Atherosclerosis

Atherosclerosis is a condition in which fatty plaques build up in your arteries. As a result, arteries become thick and stiff. These are the arteries that carry blood from the heart to the rest of the body. Thus blood flow is restricted due to atherosclerosis. Atherosclerosis is the reason behind many heart diseases. The plaques formed in atherosclerosis have the ability to burst and they can trigger the formation of blood clot. The treatment and prevention of atherosclerosis is available. Atherosclerosis can affect arteries anywhere in the body.

Causes

Any damage or injury to the inner layer of artery leads to the development of fatty plaques. This damage can be caused by,

• High level of cholesterol
• High blood pressure
• Diabetes

Symptoms

No signs and symptoms appear until the arteries become narrow, thick and stiff. The clinical presentation may be similar to other heart problems like,

• Chest pain
• Sudden numbness in your legs or arms
• Weakness
• Difficult or slurred speech
• Erectile dysfunction (rare)
• Difficult breathing
• Paralysis
• Extreme anxiety
• Loss of appetite
• Headache
• Hands and foot swelling
• Faintness
• Vomiting

Risk Factors

The following factors increases the risk of atherosclerosis,

• Increasing Age
• Gender
• Family history
• Smoking
• Hypertension
• Diabetes
• Stress
• Diet rich in fats 
• Genetic abnormalities
• Male gender
• Physical inactivity
• Chlamydia pneumoniae infection

Treatment

There is no treatment available that stops the formation of plaques in the arteries. But lifestyle modifications help to avoid the worsening of atherosclerosis. But the doctor may prescribe certain medications to reduce the risk of other heart problems.

Statins

Statins are given to reduce the level of cholesterol in your body. They are the most common medicines used for high cholesterol levels. They reduce the amount of cholesterol that your body makes.

Diuretics

They are cheap and effective for the management of high blood pressure. They are more effective in older patients and resistant hypertension. There are two main types of diuretics, loop and thiazide. Drugs included are bendroflumethiazide, spironolactone and furosemide.

Calcium channels blockers

They are well tolerated especially for elderly patients and those with ischemic heart disease or diabetes. They protect the heart tissue by inhibiting the entry of calcium into cardiac and smooth muscles. All calcium channels blockers are arteriolar vasodilators. They cause a decrease in smooth muscle tone and peripheral vascular resistance. There are two main types of calcium channel blockers, dihydropyridines and non dihydropyridines. Dihydropyridines include amlodipine, felodipine and nifedipine. Non dihydropyridine calcium channel blockers include diltiazem and verapamil.

Beta blockers

They decrease the myocardium oxygen demand by blocking β1receptors. As a result, a decrease occurs in heart rate, contractility, cardiac output and blood pressure. They can also reduce oxygen demand even during rest or exertion. Drugs included are atenolol, bisoprolol, metoprolol, pindolol and propranolol.

Angiotensin-converting enzyme (ACE) inhibitors

They are more effective in younger patients and those with diabetes or heart failure. Drugs include captopril, fosinopril, perindopril, lisinopril and ramipril.

Angiotensin II receptor blockers

They antagonize the effects of angiotensin II directly at the AT1 receptor. They are effective and recommended for use in patients who cannot tolerate ACE inhibitors due to severe cough. Losartan, valsartan, candesartan and irbesartan are angiotensin II receptor blockers.

Αlpha Blockers

They are used as second line agents for the treatment of hypertension. They are more expensive and less effective than other drugs. Drugs included are terazosin, prazosin and doxazosin.

Vasodilators

They are third line agents for the management of blood pressure. They are poorly tolerated and are used in severe hypertension and gestational hypertension. There are two main types of vasodilators, centrally and direct acting. Direct acting vasodilators are diazoxide, minoxidil and nitroprusside. Centrally acting vasodilators are methyldopa and moxonidine.

Antithrombotic agent

They reduce the formation of blood clots (thrombi). They can be used therapeutically for the prevention or treatment of thrombus. There are two types of drugs that are used, aspirin and clopidogrel. Aspirin causes irreversible inactivation of cox-I hence thromboxane. Chewable aspirin provides the more rapid blood levels. Patients who are allergic to aspirin must receive clopidogrel.

Surgical procedures

The surgical treatment for atherosclerosis includes,

• Coronary angioplasty
• Coronary artery bypass graft
• Carotid endarterectomy