Alternate Names: Arteriosclerosis; Hardening of the arteries

Causes and Risks:

Atherosclerosis is a common disorder of the arteries. Fat, cholesterol, and other substances accumulate in the walls of arteries and form "atheromas" or plaques. Eventually, the fatty tissue can erode the wall of the artery, diminish the elasticity (stretchiness) of the artery, and interfere with the blood flow.

Clots may form around the plaque deposits, further interfering with blood flow. When blood flow in the arteries to heart muscle becomes severely restricted, it leads to symptomslike chest pain.

Risk factors include smoking, diabetes, obesity, high blood cholesterol, a diet high in fats, and having a personal or family history of heart disease. Cerebrovascular disease, peripheral vascular disease, high blood pressure, and kidney disease involving dialysis are also disorders that may also be associated with atherosclerosis.

Prevention: Diet recommendations may include low-fat, low-cholesterol, and low-salt diet. Follow the health care provider’s recommendations for treatment and control of hypertension, diabetes, and other diseases. Reduce body weight if overweight and stop smoking if a smoker. Get regular exercise to improve the fitness of the heart and circulation.

Symptoms: Atherosclerosis shows no symptoms until a complication occurs.

Signs and Tests:

Atherosclerosis may not be diagnosed until complications occur. Prior to complications, atherosclerosis may be noted by the presence of a "bruit" (a whooshing or blowing sound heard over the artery with a stethoscope). The affected area may have a decreased pulse.

Tests that indicate atherosclerosis (or complications) include:

• An abnormaldifference between the blood pressure of the ankle and arm (ankle/brachial index, or ABI)
• A Doppler study of the affected area
• Ultrasonic Duplex scanning
• A CT scan of the affected area
• Magnetic resonance arteriography (MRA)
• An arteriography of the affected area
• An intravascular ultrasound (IVUS) of the affected vessels

Treatment:

To some extent, the body will protect itself by forming new blood vessels around the affected area.

Medications may be recommended to reduce fats and cholesterol in your blood. These include cholestyramine, colestipol, nicotinic acid, gemfibrozil, probucol, lovastatin, and others. Aspirin, ticlopidine, and clopidogrel (inhibitors of platelet clumping) or anti-coagulants may be used to reduce the risk of clot formation.

Balloon angioplasty uses a balloon-tipped catheter to flatten plaque and increase the blood flow past the deposits. The technique is used to open the arteries of the heart and other arteries in the body. Another widely used technique is stenting, which consists of implanting a small metal device inside the artery (usually following angioplasty) to keep the artery open.

Surgically removing deposits (an "endarterectomy") may be recommended in some cases. A bypass graft is the most invasive procedure. It uses a normal artery or vein from the patient to create a bridge that bypasses the blocked section of the artery.

Prognosis: The outcome varies. All people begin to develop atherosclerosis at birth, and in some people it leads to complications.

Complications:

• Coronary artery disease (atherosclerosis of arteriesto the heart) where the blood supply to the heart is insufficient due to obstruction (ischemia). A symptom is angina, or chest pain.
• Heart attack
• Transient ischemic attack (TIA) or stroke
• Insufficient blood supply to the limbs (mainly the legs and feet) due to obstruction
• Damage to organs
• Atherosclerosis and obstruction of bypass grafts

Call for an appointment with the health care provider if you are at risk for atherosclerosis, particularly if symptoms of complications occur.