arteriosclerosis

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In atherosclerosis, the arteries narrow due to deposits. As a result, the blood flow is restricted or, in the worst case, completely interrupted - then there is a risk of a heart attack. Older people are particularly often affected by atherosclerosis, but lifestyle factors such as a high-fat diet or lack of exercise also increase the risk of atherosclerosis. Here you can find out everything you need to know about risk factors, consequences and prevention of arteriosclerosis.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. I70

Atherosclerosis: description

Atherosclerosis, also known colloquially as hardening of the arteries, is a disease of the arteries in the body (arteries). By definition, these blood vessels carry blood away from the heart. In the great bloodstream, they transport oxygen-rich blood from the heart to the organs, muscles and tissues. In atherosclerosis patients, blood lipids, blood clots, connective tissue and calcium are deposited in the vessel walls. These deposits are called plaques.

Atherosclerosis includes all hardening of the artery wall. This also includes, for example, Mönckeberg media sclerosis, in which the middle vascular wall (media) calcifies. It is the result of too much calcium in the blood and is associated with diseases such as chronic kidney failure or diabetes. The well-known and most common form of arteriosclerosis with plaque formation in the inner vessel wall (intima) is called atherosclerosis. In everyday language use, however, both terms are often equated.

In principle, arteriosclerosis can develop in all arteries in the body, but it tends to develop in certain vascular regions in the neck, brain, heart, pelvis or the main and leg arteries. Areas where the blood flow encounters physical obstacles - for example at branching vessels - are particularly often affected. The consequence of arteriosclerosis: the blood vessels become narrower and lose their elasticity.

As a result, the blood can no longer flow freely. In the worst case, a clot of blood platelets (thrombus) forms on the plaques - then there is a risk of a heart attack. The vascular wall can also be weakened by arteriosclerosis to such an extent that it expands and an aneurysm arises. Consequences of arteriosclerosis are the most common cause of death in the western industrialized nations.

Atherosclerosis: symptoms

Atherosclerosis develops slowly - symptoms often only show up after years or decades. The symptoms of arteriosclerosis often only appear at an advanced age. How the disease manifests itself depends on which vessels in the body are affected.

If the coronary arteries are narrowed, there is coronary artery disease. Symptoms arise from the decreased blood flow to the heart muscle. Patients experience tightness in the chest or chest pain on the left side (angina pectoris). If a blood clot blocks an already narrowed coronary artery, a heart attack occurs.

If the blood flow in the carotid artery and its branches is disturbed or if the carotid artery is blocked by a blood clot, there is a risk of a stroke. Functional disorders of the nervous system such as paralysis or speech disorders occur.

Arteries in the pelvis and legs can also be narrowed due to atherosclerosis. The so-called peripheral arterial occlusive disease (PAD) is caused by circulatory disorders in the thighs and calves. Leg pain occurs after just short walking distances. Because those affected have to take frequent breaks from walking, one speaks of "intermittent claudication" (intermittent claudication). Narrowing arteries in the pelvis can also lead to impotence in men.

Atherosclerosis in the kidney vessels leads to symptoms of impaired kidney function and high blood pressure. In the worst case, kidney failure occurs.

Atherosclerosis: causes and risk factors

Exactly how arteriosclerosis develops is not yet known. The immediate cause is damage to the inner layer of the vessel wall. Among other things, this favors the accumulation of fats. What causes this arterial damage - the experts do not agree. There are therefore different theories for the mechanism by which atherosclerosis develops.

Lipoprotein-induced atherosclerosis hypothesis on the development of arteriosclerosis

There are two forms of cholesterol: "good cholesterol", or HDL for short, which removes fat from the body and brings it to the liver, where it is broken down, and "bad cholesterol", LDL. The latter transports fat from the liver to the body cells. The fat can then accumulate in the inner walls of the arteries and cause inflammation there. This then triggers plaque formation: white blood cells migrate into the vessel wall and take up as much LDL as possible there. In the process, the immune cells swell to so-called foam cells, which means that additional defense cells are activated and release substances that promote inflammation. Together with blood cells and foam cells, they form a growing "strip of fat" in the arterial wall - the basis for arteriosclerotic plaques.

Response-to-injury hypothesis for the development of arteriosclerosis

According to this hypothesis, the trigger for arteriosclerosis is a mechanical injury to the inner arterial wall layer. For example, it can be caused by high blood pressure. The body reacts to the injury with growths and the formation of foam cells - focal plaques are formed.

Infection hypothesis for the development of arteriosclerosis

According to this explanatory model, the inner wall of the vessel is damaged by toxins from certain bacteria, viruses or immune reactions.

Atherosclerosis Risk Factors

Older people are more likely to suffer from atherosclerosis. It also affects men more than women. Experts see the reason in the female hormones, primarily estrogen, which is said to have a protective effect. Men also develop arteriosclerosis earlier than their female counterparts.

The genetic makeup also plays a role (genetic predisposition). If close relatives (men under 55 years of age, women under 65 years of age) suffer from cardiovascular disease caused by arteriosclerosis, the risk for the person concerned is also increased. Hereditary disorders of lipid metabolism, but also geographical origin, also influence the risk of arteriosclerosis.

Age, gender and genome cannot be changed by yourself. But diet, lack of exercise, smoking, metabolic diseases such as diabetes and other aspects also promote the development of diseases in all age groups. The main risk factors are:

High-fat and high-calorie foods lead to high LDL cholesterol levels and obesity - both factors increase the risk of atherosclerosis.
Lack of exercise can raise blood pressure and worsen cholesterol metabolism.
High levels of LDL cholesterol encourage plaque build-up.
High amount of triglycerides in the blood
Increased blood pressure directly damages the inner walls of the blood vessels.
Substances from tobacco smoke promote the formation of so-called unstable plaques, among other things. These are deposits in the arteries that can break open.
Psychosocial problems: These include not only factors such as poor education, hardly any income or unemployment, but also loneliness and mental illnesses such as depression or severe anxiety disorders
Diabetes mellitus (diabetes) damages the blood vessels (angiopathy), especially if the blood sugar levels are permanently or often elevated
Rheumatoid arthritis ("joint rheumatism") and other chronic inflammation or autoimmune diseases
Sleep apnea (obstructive sleep apnea syndrome)
Menopause (due to lack of estrogen) in women

Atherosclerosis: examinations and diagnosis

As part of a medical examination, the doctor will ask you about your lifestyle. In this way, he can create an individual risk profile. He is interested, for example, in whether you smoke, exercise regularly and adequately, how you eat, or whether you have pre-existing conditions that promote arteriosclerosis. He also inquires about cardiovascular diseases in family members (family history).

The doctor can use a blood test to determine whether there are high blood lipids (cholesterol, triglycerides) and blood sugar levels. In addition, if you suspect arteriosclerosis, the doctor will determine your blood pressure, weight and possibly your waist circumference. He also feels your pulse, which is weakened in the event of relevant constrictions.

The doctor pays attention to signs of secondary diseases of arteriosclerosis and carries out appropriate tests. These are for example:

Through the so-called auscultation, i.e. listening with a stethoscope, abnormal flow noises can sometimes be heard above the heart, the main artery (aorta) or the arteries in the neck.
Vascular constrictions or widening of the arteries can be recognized from the outside with a special ultrasound examination (Doppler sonography). The risk of a stroke can also be estimated from the result for carotid arteries.
If there is coronary artery disease (CHD), the doctor not only performs a normal EKG, but also an exercise EKG. The doctor can detect deposits in the inner walls of the coronary arteries during a cardiac catheter examination. Sometimes he also inserts a small ultrasound probe directly into the coronary artery to be examined.
If the doctor suspects peripheral arterial occlusive disease (PAD), he measures the walking distance that the patient can walk without a break.
If atherosclerosis of the kidney vessels is suspected, the examiner checks the kidney function with blood and urine tests.
Atherosclerosis is also the leading cause of impotence. Appropriate information from the patient and an ultrasound examination can provide information about whether the blood vessels in the penis (or in the pelvis) are narrowing.

The extent of the vascular narrowing can also be revealed with other imaging techniques. The blood vessels can be visualized through X-ray examinations (including CT) or magnetic resonance tomography (MRT) with contrast media.

Atherosclerosis: treatment

In principle, arteriosclerosis can be treated with medication or with an operation. Which therapy is used in each individual case depends on the extent of the vascular narrowing and the impending complications. It is even more important, if possible, to eliminate risk factors.

Lifestyle changes and drug treatment

Those who already have atherosclerosis or are at increased risk for the disease can slow down their development or progression by changing their lifestyle. In the early stages, the plaques in the vessels can even recede. Eat a healthy diet and get enough exercise. For some patients, a cholesterol-lowering diet can be useful. Obesity should be reduced, quit smoking and avoid permanent, negative stress.

Specific diseases that increase the risk of atherosclerosis require treatment. These include, for example, diabetes mellitus or chronic kidney failure.

Antihypertensive drugs (ACE inhibitors) can also reduce the risk of atherosclerosis. Other active ingredients lower the unfavorable blood lipid levels, such as statins, fibrates or substances that inhibit the absorption of cholesterol in the intestine.

For the drug treatment of advanced arteriosclerosis, the same drugs are often used as for the treatment of some cardiovascular diseases. These contain active ingredients that inhibit blood clotting and thus prevent the formation of a blood clot (thrombus). Examples are acetylsalicylic acid or clopidogrel.

Surgical treatment

Life-threatening effects of arteriosclerosis, such as advanced disease of the coronary arteries (coronary artery disease) or an impending occlusion of the leg arteries must be treated surgically (or interventionally). The choice of therapy method depends on the type and extent of calcification.

Balloon expansion with a stent: A small balloon catheter is advanced through the bloodstream to the narrowed point and inflated. This causes the vessel to expand and the blood to flow freely again. If there is a threat of renewed vascular occlusion or if the arteriosclerosis is very pronounced, a small wire mesh (stent) is inserted into the vessel at the same time to keep it open.
Bypass: The surgeon creates a "diversion" that guides the blood past the narrowed area. To do this, he either uses an endogenous vessel (usually a piece of vein from the lower leg or a thoracic artery) or a vascular prosthesis made of plastic.
Operation of a narrowed carotid artery (carotid artery stenosis): If the carotid artery is narrowed, surgery is usually also carried out. Often times, the narrowing is scraped off the artery. To do this, the doctor makes an incision in the affected area, exposes the artery and removes the arteriosclerotic deposits.

Atherosclerosis: disease course and prognosis

The course and prognosis of an atherosclerotic disease depend on various factors:

Location of critical plaques and vascular changes
The extent of the vascular narrowing (stenosis) and the length of the obstacle to blood flow
Health status of the patient: People who have had a heart attack or stroke are at greater risk
Elimination of risk factors (lifestyle changes, treatment of triggering metabolic diseases)

The sooner you decide to make a lifestyle change, the better the prospects. Because arteriosclerosis can lead to serious secondary diseases - such as coronary heart disease.

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