Atherosclerosis
What Is It?
Atherosclerosis is a narrowing of the arteries that can significantly reduce the blood supply to vital organs such as the heart, brain and intestines. In atherosclerosis, the arteries are narrowed when fatty deposits called plaques build up inside. Plaques typically contain cholesterol from low-density lipoproteins (LDL), smooth-muscle cells and fibrous tissue, and sometimes calcium. As a plaque grows along the lining of an artery, it produces a rough area in the artery's normally smooth surface. This rough area can cause a blood clot inside the artery, which can totally block blood flow. As a result, the organ supplied by the blocked artery starves for blood and oxygen, and the organ's cells may either die or suffer severe damage.
Prevention
You can help to prevent atherosclerosis by changing your risk factors for the illness. You should practice a lifestyle that promotes good circulation and combats atherosclerosis:
* Avoid cigarette smoking. If you smoke, it is essential that you quit.
* Maintain a healthful weight. Obesity, especially a concentration of body fat around the waist, has been linked to unhealthy levels of HDL cholesterol and triglycerides.
* Eat a healthy diet that is rich in vegetables and fruits. Avoid saturated and trans fats. Use monounsaturated (olive) and polyunsaturated (sunflower, safflower, peanut, canola) oils for cooking. Dietary protein should come primarily from fish and plant sources (soy, beans, and legumes).
* Exercise regularly.
* Control high blood pressure. You may have to take medication to do this. If you have never been diagnosed with high blood pressure, you should have it checked every two years.
* If you have diabetes, you need to work even harder on controlling weight, exercising more, lowering LDL cholesterol and triglyceride levels, and keeping blood pressure less than 130/85.
* If you do not have diabetes, you should have a fasting blood sugar test every few years if you have risk factors for diabetes (being overweight, having high blood pressure or high cholesterol) starting at age 45.
* Work with your doctor to maintain proper cholesterol levels. If you have never been diagnosed with cholesterol problems, you should have your cholesterol checked every 5 years starting at age 20.
Treatment
There is no cure for atherosclerosis, but treatment can slow or halt the worsening of the disease. The major treatment goal is to prevent significant narrowing of the arteries so that symptoms never develop and vital organs are never damaged. To do this, you would begin by following the healthy lifestyle outlined above. If you have high cholesterol that cannot be controlled by diet and exercise, medication may be necessary. There are currently five classes of cholesterol-lowering medications:
* HMG-CoA reductase inhibitors, including lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), rosuvastatin (Crestor), and atorvastatin (Lipitor). HMG-CoA reductase inhibitors block an enzyme called HMG-CoA reductase, which controls the production of cholesterol in the liver.
* Bile acid-binding resins, including cholestyramine (Questran) and colestipol (Colestid)
* Niacin
* Fibrates, including gemfibrozil (Lopid) and fenofibrate (Tricor)
* Cholesterol-absorption inhibitors, which is the newest class of cholesterol lowering agents. Ezetimibe (Zetia) is currently the only one on the market.
Once symptoms of atherosclerosis-related organ damage develop, the specific treatment depends on the organ involved:
* Heart — Treatments for coronary artery disease include medications to manage symptoms of angina (nitrates, beta-blockers, calcium channel blockers) and prevent heart attacks (aspirin and beta-blockers), balloon angioplasty often with wire mesh stents, and less commonly coronary artery bypass surgery.
* Brain — Treatments to help prevent transient ischemic attacks (TIAs) and stroke include antiplatelet medications such as aspirin, dipyridamole and clopidogrel (Plavix), and anticoagulant medications such as warfarin and heparin.
* Abdomen — When atherosclerosis narrows arteries that supply the bowel, the patient may be treated with balloon angioplasty with or without stents or a bypass arterial graft.
* Legs — The mainstays of treatment for intermittent claudication are quitting smoking, exercise (usually a walking program), and aspirin. People with severe arterial narrowing may be treated with balloon angioplasty with or without stents, laser angioplasty, atherectomy or bypass grafts.
