Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a disease characterized by the build-up of fatty plaques on the inner wall of blood vessels. Over time, this leads to atherosclerosis and narrowing of the arteries, resulting in reduced blood flow and not enough oxygen and nutrients reaching the organs.

Atherosclerosis develops in several stages. First of all, as a result of dysfunction in the cells of the layer we call endothelium, which lays the inner surface of the vessel, this process begins when LDL, popularly known as bad cholesterol in the bloodstream, leaks into the vessel wall and accumulates and oxidizes here. A group of our immune cells, macrophages, try to clean the oxidized LDL. In this process, macrophage cells become loaded with lipids (fat) and are called foam cells. As a result, yellow spots called fat lines begin to form on the vessel wall. Over time, the fatty streak formations, which we call yellow spots, turn into a fibrous structure and form plaques. Plaques continue to grow over time and calcium deposits form on them. For this reason, the hardened plaque puts more strain on the vessel wall and increases the risk of rupture. Cracked plaques tend to form blood clots in the vessel, which can block the vessel and prevent blood flow. The final stage of atherosclerosis occurs, resulting in complete blockage or narrowing of the vessel. This can lead to serious problems such as heart attack (myocardial infarction (MI)), stroke (cerebrovascular event (CVE)) or organ failure. 

Causes of atherosclerosis

Atherosclerosis is thought to be caused by many factors, including genetic and environmental factors. The main factor in the development of atherosclerosis is a family history of atherosclerosis. 

• Diabetes and insulin resistance 
• Obesity and unhealthy eating,
• Smoking and use of other tobacco products, 
• Hypercholesterolemia (high LDL cholesterol),
• Hypertension (high blood pressure),
• Inflammatory diseases (psoriasis, arthritis, etc.)
• Sleep apnea 
• Sedentary and stressful life  

LDL cholesterol is colloquially known as bad cholesterol. High levels of this and low levels of HDL cholesterol, known as good cholesterol, increase the risk of atherosclerosis. 

Symptoms of atherosclerosis

It usually first manifests itself as chest pain. This chest pain is called angina. There are basically two forms of angina: stable and unstable. Usually, patients experience a burning, squeezing and pressing pain in the center of the chest during mild exertion. When the exertion is stopped, the pain is said to go away. This is the first sign of a blood vessel blockage. Some patients report chest pain even when they are at rest. This is a sign of a very serious arterial blockage. 

The pain is caused by ischemia (lack of oxygen and nutrients) in the blood supply due to blockage or narrowing of the artery. However, symptoms may not appear until the arteries are blocked and you have a heart attack or stroke. Chest pain due to blocked arteries in the heart, leg pain due to blocked arteries in the legs or blockage of any organ can cause that organ to stop functioning.

Stroke (cerebrovascular event (CVE)) may occur due to vascular occlusion in the brain. 

Symptoms of atherosclerosis can be listed as follows: 

• Chest pain (with or without exertion)
• Numbness or weakness in the arms and legs 
• Severe headache 
• Speech difficulties 
• Stroke (Cerebrovascular Event (CVE))
• Visual disturbances 

Who has atherosclerosis?

Risk factors that lead to atherosclerosis;

• Advanced age 
• Diabetes 
• Hypercholesterolemia (high cholesterol) 
• Sedentary life 

How is atherosclerosis diagnosed?

Pain is the most important symptom in atherosclerotic blockages, and tests and treatment are performed according to the blocked organ. For atherosclerosis, a physical examination should be performed and the history of the disease should be listened to. Ultrasound, ECG (electrocardiography), ECHO (echocardiography), stress test and cardiac scintigraphy are among the diagnostic methods. Angiography is recommended for the definitive diagnosis of atherosclerosis. ECG is the process of recording electrical activity in the heart to study the functioning of the heart muscle and the neurotransmission system.  It is very important that the ECG also shows something suggestive of acute ischemia (ST wave elevation on the ECG). ECGs suggestive of an acute ischemic condition are cardiac emergencies. They include situations where the patient needs urgent angiography. Echo is the process of visualizing the walls of the structures of the heart. Detection of any wall motion defects in the walls of the heart may be the result of a previous heart attack due to possible atherosclerosis. The effort test is performed by walking the patient on a treadmill and the patient's ECG is taken during the effort and examined for any ECG changes. Patients with a positive effort test are scheduled for angiography under elective conditions. Angiography: A dye called contrast is injected into the coronary artery with the help of thin and soft catheters and the inside of the vessel is visualized with X-rays. Angiography can be performed for many vessels. 

Treatment of atherosclerosis

In the treatment of atherosclerosis, it is recommended to stop using tobacco products and to establish a healthy diet. In patients with high cholesterol, it is important to eat a balanced and regular diet (avoiding the consumption of high carbohydrate and saturated fat foods, etc.), to exercise and to end sedentary life. If deemed necessary by the physician, drug treatment can be initiated with drugs used in the treatment of hypercholesterolemia (high cholesterol), such as statins (such as atorvastatin, rosuvastatin), ezetimibe, and drugs such as low-dose aspirin etc. which prevent the clumping of blood cells called platelets (blood thinners). Today, thanks to advances in technology and medicine, blocked vessels can be opened without surgery with the angiography method. With angioplasty, a non-surgical method, the procedure is performed in 20-30 minutes. With the help of a catheter, the heart vessels are accessed and the diseased vessels are opened with imaging techniques. Bypass (coronary artery bypass graft (CABG)) surgery, which is a surgical method, is one of the applications with a high success rate with comfortable and longer life expectancy.