Atherosclerosis

Diseases caused by atherosclerosis are the leading cause of illness and death for both men and women in the United States, according to the National Heart, Lung, and Blood Institute. Although breast cancer is often the illness most feared by women, the disease affects one out of eight women over the lifetime, compared to coronary heart disease, which is responsible for more than one in three female deaths in America. Atherosclerosis is often the first stage of coronary heart disease (CHD).

Often referred to as “hardening of the arteries,” atherosclerosis occurs when your arteries narrow and become less flexible. This happens when cholesterol, fatty substances, cell waste products, calcium and fibrin—collectively called plaque—collect on the inner walls. The arteries respond to the buildup by becoming inflamed, which, in turn, results in the formation of scar tissue and the collection of other cells in the affected areas, further narrowing the artery.

Atherosclerosis can affect medium and large arteries anywhere in your body. If someone has atherosclerosis in one part of their body, they typically will have atherosclerosis in other parts of their bodies. Atherosclerosis restricts blood flow, thus limiting the amount of oxygen available to your organs. When blood flow to the heart is reduced, for instance, chest pain, or angina, may result. Similarly, when blood flow to the arteries in the legs is reduced, leg pain called claudication may result.

As the disease progresses, atherosclerosis can completely clog arteries, cutting off blood flow. This usually happens suddenly when a blood clot forms in the damaged arteries on top of the atherosclerosis. This is especially dangerous in arteries near the brain, heart or other vital organs. If blood flow to the heart is nearly or completely blocked, a heart attack results and muscle cells in the heart die. The result is permanent heart damage. Similarly, if blood flow is abruptly cut off to the brain, this can cause a stroke, which may also result in permanent brain damage. And if blood flow is abruptly cut off to the legs, the leg may have to be amputated. Thus atherosclerosis can lead to serious life-threatening complications if not addressed early through prevention and early treatment.

Atherosclerotic plaques have a cholesterol- or lipid-rich core covered by a fibrous cap. If this cap ruptures, it exposes this lipid-rich core to blood. The sticky core attractsplatelets, forming a blood clot, called a thrombus, at the site. This clot can completely clog the artery and cut off blood flow.

More mature plaques (stable plaques) have a thick fibrous cap, which is less likely to rupture. Softer, fattier plaques (unstable plaques) have a weaker cap and are more likely to rupture.

Surprisingly, the majority of heart attacks occur in arteries that were less than 50 percent blocked before the attack. So the degree of blockage in a particular artery does not necessarily predict heart attack risk. However, the overall total burden of atherosclerosis throughout all the arteries does affect your risk of a heart attack.

We don’t know what causes plaque to begin building up in arteries. Some experts think plaque begins to accumulate in places where the inner layer of an artery is damaged.

The specific arteries most at risk for atherosclerosis-induced blockage are those going to your brain (carotid), heart (coronary) and legs (femoral or iliac). Atherosclerosis in the legs is the most common form of peripheral arterial disease (PAD) and can lead to intermittent claudication—severe pain, aching or cramping when walking, numbness, reduced circulation, and if left untreated, gangrene (death of tissue).

While atherosclerosis typically progresses gradually—sometimes even starting in childhood—you are most at risk when arterial blockage builds up quickly, completely closing off an artery. This can happen if the plaque ruptures.

Risk Factors for Atherosclerosis

Over the last two decades, researchers have identified many risk factors for developing cardiovascular diseases. They include:

Elevated cholesterol levels (both total cholesterol and LDL [“bad”] cholesterol)
Elevated triglyceride levels
Low HDL cholesterol (the “good” cholesterol, which clears away artery-clogging LDL cholesterol—the “bad” cholesterol)
High blood pressure (hypertension)
Cigarette smoking
Diabetes (elevated blood sugar)
Advanced age
High cholesterol. More than half of women over age 55 need to lower their blood cholesterol, and a quarter of all American women have blood cholesterol levels high enough to pose a serious risk for coronary heart disease—a result of atherosclerosis.

Cholesterol begins collecting in the walls of the arteries at an early age. In fact, the earliest type of arterial lesion, the “fatty streak,” is present even in young children.

According to the National Cholesterol Education Program (NCEP), elevated LDL cholesterol is a major cause of coronary heart disease. That’s why the NCEP panel recommends aggressive treatment. Treatment may include lifestyle changes, such as exercising more and reducing the amount of saturated fat in your diet, and medication. A combination of approaches is typically recommended.

Other lipid abnormalities, such as elevated triglycerides or low HDL (the good cholesterol), are also associated with increased cardiovascular risk.

Cigarette smoking. Smoking accelerates the development of atherosclerosis, increases blood pressure and restricts the amount of oxygen the blood supplies to the body. Quitting smoking dramatically and immediately lowers the risk of a heart attack and reduces the risk of a second heart attack in people who have already had one.

Diabetes. Having diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself, according to NHLBI. In fact, cardiovascular disease is the leading cause of diabetes-related deaths. People with diabetes who have not yet had a heart attack have the same risk of future heart attack as someone with known coronary heart disease. Because their risk of heart attack is so high, NHLBI recommends that people with diabetes be treated aggressively with LDL cholesterol–lowering medication and carefully manage their blood sugar to reduce their cardiovascular risk.

Age. Generally, women over age 55 and men over age 45 are at greatest risk for developing atherosclerosis. The risk of cardiovascular events increases with age.

Other risk factors for coronary heart disease include:

A family history of early heart disease (before the age of 60) in a member of your immediate family (parent, sibling, child)
Obesity

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