Arteriosclerosis (hardening of the arteries)

Description

When arteries (arteries) show deposits on their inner side, which lead to hardening and narrowing, this is called arteriosclerosis (also known as vascular calcification).

This effect is caused by fat deposits in the walls of the blood vessels. As a result, both elasticity and vessel diameter decrease, which impedes blood flow.

The likelihood of a stroke or heart attack due to arterial occlusion increases. Circulatory problems in the legs (peripheral arterial disease, or PAVK) are also common.

The risk of developing arteriosclerosis increases with age. White blood cells can pass from the blood into vessel walls and, once there, absorb oxidized (i.e. hardened) LDL cholesterol that is present in the blood. This is known as foam cells, which cause an inflammatory reaction in the vessel walls.

As a result of the inflammatory reaction, white blood cells are attracted by growth and inflammatory factors. These can also be deposited in the vessel wall and give rise to so-called arteriosclerotic plaques (foam cells), which are surrounded by a capsule of connective tissue.

These calcium deposits cause the inner lining and wall of the arteries to narrow and stiffen. If the connective tissue capsule tears, blood platelets accumulate there, which can form a thrombus that further narrows the vessel.

There is a risk of vascular occlusion (thrombosis) and consequently a heart attack.

Basically, arteriosclerosis is part of the natural aging process. However, if it starts early, many factors, many of which are unknown, can be the cause.

Known risk factors for early atherosclerosis:

• Diet: high cholesterol in the blood and obesity due to excessively fatty and caloric foods.
• Obesity: The result of an unhealthy diet over many years.
• Lack of exercise: exercise in sufficient amounts helps to lower blood pressure and cholesterol, as well as increasing insulin sensitivity in muscle cells at the same time.
• Male sex: Low levels of female sex hormones, resulting in less protection.
• Hereditary predisposition: Hereditary factors are thought to play a role in atherosclerosis due to familial clustering.
• Tobacco consumption: Ingredients of smoke promote the formation of unstable plaques (can break open).
• High blood pressure: The inner walls of the vessels are directly damaged by hypertension.
• High cholesterol: The formation of plaques is promoted by high LDL levels.
• Diabetes mellitus: If poorly controlled, high blood sugar levels in diabetes damage the vessels.
• Age: After a certain age, everyone is affected by arteriosclerosis, albeit to varying degrees.

Deposits in the arteries alone do not cause any symptoms. Only a significant narrowing leads to the development of symptoms. Which exactly depends on which vessels are affected.

• Brain: A stroke with hemiplegia is possible.
• Heart: Angina pectoris (heart stenosis), heart failure (cardiac insufficiency) or heart attack can occur.
• Aorta: The weakened vessel wall may develop into an aortic aneurysm (dilated aorta).
• Kidneys: Arteriosclerotic changes in the renal vessels usually lead to hypertension (high blood pressure) or even kidney failure.
• Legs, pelvis: Pain may occur during intense exertion, later also after short distances in the course of peripheral arterial occlusive disease. In men, vasoconstriction can even lead to impotence.

In order to be able to create a risk profile, the attending physician will take a medical history. In doing so, he will ask in detail about your lifestyle, especially about the following areas:

• Smoking
• Sufficient exercise, sport (what, how often)
• Eating habits, preferred foods and fats
• Familial diseases (heart attacks, strokes, diabetes mellitus)

After a blood test, cholesterol and blood sugar levels are assessed. Blood pressure, weight and possibly waist circumference are also examined.

The location of a possible arteriosclerotic change is assessed by a more detailed questioning. The attending physician pays special attention to indications for:

• KHK - coronary heart disease
• pAVK - peripheral arterial occlusive disease
• Aortic aneurysm - dilated aorta
• Stroke
• Calcified renal arteries
• Impotence

Depending on the results of the questioning, further examinations will follow, e.g. angiography or Doppler sonography to show constrictions.

Lifestyle

Arteriosclerosis cannot be cured, but it can be prevented. Even if arteriosclerosis already exists, its progression can be positively influenced by lifestyle changes and medication. Regression of plaques through diet and exercise is only possible in the early stages.

Studies have also shown that the progression of atherosclerosis can be slowed by cholesterol-lowering drugs (CSE inhibitors or statins, cholesterol resorption inhibitors) and blood pressure-lowering drugs (ACE inhibitors).

Blood lipid levels can be improved, i.e. lowered, by omega-3 acid thyl esters, fibrates or nicotinic acid.

Surgery

In the case of life-threatening calcifications, surgical interventions are possible for treatment. Depending on the type and dimension of the vascular alteration, various procedures are used.

Bypass: Using an endogenous vessel (usually from the calf) or a vascular prosthesis (usually Gore-Tex), the blood flow is diverted around the narrowed area. It attaches to a free section of the artery, above the narrowing, and reconnects behind it.

Percutaneous transluminal angioplasty (balloon dilation): In this procedure, a small, balloon-like catheter is pushed into the narrowed vessel via the bloodstream and inflated. This dilates the vessel and restores the free flow of blood.

In case of a renewed constriction, a so-called stent, a mesh-like wire net, can be inserted, which keeps the vessel permanently open.

The prognosis depends largely on how pronounced the atherosclerosis is and where it is localized. Lifestyle is also an important factor.

In general, the fewer risk factors, the better the outlook.

Plaques in the early stages can still regress. To do this, cholesterol levels must be reduced significantly and the ratio between HDL (good) and LDL (bad) cholesterol must improve. This can be achieved, for example, through endurance sports.

A healthy lifestyle is a prerequisite, especially in the case of advanced arteriosclerosis. Abstaining from tobacco, more exercise and a balanced, fat-conscious diet can significantly improve the prognosis.

If left untreated and without a change in lifestyle, arteriosclerosis can lead to stroke, heart attack, kidney failure or peripheral arterial occlusive disease, depending on its extent and location.

Depending on the individual risk factors, everyone can well prevent atherosclerosis.

• Give up smoking. Get support from your GP or a smoking cessation programme.
• Eat a healthier diet. This should include eating plenty of vegetables, low in fat and varied. Avoid saturated fats (e.g. animal fats) and trans fats (e.g. fried, baked, hydrogenated vegetable fats).
• Avoid being overweight. If you are overweight, you will do your body good by losing a few kilos.
• Exercise. Do more sports and endurance sports, even a daily 30 minute walk helps.
• Deal consistently with existing diseases such as diabetes mellitus, high cholesterol or high blood pressure. Only a lasting and regularly controlled therapy will benefit you.