Atherosclerosis: what is it?

From an atherosclerosis speaking doctors when the arteries suffer chronic. Arteries are the blood vessels that carry oxygen-rich blood from the heart to the organs. Lay people often use arteriosclerosis and atherosclerosis as synonyms. The two formulations differ, however: atherosclerosis is a collective term for diseases of the arteries. In around five to ten percent of case, inflammation, recurrent blockages of the blood vessels (embolism) and other, rarer causes damage the vessels.

In most cases (90 to 95 percent) the so-called atherosclerosis is the trigger for the disease of the blood vessel. In the process, fats , blood clots or lime accumulate on the vessel wall and create so-called plaques. Experts also speak of hardening of the arteries. This can arise in different parts of the body - such as the heart, neck, pelvis, legs or kidneys.

The plaques thicken, harden, and narrow the arteries. The result is that the blood can no longer flow properly through the vessels. In the worst case, the deposits completely interrupt blood flow. This can trigger a life-threatening heart attack , for example .

Smoking, sedentary lifestyle and an unhealthy diet all contribute to calcifying arteries. The disease has been increasing in western countries for several decades. Older people are particularly often affect by arteriosclerosis. Men get sick more often than women.

Atherosclerosis: causes

Scientists cannot yet fully explain how arteriosclerosis develops. Experts used to think that only fats were deposited on the vessel walls. Today they suspect that atherosclerosis is a complex disease that has several triggers. The following two central theories have emerged:

Atherosclerosis: lipoprotein-induced atherosclerosis hypothesis

This hypothesis suggests that a certain form of cholesterol causes atherosclerosis. Doctors distinguish between two groups: The “good” HDL (high-density lipoprotein) cholesterol transports fat to the liver, where it is then broken down. The "bad" LDL (low-density lipoprotein) cholesterol brings fat into the body's cells.

Along the way, it can build up on the artery walls and cause inflammation there. The body then creates killer cells that bind the cholesterol. Ordinary cells swell into so-called foam cells. Blood cells and foam cells condense and form plaque.

Atherosclerosis: response-to-injury hypothesis

This theory assumes that atherosclerosis is caused by damage to the inner layer of the arterial wall. The blood flowing past (in the case of high blood pressure ), bacteria or viruses can damage the vessel wall. The damage leads to two processes:

• On the one hand, the body tries to repair the injury and triggers growth processes. In some cases, not only does the wound grow, but it also grows.
• On the other hand, the “bad” LDL cholesterol attaches to the affected area. As a result, foam cells form - as in the lipoprotein-induced atherosclerosis hypothesis.

Growths and foam cells form plaques that narrow the vessel.

Atherosclerosis: Risk Factors

Experts are not yet able to explain exactly how arteriosclerosis develops. But you know a number of risk factors that favor the disease. Mostly older people and more often men are affected. Doctors divide the causes into different groups:

• High blood pressure: The disease damages the inner walls of the blood vessels.
• Diabetes : The blood vessels suffer when blood sugar is elevated over a long period of time.
• Fat metabolism disorders: high LDL cholesterol levels cause plaques to form.
• Family predisposition: Diseases such as high blood pressure, diabetes and lipid metabolism disorders and thus arteriosclerosis can be inherited.
• Behavior: Smoking, lack of exercise, unhealthy diet and alcohol can cause various diseases such as obesity , high blood pressure and diabetes and thus promote arteriosclerosis.
• Mental health: Chronic stress and strain in the family or at work can lead to high blood pressure and thus to arteriosclerosis.

Atherosclerosis: symptoms

The disease develops very slowly. It often takes several years or decades before patients notice the first signs of arteriosclerosis. For many of those affected, the disease only shows up in an acute emergency, without having felt any warning signals beforehand. The symptoms differ depending on which arteries are damaged:

• Heart: If the coronary arteries are affected, doctors speak of coronary artery disease (CHD). Those affected often have seizure- like chest pain, a feeling of tightness and pressure, and panic . Experts refer to these attacks as angina pectoris. If the coronary artery closes, a heart attack can follow with similar symptoms.
• Neck: If the patient's carotid artery is narrowed, a stroke can occur. Typical signs are drooping corners of the mouth, paralysis, confusion, speech and coordination disorders and unconsciousness. Dizziness, headaches, and memory problems can all herald a stroke.
• Legs: Calcified arteries in the pelvis and thighs cause what is known as peripheral arterial disease (PAD) . People have muscle pain when they walk. You can't travel long distances and you have to take breaks. Because patients so often stop on the way, experts also speak of intermittent claudication . The vessels of the legs can also close completely. Then there is sudden, severe pain and sensory disturbances . The affected part of the body is usually pale .
• Kidney: If the kidney artery is narrowed, the person's blood pressure often increases . He often has a headache in the morning . Also, dizziness, nausea and blurred vision may occur. If the disease progresses, kidney weakness can develop. Affected people have to go to the toilet less often and often feel tired and light-headed .

Atherosclerosis: Diagnostics

The doctor will usually first ask you about your symptoms and lifestyle (anamnesis). He asks, for example, whether you smoke, how you eat, whether you play sports and whether you have relatives who have already had a heart attack or stroke. He will also check whether you have any pre-existing conditions such as diabetes or high blood pressure.

Atherosclerosis: blood test

The doctor will then take your blood. The blood values , especially blood sugar and blood lipids, can give an indication of arteriosclerosis. An increased (“bad”) LDL (low density lipoprotein) cholesterol and a low (“good”) HDL (high density lipoprotein) cholesterol favor the disease. An increased triglyceride level also indicates arteriosclerosis. These are fats that the body stores as energy reserves in adipose tissue.

Further diagnostic tests

• The doctor will then listen to you with a stethoscope . In some cases, he can tell from the sounds of the flowing blood that the arteries in the heart are narrowed.
• If the doctor suspects coronary heart disease, he can also order an electrocardiogram (EKG), which records the heart currents.
• With a special ultrasound examination (Doppler sonography) narrowed vessels in the neck can be detected.
• If there is a suspicion of occlusive disease of the legs, the doctor will perform a walking test . It checks how long the person concerned can move on a treadmill without pain.
• If the doctor suspects that your kidney arteries are damaged, they will ask you for a urine sample .

The doctor may use additional imaging tests to assess how far the arteriosclerosis has progressed. With an X-ray examination or a magnetic resonance imaging ( MRI ) with contrast agent, he can make the blood vessels visible.