What is atherosclerosis?
It is a common problem that develops when the blood vessels (arteries) that transport oxygen and nutrients from the heart to the rest of the body develop a sticky material known as plaque, which slowly builds up and narrows the artery.
Plaque forms gradually as cholesterol, fat, blood cells, and other elements in your blood accumulate. Plaque buildup causes thick, inflexible arteries, leading to impaired blood flow and the danger of plaque rupture also raises the possibility of blood clotting. Disease connected to atherosclerosis is the leading cause of mortality in the United States, about half of Americans between ages 45 and 84 have atherosclerosis and don't realise it (2), which is dangerous as atherosclerosis can be fatal.
Atherosclerosis can damage the majority of the arteries in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys and impair proper blood flow to the organs. Due to this, the tissue won't get enough oxygen and other nutrients which can lead to necrosis. It goes by several names depending on which arteries are impacted.
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Atherosclerosis phases
The pathophysiologic mechanism that leads to atherosclerosis is complicated and somewhat contentious. The working hypothesis contains four steps :
Endothelial cell injury: Endothelial cells form the lining of blood and lymphatic vessels with vascular trees. This is likely the primary factor that initiates the process of atherosclerotic plaque development because the endothelium is constantly exposed to the circulation. Any toxin present can result in damage, such as cigarette use, diabetes and dyslipidemia (imbalance of lipids such as cholesterol).
Lipoprotein deposition: When the endothelium is wounded or disturbed, lipoprotein molecules can enter and undergo oxidation (through free radicals or oxidising enzymes) or glycation (in diabetes). This inflammatory modified lipoprotein, or LDL, can be absorbed by macrophages, resulting in "foam cells" and a "fatty stripe" in the artery wall.
Inflammatory reaction: This is due to the changed LDL being antigenic and drawing inflammatory cells into the artery wall. In addition, after endothelial damage, inflammatory mediators are produced in more significant quantities, boosting leukocyte recruitment.
Smooth muscle cell cap creation: Smooth muscle cells move to the plaque's surface, generating a "fibrous cap" that triggers its formation. The plaque is stable when this cap is thick; however, thin-capped atherosclerotic plaques are considered to be more prone to rupture or erosion, which causes thrombosis.
What are the risk factors for atherosclerosis?
High cholesterol and triglyceride levels
High blood pressure
Smoking
Type 1 diabetes
Obesity
Physical inactivity
High saturated fat diet
Symptoms
Atherosclerosis symptoms may appear gradually as plaque accumulates in the artery. Symptoms may also differ based on the afflicted artery. However, when a major artery is blocked, indications and symptoms may be severe, such as those occurring with heart attack, stroke, or blood clot (3)
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Treatment
Healing Without Surgery:
Antiplatelet medications: A type of treatment that may be used to treat atherosclerosis. These drugs lessen the capacity of platelets in the blood to stay together and produce clots. Antiplatelet medications include aspirin, clopidogrel, ticlopidine, and dipyridamole. Half a million people get coronary bypass surgery every year, with a 98 per cent success rate.
Anticoagulants: These medications, often known as blood thinners, reduce the capacity of the blood to clot. Anticoagulants include warfarin and heparin.
Medications for controlling cholesterol: These drugs decrease fats in the blood. Statins are a type of cholesterol-lowering medication. They include simvastatin, atorvastatin, and pravastatin. Your doctor may also prescribe fibrates to improve your cholesterol and triglyceride levels. Research shows this treatment is very effective
Medications for high blood pressure: Several distinct types of drugs operate in different ways to reduce blood pressure. A few commonly used high-bp drugs are enalapril, lisinopril, perindopril and ramipril.
Alternative therapies include living a better lifestyle, stopping smoking, keeping a healthy weight, minimising stress, and so on. Certain foods and nutritional supplements may help lower high LDL cholesterol and blood pressure, two risk factors for atherosclerosis. Foods and supplements that may be helpful include barley, cocoa, calcium, cod liver oil, tea, vitamin C, and garlic.
Surgical Treatments:
Angioplasty: This is the process of inserting a long thin tube (catheter) into the blocked or narrowed artery and passing a second tube containing a deflated balloon tip through it. The balloon is inflated, pushing the blockage against your artery walls. A mesh tube is then placed in the artery to keep it open. 95.8% of the 72 patients in the angioplasty group had positive results.
Endarterectomy: This procedure involves surgically removing plaque deposits from the walls of a narrowed artery. It’s often performed on the carotid arteries (in your neck).
Bypass Grafting: This is the procedure in which a surgeon bypasses a clogged artery by grafting a blood vessel from another portion of your body or a synthetic fabric tube around the impediment.
Coronary artery bypass surgery: Also known as bypass surgery, this procedure is frequently performed on persons who suffer angina (chest discomfort) caused by coronary artery disease (where plaque has built up in the arteries). A bypass is produced after surgery by transplanting a segment of a healthy vein from elsewhere in the body and placing it above and below the blocked section of a coronary artery. This allows blood to flow around the barrier. Veins are often extracted from the leg or the chest wall. Sometimes more than one artery needs to be bypassed in the same procedure. Coronary bypass surgery is performed half a million times every year, with a success rate of about 98 per cent.
Atherosclerosis-Related Complications
The accumulation of plaque inside the arteries lowers blood flow. A heart attack may develop if the blood flow is decreased to the heart. A damaged heart muscle may not be able to pump as well as it should, potentially leading to heart failure. A stroke can happen if the brain's blood supply is cut off. If the blood supply to the arms and legs is cut off, severe agony and tissue death can result.
Conclusively, Atherosclerosis is a deadly yet prevalent phenomenon in our society. About half of Americans aged 45 and above have atherosclerosis and aren't aware of it until it is too late (2). One way to prevent this silent killer is to lead a healthy life by not smoking, exercising and having healthy eating habits. Still, once you have developed a plaque, blood thinners or blood cholesterol medication prescribed by a doctor is a good way to control this disease at home. However, in the cases where it becomes fatal, Doctors and Scientists have found a way to treat it surgically as well, but in the end, complications come along with it. Leading a healthy lifestyle gives you the best chances to escape this silent killer.
Written By: Vridhi Talwar
Edited By: Sakshi Deshpande
Bibliography:
Dunleavy, Brian P., et al. “Treatment Options for Atherosclerosis.” EverydayHealth.com, Aug. 2022, https://www.everydayhealth.com/atherosclerosis/guide/treatment/.
“ATHEROSCLEROSIS.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, 24 Mar. 2022, https://www.nhlbi.nih.gov/health/atherosclerosis/living-with.
Atherosclerosis. Atherosclerosis | Johns Hopkins Medicine. (2022). Retrieved December 10, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/atherosclerosis
Hyperarts, R. M.-. (2022). Atherosclerosis. Vascular & Endovascular Surgery - Atherosclerosis. Retrieved December 15, 2022, from https://vascularsurgery.ucsf.edu/conditions--procedures/atherosclerosis.aspx
“Learn the Heart.” Learn the Heart, 2022, www.healio.com/cardiology/learn-the-heart.
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