Balloon angioplasty and stent implantation (PCI): Opening narrowed coronary arteries
Bypass surgery: Surgical bypassing of blocked vessels
Carotid endarterectomy: Surgical removal of plaques in the carotid arteries

Prevention

Since atherosclerosis progresses silently over decades, prevention is critical. Regular medical check-ups, monitoring of blood pressure, blood sugar, and blood lipids, as well as a heart-healthy lifestyle, can significantly slow or prevent the progression of the disease.

References

Libby, P. et al. – Atherosclerosis. In: Nature Reviews Disease Primers, 2019. DOI: 10.1038/s41572-019-0106-z
Fuster, V. et al. – Harrison's Principles of Internal Medicine, 21st Edition. McGraw Hill, 2022.
World Health Organization (WHO) – Cardiovascular diseases (CVDs) Fact Sheet. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

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