Atherosclerosis

Description of the disease

Atherosclerosis is one of the main causes of heart and vascular diseases. It is an early-onset and slowly progressing pathology in which deposits made of fats, cholesterol, calcium, and other substances accumulate in the inner layer of the artery (intima). During the process, a so-called atherosclerotic plaque forms, which reduces the diameter of the blood vessel, leading to decreased blood flow.

The disease usually starts in adolescence, often even in childhood, and gradually progresses throughout a person’s life. Detecting atherosclerosis is complex, practically impossible, as clinical symptoms appear only when the vessel diameter significantly decreases, leading to a condition called ischemia, where tissues and organs are poorly supplied with oxygen due to insufficient blood flow. According to some authors, atherosclerosis develops in everyone, but only reaches a significant level and presents clinically in a portion of individuals.

Risk factors

Several factors contribute to the development of atherosclerosis. Non-modifiable (unchangeable) risk factors include genetics, old age, male gender (postmenopausal women are equally affected as men). However, more significant modifiable (changeable) risk factors include elevated total cholesterol concentration in the blood (especially increased LDL-C concentration and decreased HDL-C concentration), high blood pressure, smoking, obesity, lack of physical activity, diabetes, and frequent stress.

Symptoms

Atherosclerosis is primarily a disease of the artery wall for a long time, and symptoms only appear when there are significant constrictions in the blood vessel. If atherosclerosis affects the coronary arteries, it results in coronary artery disease, manifesting as chest pain during physical exertion or at rest. If blood flow is interrupted for an extended period, a myocardial infarction occurs. When atherosclerosis affects the arteries supplying the brain, it leads to cerebrovascular disease, presenting as transient ischemic attacks or strokes. The arteries in the legs can also be affected, causing intermittent claudication (leg muscle pain after physical activity, e.g., walking).

Diagnosis

Atherosclerosis can be suspected based on risk factors or symptoms associated with this condition, but a thorough examination of the patient’s vascular condition is necessary to confirm the diagnosis. Blood pressure is measured, pulses are palpated, and for a more precise assessment of the affected area, instrumental tests such as X-rays, abdominal ultrasound, carotid artery ultrasound, magnetic resonance imaging, computed tomography, and others are performed. The choice of examination depends on the suspected location of the pathology.

Treatment

The treatment of atherosclerosis consists of two parts. The most important is the correction of modifiable risk factors that promote atherosclerosis, such as exercise, healthy diet, and smoking cessation. The other part is drug therapy, aimed primarily at reducing cholesterol concentration with statins, resins, fibrates, and other medications. Proper management of arterial hypertension and diabetes medication is also crucial.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology