In atherosclerosis, arteries slowly stiffen and narrow. This can reduce blood flow to such an extent that affected organs or parts of the body function less well. In the worst case, cells die due to lack of blood, as in heart attacks and strokes. Along with other cardiovascular diseases, they are among the possible consequences of arteriosclerosis.
Basically, arteriosclerosis is a natural aging process. However, the lifestyle in industrialized nations often favors and accelerates their premature development, making arteriosclerosis a typical disease of civilization. Experts sometimes refer to this as atherosclerosis in order to differentiate the pathological form from the natural aging process. Colloquially, the terms “hardening of the arteries”, “hardening of the arteries” and “hardening of the arteries” are often used.
The most important risk factors are obesity, lack of exercise, high blood pressure, increased blood sugar levels (diabetes), increased blood fat levels (hyperlipidemia) and smoking.
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Causes, risk factors and frequency
Arteriosclerosis risk factors fall into two groups: Genes, i.e. family predisposition, gender and age form the “uncontrollable”. Lifestyle is decisive for risk factors that can be influenced.
Genes can cause people to age faster and get old age diseases earlier than others. However, this is not an inevitable fate in the case of civilization diseases. Those who have unfavorable genes and an unhealthy lifestyle are more likely to develop arteriosclerosis than someone with favorable genes and the same lifestyle. A healthy lifestyle can largely compensate for this: regular exercise, a varied diet, normal body weight and, if necessary, not smoking, prevent or slow down the development of arteriosclerosis and risk factors such as high blood pressure or high blood lipid levels. This works with "unfavorable" genes as well as with "favorable". If someone in the family had a "heart disease", high blood pressure or diabetes, nobody has to watch helplessly as the diseases appear in oneself. However, people with a family disposition should be more careful that their values do not run out and do something about it early on. Often, even small lifestyle changes can normalize levels and neutralize the influence of unfavorable genes.
Being male has long been considered a risk factor for arteriosclerosis. However, it is now becoming apparent that cardiovascular diseases in men do not occur more often, only earlier – on average around ten years. Women clearly lag behind until menopause. Then they catch up and ultimately even overtake the men. The risk has largely leveled out. The fact that the number of female smokers grew faster than that of smokers in the second half of the 20th century probably contributed to this.
As people age, doctors also find more arteries with plaque. In men, the frequency increases significantly from the age of 45, in women after the 50th birthday. In people over 75 years of age, older, calcareous deposits can be detected in a large majority of cases using certain examination methods. But only some seniors have health problems as a result. Arteriosclerosis is a sign of aging, as the saying goes: “A person is as old as their blood vessels”.
The modern lifestyle
Life in the affluent society of industrialized nations tempts many people to lead an unhealthy lifestyle. They move too little, eat too much, too fat, too sweet or too salty. Tobacco consumption is very old, but it often plays a decisive role in the development of arteriosclerosis and cardiovascular diseases. The most important atherosclerosis risk factors are:
- Increased arterial blood pressure
- Elevated blood sugar levels
- Elevated blood lipids
- Overweight
- Lack of exercise
- Smoking
The last three factors in particular are not accidental phenomena, they never arise without your own doing. Obesity, lack of exercise and smoking play a decisive role in arteriosclerosis. Those who fight them can achieve great success: According to studies, the risk of cardiovascular disease in people who exercise at least 30 minutes two to three times a week decreases by an average of around 35%. Quitting smoking has the same effect on smokers. Individuals who change their diet to include less animal fat and salt can reduce their risk by 15%. Small changes often have good effects – if you tackle them. Staying healthy is largely in everyone's own hands.
Frequency
The frequency of arteriosclerosis increases with age. In old age, almost all residents of industrialized nations have deposits in their arteries without necessarily suffering from them. Numbers on the consequences of arteriosclerosis, the cardiovascular diseases, are therefore more meaningful. In the cause of death statistics from the Federal Statistical Office, cardiovascular diseases are number one. They account for around a third of all deaths (2012 – women: 35.6%, men: 31.7%). Poor circulation leads to 30,000 painful and sometimes dangerous heart attacks or heart attacks every year. In addition, there are 16,000 strokes per year, which are also mostly due to arteriosclerosis, and other diseases due to poor circulation. Arteriosclerosis occurs in four out of five cases in 60-year-olds and in nine out of ten cases in 90-year-olds.
Symptoms
Atherosclerosis can remain without symptoms for a long time. The arteries supply the body and its organs with oxygen-rich blood. Oxygen is necessary for the heart, brain, liver, kidneys and muscles to work properly. However, less blood flows through arteries that are narrowed due to deposits (plaques): the oxygen supply decreases. The body can cope with this initially without any symptoms appearing. They only occur when the recipients' oxygen levels run low. Then the function of affected organs suffers, for example muscles perform less under oxygen deficiency. After short periods of stress, they therefore begin to hurt. Initially, however, this pain disappears again after short rest periods. The deposits often only grow slowly, so that the symptoms of arteriosclerosis do not or only slightly increase for a long time. Over time, however, the lack of oxygen can become critical. It causes the muscles to ache even with very little exertion and at rest.
Sometimes, however, plaques break open and small clumps detach. They can completely clog arteries - where they form or elsewhere when blood washes them away. The affected areas no longer receive any oxygen, cells die, they "suffocate". If this happens to the heart muscle, one speaks of a heart attack, in the brain of a stroke. Certain deposits, the vulnerable plaques, can break open surprisingly and relatively early in the course of arteriosclerosis.
In principle, all arteries in the body can become narrowed or blocked by deposits. However, arteriosclerosis tends to appear in certain vessels: in the heart, in the brain, in the neck, in the pelvis, in the legs and in the kidneys. This is where health problems are most noticeable – individually or together, one after the other or at the same time. Whether, when and where symptoms of arteriosclerosis occur are determined by family predisposition, lifestyle and the location of the bottlenecks in the body. Some of the most common dangers or complications to fear from atherosclerosis include the following conditions:
- When the arteries that supply the heart muscle (the coronary arteries) are narrowed, doctors call it coronary artery disease. Angina pectoris is present as soon as a lack of oxygen in the heart muscle leads to pain and feelings of tightness. A stable form is distinguished, which does not deteriorate for a long time. On the other hand, a so-called acute coronary syndrome, which includes the symptoms of unstable angina pectoris, heart attack and sudden cardiac death, can be life-threatening.
- In the brain, deposits that have come loose from artery walls can block vessels. Atherosclerosis can also severely constrict even large or small cerebral arteries. In both cases, brain cells can die from a lack of oxygen (stroke). When very small areas are affected, memory, learning, and other mental functions can decline (vascular dementia) without the paralysis or other physical disabilities associated with full-blown strokes.
- The arteries in the neck and their branches are places where constrictions are often found due to deposits. Deposits that have become loose elsewhere can also block the carotid arteries. As a result, strokes are possible.
- Narrowing of the arteries in the pelvis can lead to erectile dysfunction (erectile dysfunction) in men. Sometimes such constrictions also contribute to the development of a “window syndrome” (peripheral arterial occlusive disease, PAOD).
- When there is a narrowing of the arteries in the legs, the thigh and calf muscles can no longer receive enough oxygen. Because of pain in these muscles, those affected have to take breaks after walking short distances ("intermittent claudication"). Later, the legs will hurt even at rest, and tissue can die there.
- Deposits in the arteries of the kidneys make these organs work less well. Their function can decrease permanently (chronic kidney weakness) or, in the worst case, fail completely (kidney failure). In addition, blood pressure rises or existing high blood pressure worsens.
- In principle, in all arteries, the vessel walls can expand locally due to deposits. This results in permanent bulges with a spindle or sac-like appearance (aneurysm, plural: aneurysms). An aneurysm usually does not initially cause any symptoms. If the bulge is very large, it can press on adjacent structures and cause discomfort. The more serious danger is that aneurysms may rupture and lead to life-threatening internal bleeding or cerebral hemorrhage. The risk increases with the size of the bulge. Likewise, blood clots (thrombi) form easily in aneurysms that are far from the heart. They can clog vessels and block the blood supply to organs. Doctors most commonly find the bulges on the part of the main artery (aorta) that runs in the abdomen, followed by the thoracic part of the aorta. Aneurysms can also form on cerebral vessels and rarely on arteries in the arms, legs or internal organs.
- Blood clots can form on atherosclerotic deposits. The clots can block blood vessels (thrombosis) and impede or stop the blood supply to vital organs. Possible consequences are heart attacks, strokes and pulmonary embolisms.
Treatment
The therapy for arteriosclerosis is particularly based on the fact that those affected change their lifestyle in a suitable way, in which case further measures are often unnecessary. Otherwise medication can support the treatment. However, the agents do not remove or combat the actual deposits in the vessels. They either aim to reduce the risk of arteriosclerosis (e.g. blood-thinning agents). Other drugs are aimed at diseases or metabolic disorders (high blood pressure, elevated blood lipid levels, diabetes) that represent risk factors, i.e. promote the development and deterioration of arteriosclerosis. Finally, surgeons can sometimes remove narrowings or replace narrowed vascular sites.
A healthy lifestyle is artery friendly
What is commonly considered a healthy lifestyle is also good for the arteries. It is therefore a question of exercising sufficiently and regularly, eating the right things and not too much of it, maintaining or striving for a normal body weight, avoiding permanent stress and high alcohol consumption and, if necessary, stopping smoking. Lack of sleep, only infrequent social contact and a few other circumstances are also risk factors (see "Causes, risk factors and frequency").
Medication
Drugs that can be used in therapy are directed against the risks of arteriosclerosis or its risk factors.
- Drugs that inhibit blood clotting can prevent blood clots from forming. In most cases, the platelet aggregation inhibitors acetylsalicylic acid (ASA) or clopidogrel are used.
- The substance group of antihypertensives is suitable for normalizing high blood pressure. It includes active ingredients from the families of diuretics, beta blockers, calcium channel blockers, ACE inhibitors and sartans.
- Elevated blood fat levels can be reduced by so-called lipid-lowering drugs. This umbrella term includes some active ingredients from different families. Many sufferers take statins, which are also called cholesterol synthesis inhibitors or CSE inhibitors.
- Elevated blood sugar levels can be influenced in different ways by different means. The active ingredients, including the hormone insulin and related substances, are summarized under the umbrella term antidiabetics.
Operations
Whether surgical procedures are an option depends on a number of circumstances, such as which artery is affected where, the size of the narrowing, and the general health of the patient.
- Balloon dilatation and stenting: To dilate narrowed areas (percutaneous transluminal angioplasty, PTA), surgeons insert a type of thin tube (catheter) through an artery to the narrowed area. There is a small balloon at the tip of the catheter. It is pumped up, which widens the constriction. In most cases, a fine mesh tube (stent) is inserted to keep the artery open so that it does not close again immediately. Likewise, medical specialists can remove debris with catheters carrying tiny knives or lasers.
- Bypass surgery: Here, surgeons create a diversion for the narrowed section. They cut a small hole in the affected artery in front of and behind the constriction. They connect the two openings with a replacement vessel - a piece of vein that they have removed from somewhere else, or with an artificial tube.
- Opening of vessels (thrombendarterectomy, TEA): Vascular surgeons expose the affected artery, clamp it and open it with an incision. They then scrape out the deposits or remove the inner layer. Finally, the vessel is closed again, sometimes with a new piece of wall, a kind of patch, being inserted (TEA with patch plastic).