Brief overview:
- Description: Vascular disease in which arteries harden and narrow; the most common form is atherosclerosis, in which plaques are deposited on the inner walls of the blood vessels; blood flow is disturbed and, in the worst case, interrupted (emergency!)
- Symptoms: Asymptomatic for a long time, often only noticeable due to secondary diseases, such as pain and tightness in the chest in coronary heart disease or heart attacks, speech disorders and paralysis in strokes or painful, numb and pale legs in intermittent claudication (PAD)
- Causes and risk factors: Not yet fully understood, atherosclerosis is a complex interaction of several factors that lead to plaque formation in the arteries. Risk factors include age, elevated blood lipid levels, high blood pressure, diabetes mellitus and smoking
- Treatment: lifestyle changes (healthy diet, exercise, smoking cessation, etc.), treatment of pre-existing conditions such as diabetes or high blood pressure, cardiovascular drugs such as lipid-lowering drugs, surgery (catheter, stent, bypass)
- Progression and prognosis: regression possible at an early stage; progression can be favorably influenced by correct treatment and avoidance of risk factors; secondary diseases often associated with shorter life expectancy
- Prevention: If possible, avoidance of risk factors and early treatment of underlying diseases that promote arteriosclerosis
Description: What is arteriosclerosis?
By definition, arteriosclerosis is the hardening (sclerosis) of the arteries in the body. Colloquially, this disease is also known as hardening of the arteries. The walls of the arteries thicken, lose their elasticity over time and in many cases become increasingly narrow. These changes increasingly restrict the flow of blood.
In principle, arteriosclerosis can develop in all arteries of the body, for example in the neck, brain, heart, kidneys, pelvis, legs or arms. Particularly frequently affected are areas where the blood flow encounters physical obstacles – for example at vascular branches. The main artery (aorta) can also harden in the course of arteriosclerosis (atherosclerosis of the aorta).
Forms of arteriosclerosis
By far the most common form of arteriosclerosis is atherosclerosis. Blood lipids, protein components or connective tissue are deposited on the inner walls of arteries. Doctors refer to these deposits as plaques.
Mediasclerosis or Mönckeberg sclerosis refers to the hardening of the middle layer of the arterial vessel wall (media). It is the result of too much calcium in the blood and is associated with diseases such as chronic kidney failure or diabetes.
In arteriolosclerosis, the inner walls of small arteries (arterioles) in the body become calcified. People who already suffer from diabetes mellitus or high blood pressure are often affected.
Possible consequences of arteriosclerosis
The arteries transport oxygen- and nutrient-rich blood from the heart to all organs, muscles and tissues. If the blood vessels become increasingly inelastic and possibly also narrower, the blood can no longer flow unhindered.
In the worst case, a clot of blood platelets (thrombus) forms. Such a thrombosis can block the artery and completely interrupt the blood flow. The thrombus can also be carried away by the blood flow and block the artery as an embolus at another location (embolism). A blocked artery carries the risk of heart attack, stroke or acute vascular occlusion in the arms or legs (acute limb ischemia).
If the blood flow is interrupted – for example due to a thrombosis or embolism – organs or limbs are no longer supplied with oxygen. An acute arterial occlusion is always a medical emergency.
The possible consequences of arteriosclerosis – such as heart failure, heart attack or stroke – are among the most common causes of death worldwide.
Arteriosclerosis: symptoms
Arteriosclerosis develops slowly. It often remains undetected for years or decades until dangerous secondary diseases and their symptoms finally appear. The symptoms that then manifest themselves depend on which vessels in the body are affected.
Arteriosclerosis can cause arterial occlusion, which can lead to a heart attack, stroke or acute vascular occlusion in the arms or legs. This is an emergency that must be treated as quickly as possible.
If the coronary arteries are narrowed, coronary heart disease is present. Symptoms are caused by reduced blood flow to the heart muscle. Patients experience a feeling of tightness in the chest or left-sided chest pain (angina pectoris).
You can read more about this in the article Coronary heart disease.
If a blood clot blocks an already narrowed coronary artery, a heart attack occurs. This often manifests itself as severe chest pain that can radiate into the arms. Pain in the upper abdomen or back, tightness, shortness of breath, nausea and vomiting are also warning signs.
You can read more about this in the article Heart attack.
You can read more about this in the article Stroke – symptoms.
Arteriosclerosis can also occur in the pelvis and legs as well as in the shoulders and arms. Mediasclerosis or atherosclerosis of the arteries in the extremities manifests itself, for example, as peripheral arterial occlusive disease (PAD), also known as smoker’s leg. It is caused by circulatory disorders in the thighs and calves. Leg pain (intermittent claudication) occurs even after walking short distances. Because those affected have to take frequent breaks from walking, it is also known as “intermittent claudication”. Arterial constrictions in the pelvis also lead to impotence in many men.
You can read more about this in the article Smoker’s leg.
If the blood flow is interrupted due to a vascular occlusion in the arms or legs, acute limb ischemia occurs. The extremity hurts, turns pale and can no longer be moved properly. Such ischemia is a vascular surgery emergency and the most common cause of amputation.
Arteriosclerosis in the renal vessels (such as atherosclerosis of the renal artery) leads to symptoms of impaired kidney function and high blood pressure. In the worst case, kidney failure occurs, in which some patients hardly excrete any urine, but often feel no symptoms.
Development of arteriosclerosis: causes and risk factors
The development of arteriosclerosis is very complex and has not yet been fully clarified. Researchers assume that arteriosclerosis begins with damage to the inner layer (in atherosclerosis) or the middle layer (in mediasclerosis) of the arterial vessel walls.
However, it is not known exactly how this arterial damage (lesions) occurs. However, certain risk factors such as high blood pressure, smoking and increased blood lipids appear to contribute to this. A connection with infections or chronic inflammatory diseases such as rheumatism is also being discussed.
The common explanatory model for the pathogenesis of atherosclerosis is called the “response-to-injury” theory. According to this theory, damage to the inner layer of the blood vessels (intima) promotes the storage of cholesterol (especially LDL cholesterol “low density lipoprotein”, also known as LDL) and cell components. LDL cholesterol oxidizes, which triggers an inflammatory reaction.
Monocytes, which belong to the white blood cells, are called into action. They transform into macrophages, which migrate into the vessel wall and absorb as much LDL as possible.
At the same time, the macrophages release growth factors that stimulate smooth muscle cells within the vessel wall to multiply. The muscle cells then migrate to the plaques and cover them with a solid layer, making the blood vessels even narrower.
Arteriosclerosis risk factors
There are certain physical conditions and lifestyle habits that increase the risk of atherosclerosis.
Older people are more likely to suffer from arteriosclerosis. It also affects more men than women. Experts believe that this is due to female hormones, primarily oestrogen, which is said to have a protective effect. Men also develop arteriosclerosis earlier.
Heredity also plays a role (genetic predisposition). If close relatives (men under 55, women under 65) suffer from cardiovascular disease due to arteriosclerosis, the risk for the person concerned is also increased. Hereditary lipometabolic disorders and geographical origin also influence the risk of arteriosclerosis.
Age, gender and genetic make-up cannot be changed. However, lifestyle also influences the risk of arteriosclerosis. Diet, lack of exercise, smoking or metabolic diseases such as diabetes promote the development of the disease in all age groups:
- High LDL cholesterol levels promote plaque formation.
- A diet rich in saturated fatty acids, for example in animal foods, promotes high LDL cholesterol levels and obesity – both factors increase the risk of arteriosclerosis.
- Smoking promotes circulatory disorders, can damage blood vessels and increase blood pressure and cholesterol levels. In addition, substances from tobacco smoke contribute to the formation of so-called unstable plaques. These are deposits in the arteries that can rupture.
- Elevated blood sugar levels due to diabetes mellitus (diabetes) damage the blood vessels (angiopathy).
- Overweight and obesity are also associated with a higher risk of atherosclerosis.
- Lack of exercise can increase blood pressure, worsen cholesterol metabolism and promote obesity and diabetes.
- High levels of triglycerides (neutral fats) in the blood can increase the risk of atherosclerosis.
- Chronic stress can stimulate inflammatory processes in the body and constrict blood vessels.
- Rheumatoid arthritis (“rheumatoid arthritis”) and other chronic inflammations or autoimmune diseases can stimulate plaque formation.
- Sleep apnoea (obstructive sleep apnoea syndrome) promotes other risk factors such as high blood pressure or diabetes if left untreated and is associated with strokes and heart attacks.
- Alcohol can damage the heart muscle and promote other atherosclerosis risk factors.
In contrast to atherosclerosis, lifestyle plays a lesser role in the development of mediasclerosis. The main risk factors include advanced age, diabetes mellitus and chronic renal insufficiency.
Arteriosclerosis: treatment
There is no secret tip against arteriosclerosis. It is essential to eliminate the risk factors as far as possible. This can be achieved through lifestyle changes, for example.
Medication or surgery can also be considered to prevent complications or treat secondary diseases of arteriosclerosis. Which therapy is used in each individual case depends, among other things, on the extent of the vasoconstriction.
Lifestyle changes
Make sure you eat a healthy diet and get enough exercise. Patients with leg pain, such as those with PAD, also benefit from walking training.
A cholesterol-lowering diet can be useful for some patients. Try to reduce excess weight. Give up smoking and avoid chronic stress.
Diseases that increase the risk of arteriosclerosis should definitely be treated. These include diabetes mellitus or high blood pressure, for example.
Medication
Lipid-lowering drugs reduce unfavorable blood lipid levels. The drugs of choice are statins. Substances that inhibit cholesterol absorption in the intestine (cholesterol absorption inhibitors) and anion exchangers are also available. Monoclonal antibodies that inhibit a specific enzyme (PCSK9 inhibitors) can also lower LDL cholesterol. Doctors rarely use fibrates because there is still no evidence of a significant life-prolonging effect.
The same drugs are often used for the drug therapy of advanced arteriosclerosis as for the treatment of some cardiovascular diseases. These contain active ingredients that inhibit blood clotting and can 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 coronary artery disease or an impending blockage of the leg arteries, usually have to be treated surgically. The choice of treatment procedure depends on the type and extent of the calcification.
- Bypass: The surgeon creates a “bypass” that guides the blood past the narrowed area. To do this, he uses either one of the body’s own vessels (usually a piece of vein from the lower leg or a thoracic artery) or a plastic vascular prosthesis.
- Surgery for a narrowed carotid artery: Carotid stenosis is usually also treated surgically. The narrowing is often scraped out of the artery. To do this, the doctor makes an incision at the affected area, exposes the artery and removes the arteriosclerotic deposits.
- Amputation: An acute vascular occlusion in the arm or leg or non-healing wounds on the foot, such as those that can occur as part of PAD (especially in conjunction with diabetes due to the development of diabetic foot syndrome), can lead to amputation in extreme cases. In outpatient or inpatient rehabilitation, those affected learn how to deal with the loss of the limb.
Arteriosclerosis: course of the disease and prognosis
Arteriosclerosis cannot yet be cured. Anyone who already suffers from atherosclerosis or has an increased risk can slow down the development or progression of the disease by changing their lifestyle. In the early stages, the plaques in the vessels can even partially recede.
The course and prognosis of arteriosclerosis depend on various factors:
- Location of the critical plaques and vascular changes
- Extent of the vascular constrictions (stenoses) and the length over which they obstruct the blood flow
- the patient’s state of health: People who have previously suffered a heart attack or stroke are at greater risk
- Elimination of risk factors (lifestyle changes, treatment of triggering metabolic diseases)
The earlier risk factors are eliminated, the better the prospects.
Stages of arteriosclerosis
In the course of arteriosclerosis, circulatory disorders occur, which doctors classify into the following stages depending on their severity:
- Stage I: The vessels are already slightly narrowed, but those affected do not yet feel any symptoms.
- Stage II: The constrictions in the vessels cause discomfort on exertion (in the case of PAD, this is the case when walking, for example).
- Stage III: The constrictions cause symptoms even at rest.
- Stage IV: The constrictions have damaged the tissue, cells have died due to a lack of oxygen and nutrients.
Arteriosclerosis: examinations and diagnosis
The doctor can determine whether you have high blood lipids (cholesterol, triglycerides) and blood sugar levels by means of a blood test. If arteriosclerosis is suspected, the doctor will also determine your blood pressure, weight and possibly your abdominal circumference. During the arteriosclerosis diagnosis, the doctor will also look for signs of typical secondary diseases and carry out appropriate tests. These are, for example
- Abnormal flow noises above the heart, the aorta or the arteries in the neck can sometimes be heard by auscultation, i.e. listening with a stethoscope.
- Vascular constrictions or even dilations of arteries can be detected from the outside with a special ultrasound examination (Doppler sonography). The results for carotid arteries can also be used to estimate the risk of a stroke.
- If coronary heart disease (CHD) is present, the doctor will not only carry out a normal ECG, but also an exercise ECG. The doctor can detect deposits in the inner walls of the coronary arteries during a cardiac catheterization. Sometimes he also inserts a small ultrasound probe directly into the coronary vessel to be examined.
- If arteriosclerosis of the kidney vessels is suspected, the examiner checks kidney function with blood and urine tests.
- Arteriosclerosis is also the most common cause of impotence. Relevant information from the patient and an ultrasound examination can provide information as to whether there is a narrowing of the blood vessels in the penis (or pelvis).
The extent of the vasoconstriction can be revealed with further imaging procedures. X-ray examinations, computer tomography or magnetic resonance imaging (MRI) with contrast medium can be used to visualize the blood vessels.
Preventing arteriosclerosis
Atherosclerosis is a chronic disease that progressively damages the inner walls of the arteries and can thus – often only after decades – trigger a number of serious secondary diseases such as coronary heart disease or PAD.
If you want to prevent arteriosclerosis, it is best to reduce the risk factors. Diseases that promote arteriosclerosis – such as high blood pressure, sleep apnoea, chronic inflammatory diseases, diabetes mellitus and renal insufficiency in the case of mediasclerosis – should be treated.
As smoking has a negative effect on the blood vessels in several ways, quitting smoking is an important preventive measure for arteriosclerosis. Also avoid passive smoking.
Consume alcohol in moderate quantities at most. Low-risk consumption is one standard glass of alcohol (e.g. a small beer or 0.1 liter of wine) for women or two standard glasses for men per day. Alcohol should be avoided at least two days a week.
Reduce constant stress. Relaxation methods such as progressive muscle relaxation, meditation or autogenic training can help.
