What is atherosclerosis treatment?

Atherosclerosis: symptoms and treatments

Published: December, 2014

Every organ and tissue in the body needs a supply of fresh, oxygen-rich blood. That blood is delivered to all parts of the body through blood vessels called arteries. A healthy artery is like a clean pipe: It has a smooth lining and is free of blockages that interfere with blood flow.

Atherosclerosis is the buildup of cholesterol-filled deposits called plaque on the inner walls of arteries. Plaque narrows the vessels and slows down blood flow. Atherosclerosis can occur in any artery in the body, from those nourishing the heart (coronary arteries) to those supplying the brain, intestines, kidneys, and legs.

Atherosclerosis begins as microscopic damage to the inner lining of an artery wall. Many forces can cause this damage, including high blood pressure, cigarette smoke, diabetes, high cholesterol, conditions that cause blood to clot more easily, drugs such as cocaine and androgens, and possibly infections of the inner linings of the arteries.

The first signs of damage are fatty streaks called plaque in the artery wall. These fatty streaks begin early in life and even occur in young adults.

Whatever causes the initial damage, the result is that platelets from the bloodstream gather at the site, soon to be joined by a gruel-like mixture of cholesterol and other fats, calcium deposits, and cell debris.

Cells from the wall of the artery gradually surround the mixture. The artery wall becomes inflamed; white blood cells become activated, race to the injured area, and try unsuccessfully to heal the damage.

Over time, a fibrous cap forms over the fatty deposit. Even under the cap, the deposit can grow, progressively blocking blood flow and ultimately causing chest pain (angina). If the fibrous cap ruptures, a blood clot can form. Such blood clots are the cause of heart attacks and strokes.

Symptoms

Atherosclerosis in coronary arteries leads to chest pain with physical activity or stress (angina). Blockages in the arteries that feed blood to the brain can cause a stroke. Blockages in the arteries that supply the legs result in a painful condition called intermittent claudication.

Treatment

The first step in fighting atherosclerosis is to keep it from getting worse. You can do this with lifestyle changes such as exercising every day; eating a heart-healthy diet; not smoking; and controlling high blood pressure, high cholesterol, and high blood sugar.

Taking a low-dose aspirin every day is also important. By making blood less likely to clot, aspirin reduces the chances of having a heart attack among men and women with coronary artery disease or those with significant risk factors for it.

Taking a cholesterol-lowering statin can keep atherosclerosis from getting worse, and can also pull cholesterol out of artery-clogging plaque. Statins can also help stabilize atherosclerotic plaques and keep them from breaking open—the event that triggers most heart attacks and strokes.

When lifestyle changes and medications aren’t enough to prevent atherosclerosis from causing problematic symptoms—or if you are in serious danger of having a heart attack—you may need angioplasty to open a blocked artery, or coronary artery bypass surgery to carry blood around the obstruction.

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Atherosclerosis: Arterial Disease: Management and Treatment

What are the treatment options for atherosclerosis/peripheral arterial disease/peripheral vascular disease?

Atherosclerosis treatments include lifestyle changes, medications and procedures, both nonsurgical and surgical.

Nonsurgical Treatment Options for Atherosclerosis/Peripheral Arterial Disease/Peripheral Vascular Disease

Lifestyle changes. Making lifestyle changes can reduce your risk factors that lead to development of atherosclerosis or plaque blocking your arteries. Changes you can make to reduce your risk include:

  • Quit smoking. Cleveland Clinic offers smoking cessation programs.
  • Eat a balanced diet that is high in fiber and low in cholesterol, fat and sodium. Limit fat to 30 percent of your total daily calories. Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats including products made with partially-hydrogenated and hydrogenated vegetable oils. If you are overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.
  • Exercise. Begin a regular exercise program, such as walking. Walking is very important and can aid the treatment of PAD. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain. Ask your doctor if your hospital or clinic offers a structured, supervised walking program to help you succeed and maximize your exercise efforts.
  • Manage other related health problems, such as high blood pressure, diabetes, or high cholesterol.

Medications

May be recommended to treat conditions such as high blood pressure (anti-hypertensive medications) or high cholesterol (statin medications).

  • An antiplatelet medication such as aspirin or clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke. Often, patients may be prescribed both of these medications to reduce the risk of cardiovascular complications such as heart attack or stroke.
  • Cilostazol (Pletal) may be prescribed to improve walking distance. This medication has been shown to help some people with intermittent claudication exercise longer before they develop leg pain and to walk longer before they must stop because of the pain. However, not all patients are eligible to take this medication, and in some situations, other therapies can provide better relief of your leg pain. Your doctor will tell you if you are eligible.

When is a procedure to improve the flow to the leg for atherosclerosis/PAD/PVD necessary?

When lifestyle changes and medication may not be enough to improve your symptoms, or if your disease has advanced, your physician may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.

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Atherosclerosis

Atherosclerosis is a thickening or hardening of the arteries. It is caused by a buildup of plaque in the inner lining of your artery. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium and fibrin. Your affected artery walls thicken and lose elasticity. It’s a progressive disease that can begin as early as childhood. Atherosclerosis can cause coronary heart disease, the single leading cause of death in the United States. Atherosclerosis also is referred to as hardening of the arteries and blockages of the arteries.

Causes

Many of these risk factors can be reduced or eliminated by changing your lifestyle:

  • Elevated cholesterol levels
  • High blood pressure
  • Smoking
  • Diabetes
  • Obesity
  • Physical inactivity
  • High-saturated fat diet
  • Genetic factors

Symptoms of atherosclerosis develop gradually, vary depending on the affected artery and may resemble symptoms of other cardiac disease. For example, if a major artery is blocked, symptoms can be severe, such as those associated with a heart attack, stroke, aneurysm or blood clot.

If blockages in your arteries develop slowly, you can develop symptoms from a lack of sufficient blood flow to your heart. You may have chest pain, shortness of breath and become easily fatigued with physical activity. Over time, this impairment of blood flow can damage your heart, reduce its ability to pump effectively and can cause congestive heart failure.

As plaque gradually builds up in your arteries, blood flow is decreased and the oxygen supply is reduced to vital organs and extremities. A decrease in oxygenated blood to your heart may result in a heart attack. A decrease in oxygenated blood to your brain may result in a stroke. If the oxygenated blood supply to your arms and legs is reduced, limb loss can occur. Reduced blood flow or the availability of oxygen to any of your organs can impair their function, leading to kidney problems, muscle pain and weakness in the legs and impaired memory.

Why choose Ohio State for atherosclerosis treatment?

The Ohio State University Wexner Medical Center has expertise in complex and high-risk coronary catheter and surgical treatment options, including stents and coronary artery bypass graft (CABG). When stents and coronary artery bypass crafts are not reasonable options, advanced treatment is available, including laser therapies (transmyocardial revascularization), long-term artificial heart pumps (ventricular assist devices) and heart transplantation.

Diagnosis

If your physician suspects you have atherosclerosis, you will have a complete examination and diagnostic tests that may include:

  • Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
  • Ankle-brachial index (ABI) – A test that measures blood pressure in the affected extremity
  • Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves
  • Multiple gated acquisition (MUGA) scan – A nuclear scan to evaluate how the heart functions at rest
  • Thallium/myocardial perfusion scan – A nuclear scan that is performed during rest and after exercise to detect areas of the heart muscle that are not getting enough blood
  • CT heart scan – An imaging test to assess if there are blockages in blood vessels, including the blood vessels to the heart

Treatments

Treatment may include modification of risk factors, such as quitting smoking; exercising; improving dietary habits; losing weight; and reducing blood sugar levels, blood pressure and cholesterol levels. Tight control of blood sugar levels in individuals who have diabetes has proved to be an important factor.

Medication

Antiplatelet, antihyperlipidemic (statins) and antihypertensive medications may be prescribed to treat atherosclerosis. Medications such as nitrates can reduce the symptoms of impaired blood flow by improving the flow of oxygen-rich blood to the heart muscle.

Procedures

A cardiac catheterization procedure may be recommended. In minimally invasive cardiac catheterization procedures, a long, thin tube (catheter) is inserted into an artery in your groin or arm, then advanced to your heart. Contrast solution is injected into the arteries of your heart, and X-rays are taken to check for a blockage (CT angiogram). If blockage is found, then a percutaneous coronary intervention (PCI) can be performed. This procedure can include removing a clot by suctioning it out, opening the blocked artery with balloon angioplasty or placing a stent to restore blood flow to the heart muscle.

Surgery

Coronary artery bypass graft (CABG) or peripheral vascular surgery may be required to remove a blockage in a blood vessel to your heart or extremities.

Minimally invasive robot-assisted bypass surgery, which requires only small incisions in the chest wall, is available at The Ohio State University Wexner Medical Center.

Treatment Options for Atherosclerosis

Lifestyle Changes for Atherosclerosis

Certain lifestyle changes can slow or even reverse the progression of atherosclerosis, and are generally the first-line treatment for people diagnosed with the condition.

Your doctor may recommend one or more of the following steps:

Follow a heart-healthy diet. You can help control risk factors for atherosclerosis and heart disease — such as your weight, blood pressure, and blood cholesterol and glucose levels — by focusing on eating certain foods while avoiding others.

A heart-healthy diet is widely understood to be high in fruits, vegetables, and whole grains, and low in refined carbohydrates, saturated and trans fats, and sodium.

Practical tips include switching from white to whole-grain bread, eating fruits and vegetables instead of chips or crackers as snacks, using olive oil instead of solid fats like butter, and reducing sugar and sugar substitutes as much as possible. (1,2)

Stop smoking. Smoking — or using tobacco in another form — damages your arteries. If you’re a smoker, quitting is the single most effective way to stop your atherosclerosis from getting worse and reduce your risk of complications, according to the Mayo Clinic. (2)

Get enough exercise. Exercising can help your circulation and let your body use oxygen more efficiently, which can help limit the damage caused by reduced blood flow from atherosclerosis.

You should try to get 2 hours and 30 minutes of moderate aerobic exercise each week, or 1 hour and 15 minutes of vigorous aerobic exercise. Aerobic exercise is any physical activity that raises your heart and breathing rate.

While exercising in intervals of at least 30 minutes is ideal, you can break up your activity into segments as short as 10 minutes and still get substantial benefits. (1,2)

Aim for a healthy weight. If you’re overweight, losing just 5 to 10 pounds (2.3 to 4.5 kilograms) can lower your risk for high blood pressure and unhealthy cholesterol levels, according to the Mayo Clinic — both factors that can contribute to atherosclerosis. (2)

In adults, a healthy body weight is usually defined as a body mass index (BMI) — a measurement based on your height and weight — between 18.5 and 24.9.

You should also keep tabs on your waist circumference, which may be considered unhealthy if it’s above 35 inches (88.9 centimeters) in women or 40 inches (101.6 centimeters) in men. (1)

Try to manage stress. Techniques like guided relaxation, deep breathing, meditation, and yoga can help you cope with stress in a healthy way.

You may also find relief from stress through exercise, talking with friends and family, or visiting a mental health professional. (1,2)

Reversing Heart Disease

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(Source: CDC) Coronary artery disease occurs when a substance called plaque builds up in the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits, which can accumulate in your arteries. When this happens, your arteries can narrow over time. This process is called atherosclerosis.

Plaque buildup can cause angina, the most common symptom of CAD. This condition causes chest pain or discomfort because the heart muscle doesn’t get enough blood. Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, can also develop.

For some people, the first sign of CAD is a heart attack. A heart attack occurs when plaque totally blocks an artery carrying blood to the heart. It also can happen if a plaque deposit breaks off and clots a coronary artery.

Some conditions as well as some lifestyle factors can put people at a higher risk for developing heart disease. All persons can take steps to lower their risk of heart disease and heart attack by addressing these risk factors. Control of risk factors is especially need by people who already have heart disease.

You can help prevent heart disease by making healthy choices and managing any medical conditions you may have.

Source: http://www.cdc.gov/heartdisease/about.htm

Cyclodextrin Dissolves Cholesterol Crystals So They Can Be Excreted by Body; Reduces Arterial Wall Inflammation

April 19, 2016 — An American mother with twin daughters with a rare incurable disease may seem like an unlikely partner in cholesterol research. But when Chris Hempel read about the role of cholesterol crystals in heart disease in 2010, she immediately thought of her daughters Addison and Cassidy, whose cells are unable to get rid of cholesterol.

Perhaps the experimental drug that was being used to treat her girls could also treat people with heart disease? She contacted Eicke Latz, the University of Bonn researcher behind the study, and suggested he look into the idea. Latz is also an assistant professor at NTNU’s Centre of Molecular Inflammation Research (CEMIR).

Six years later, Hempel’s hunch has been confirmed: in a paper published in early April in Science Translational Medicine, Latz and an international team reported that the drug cyclodextrin can dissolve cholesterol crystals so they can be excreted by the body. The drug also changes the way the body’s immune system responds to the presence of cholesterol crystals, reducing inflammation in artery walls. Hempel is listed as one of the co-authors.

Although there already are different medicines on the market that can treat high cholesterol, some people experience side effects from these drugs. Cyclodextrin thus offers a potential new therapy for cardiovascular disease, Latz and his colleagues say.

Disappearing plaque

Your body needs (and makes) cholesterol in small amounts, but too much cholesterol can lead to hardening of the arteries, or atherosclerosis. Atherosclerosis is when artery walls are coated in plaque, which is made of a mix of cholesterol, calcium and other substances. The plaque makes arteries less flexible and causes them to narrow, thereby reducing blood flow. Eventually the arteries may be completely closed off by a blood clot, which can cause a stroke or heart attack.

In the 2010 study that caught Hempel’s attention, researchers reported how cholesterol crystals were found to cause inflammation in arteries, which then led to atherosclerosis. When Latz and his collaborators, including Terje Espevik, head of CEMIR, heard Hempel’s idea to test cyclodextrin, they “jumped on it,” Espevik said.

Tested in mice and in human plaques

The researchers tested cyclodextrin in mice that were fed a cholesterol-rich diet and that were prone to develop atherosclerosis.

“We saw that cyclodextrin prevented plaque formation. It even reduced the existing plaque the mice had in their arteries,” Espevik said.

To see if the drug would also work in human tissue, CEMIR postdoc Siril Bakke was given access to a biobank, collected by Bente Halvorsen from the University of Oslo, OUS Rikshospitalet, with plaque biopsies taken from human carotid arteries. When Bakke examined biopsies of plaques treated with cyclodextrin, she found that the cholesterol was removed from the plaques. The cells in the plaque were also reprogrammed so they were in a reduced inflammatory state.

Soaked up cholesterol and removed it

Another positive effect of cyclodextrin was that it reprogrammed macrophages, immune cells in the body that remove foreign or bad substances, Espevik said.

“What cyclodextrin did was to reprogram the macrophage so it didn’t create such a big inflammatory response,” Espevik said. That meant the macrophage could soak up excess cholesterol and remove it, while reducing the inflammation in the artery walls and thus reducing the likelihood of causing a plaque to form.

That means that cyclodextrin works via two mechanisms, Espevik said. The first is to dissolve cholesterol crystals so the body can excrete them, and the second is to reduce the inflammatory response in artery walls when macrophages soak up cholesterol crystals.

Promising therapeutic approach

The findings were so positive that the research team is now hoping to find funding and an industrial partner to conduct clinical trials in humans, Espevik said.

Latz estimates it will take approximately EUR 1 million to do the trials. One potential drawback is also one of the most positive aspects of cyclodextrin: the substance, which is a type of sugar, has already been approved by the US Food and Drug Administration for use in humans. But because it has been in existence for some time, it cannot be patented. That makes it harder to get a drug company interested in developing cyclodextrin to treat heart disease, but it also will make it easier to get the drug approved to treat heart disease if the clinic trials support the research findings.

In addition to Latz and Espevik and their colleagues at the University of Bonn and NTNU, scientists from the University of Oslo/OUS Rikshospitalet and from Australia, the USA, Denmark and Sweden contributed to the research.

Intracranial Atherosclerotic Disease

Introduction

Intracranial atherosclerosis is the build up of a sticky substance called plaque in the arteries that supply the brain with blood, causing the narrowing and blockage of these vessels. It is part of the same systemic process that affects the heart or legs causing a heart attack or pain while walking. If a vessel becomes completely blocked or severely narrowed, blood flow to the brain can be compromised and a stroke can occur

Risk Factors

The risk factors associated with intracranial atherosclerotic disease are the same for atherosclerotic disease elsewhere in the body such as in the vessels of the heart, causing a heart attack. Certain risk factors can increase your risk of carotid artery disease. Some of these risk factors cannot be changed while others can be modified or treated.

Risk factors that cannot be changed:

  • Increasing age
  • Gender
  • Family history of stroke
  • Relative with atherosclerosis
  • Prior history of stroke and/or heart attack
  • Race

Risk factors that can be modified or treated:

  • High blood pressure
  • Smoking
  • Diabetes
  • Heart disease (e.g. heart attack, heart failure)
  • Artery disease outside the heart and the major vessels
  • Obesity
  • High blood cholesterol level
  • Lack of exercise

Unfortunately, unlike atherosclerosis of the carotid arteries, which often causes transient ischemic attacks (TIA or ministrokes), intracranial atherosclerosis often is only found when a major stroke occurs. Common signs and symptoms of a stroke or TIA may include sudden:

  • Numbness or weakness of the face, arm or leg especially on one side
  • Confusion or dizziness
  • Trouble speaking or understanding
  • Trouble seeing in one or both eyes
  • Trouble walking, loss of balance or coordination
  • Severe headache with no known cause
  • Trouble swallowing

The patient may also experience sudden loss of consciousness and seizures.

If you or anyone you know experiences these symptoms, emergency medical care should be sought. It is imperative for the patient to reach the hospital as quickly as possible for certain types of treatments to be successful.

Treatment options for atherosclerotic carotid artery disease include intracranial stent placement, medications, and surgery.

Intracranial Stent Placement and Angioplasty

Intracranial stent placement is an endovascular procedure done from the inside of the blood vessel. A small puncture is made in the femoral artery in your groin area under local anesthesia. A guiding catheter is advanced under x-ray guidance into the internal carotid artery. A small caliber wire is then negotiated under x-ray guidance past the area of narrowing. A stent is then positioned across the narrowed area in the artery within the brain. The stent is released and then dilated with an angioplasty balloon. The stent stays in place permanently holding the artery open and improving blood flow. The stent also holds the plaque against the artery wall. This reduces the risk of plaque breaking off, traveling to your brain, and causing a stroke. Most stents are made from nickel-titanium, a metal that is bendable but springs back into its original shape after being bent. A vascular closure device may be used to close the small incision in your groin or pressure applied to the puncture site until bleeding stops.

Medications

Your doctor may prescribe antiplatelet or anticoagulant medications. Common drugs used include aspirin, Plavix, warfarin, Aggrenox, or Ticlid. These drugs lower the risk of clot formation. However, some studies have concluded that these medications have not prevented strokes from occurring. Your doctor may also prescribe medications to lower your blood pressure or cholesterol. He or she may recommend ways to control your risk factors, such as quitting smoking, exercising and losing weight.

ECA/MCA Bypass Surgery

ECA/MCA bypass is a surgical procedure in which the superficial temporal artery over the skull is attached to a branch of the middle cerebral artery to increase blood flow to the brain. This is useful in certain select patients to prevent a stroke from occurring.

Atherosclerosis

Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. That limits the flow of oxygen-rich blood to your body.

Atherosclerosis can lead to serious problems, including

  • Coronary artery disease. These arteries supply blood to your heart. When they are blocked, you can suffer angina or a heart attack.
  • Carotid artery disease. These arteries supply blood to your brain. When they are blocked you can suffer a stroke.
  • Peripheral arterial disease. These arteries are in your arms, legs and pelvis. When they are blocked, you can suffer from numbness, pain and sometimes infections.

Atherosclerosis usually doesn’t cause symptoms until it severely narrows or totally blocks an artery. Many people don’t know they have it until they have a medical emergency.

A physical exam, imaging, and other diagnostic tests can tell if you have it. Medicines can slow the progress of plaque buildup. Your doctor may also recommend procedures such as angioplasty to open the arteries, or surgery on the coronary or carotid arteries. Lifestyle changes can also help. These include following a healthy diet, getting regular exercise, maintaining a healthy weight, quitting smoking, and managing stress.

NIH: National Heart, Lung, and Blood Institute

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