atherosclerosis

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

Some people may confuse atherosclerosis and arteriosclerosis, but they are not the same thing:

• Arteriosclerosis is hardening of the arteries, which means that the arteries thicken and become less flexible. It can have several different causes.
• Atherosclerosis, which develops from plaque buildup, is a common type of arteriosclerosis.

Atherosclerosis can affect most of the arteries in the body. It has different names, based on which arteries are affected:

• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart.
• Peripheral artery disease (PAD) is plaque buildup in the arteries that carry blood away from the heart to other parts of the body. It most often affects the arteries of your legs, but it can also affect the arteries of your arms or pelvis.
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain.
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys.
• Vertebral artery disease is plaque buildup in the arteries that supply blood to the back of your brain.
• Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood.

Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

You may be more likely to develop atherosclerosis if you:

• Have certain medical conditions, including:
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Metabolic syndrome
  • Inflammatory diseases such as rheumatoid arthritis and psoriasis
• Have a family history of high blood cholesterol
• Eat a lot of foods high in saturated fats
• Smoke or chew tobacco
• Are older - the risk increases after age 45 men and age 55 in women

In the early stages, atherosclerosis often does not cause any symptoms. You may first notice some symptoms at times when your body needs more oxygen. For example, this could be when you are having physical or emotional stress.

Your symptoms will depend on which arteries are affected and how much blood flow is blocked:

• With coronary artery disease, the symptoms may include angina (a type of chest pain), palpitations (racing or pounding heart), and shortness of breath.
• With carotid artery disease, you may have a bruit. This is a whooshing sound that your health care provider hears when using a stethoscope. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke.
• With peripheral artery disease, you may have pain, aching, heaviness, or cramping in the legs when walking or climbing stairs.
• With vertebral artery disease, you may have problems with thinking and memory, weakness or numbness on one side of the body or face, and vision trouble. You could also have a transient ischemic attack.
• With mesenteric artery ischemia, the symptoms can include severe pain after meals, weight loss, and diarrhea.

For men, erectile dysfunction (ED) is an early warning sign that you may be at higher risk for atherosclerosis and its complications. If you have ED, talk with your provider about your risk of plaque buildup.

Atherosclerosis can cause other health problems, or complications. For example, if a plaque bursts, a blood clot may form. The clot could block the artery completely or travel to another part of the body. Other possible complications can vary, depending on which arteries are affected. For example, blockages in different parts of the body can lead to complications such as a heart attack, stroke, vascular dementia, or limb loss.

To find out if you have atherosclerosis, your provider:

• Will ask about your medical and family health history
• Will ask about your lifestyle and risk factors for plaque buildup in the arteries
• Will do a physical exam, which will include listening to your heart and the blood flow in your arteries
• Will likely order tests, such as blood tests and heart health tests

If you have atherosclerosis, your provider will work with you to create a treatment plan that works for you. Your plan will depend on which arteries are affected, how much the blood flow is blocked, and what other medical conditions you have. Possible treatments may include:

• Heart-healthy lifestyle changes.
• Medicines to:
  • Manage your risk factors.
  • Treat atherosclerosis or its complications.
  • Treat any medical conditions you have that can worsen plaque buildup.
• Procedures or surgeries to treat diseases or complications that were caused by plaque buildup. The specific type of procedure or surgery will depend on which arteries are affected.
• Cardiac rehabilitation, if you have had certain complications from atherosclerosis.

There are steps you can take to try to prevent atherosclerosis:

• Choose heart-healthy foods, such fruits, vegetables, and whole grains. Limit foods that are high in saturated fats, salt, and added sugars.
• Do regular physical activity. But before you start an exercise program, ask your provider what level of physical activity is right for you.
• Aim for a healthy weight.
• Limit how much alcohol you drink. Drinking less is better for health than drinking more. Men should limit their intake to 2 drinks or less in a day. Women should drink 1 drink or less per day.
• Manage stress.
• If you smoke, quit smoking.
• Avoid secondhand smoke.
• Get enough good-quality sleep.

NIH: National Heart, Lung, and Blood Institute

Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women.

CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage.

Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body. Arrhythmias are changes in the normal beating rhythm of the heart.

NIH: National Heart, Lung, and Blood Institute

Your carotid arteries are two large blood vessels in your neck. They supply your brain and head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because of atherosclerosis. Atherosclerosis is the buildup of plaque, which is made up of fat, cholesterol, calcium, and other substances found in the blood.

Carotid artery disease is serious because it can block the blood flow to your brain, causing a stroke. Too much plaque in the artery can cause a blockage. You can also have a blockage when a piece of plaque or a blood clot breaks off the wall of an artery. The plaque or clot can travel through the bloodstream and get stuck in one of your brain's smaller arteries.

Carotid artery disease often does not cause symptoms until the blockage or narrowing is severe. One sign may be a bruit (whooshing sound) that your doctor hears when listening to your artery with a stethoscope. Another sign is a transient ischemic attack (TIA), a "mini-stroke." A TIA is like a stroke, but it only lasts a few minutes, and the symptoms usually go away within an hour. Stroke is another sign.

Imaging tests can confirm whether you have carotid artery disease.

Treatments may include:

• Healthy lifestyle changes
• Medicines
• Carotid endarterectomy, surgery to remove the plaque
• Angioplasty, a procedure to place a balloon and stent into the artery to open it and hold it open

NIH: National Heart, Lung, and Blood Institute

A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the more common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke.

Symptoms of stroke are:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage.

NIH: National Institute of Neurological Disorders and Stroke

People can lose all or part of an arm or leg for a number of reasons. Common ones include:

• Circulation problems from atherosclerosis or diabetes. They may cause you to need an amputation.
• Traumatic injuries, including from traffic accidents and military combat
• Cancer
• Birth defects

If you are missing an arm or leg, an artificial limb can sometimes replace it. The device, which is called a prosthesis, can help you to perform daily activities such as walking, eating, or dressing. Some artificial limbs let you function nearly as well as before.

A blood clot is a mass of blood that forms when platelets, proteins, and cells in the blood stick together. When you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body usually breaks down and removes the blood clot. But sometimes the blood clots form where they shouldn't, your body makes too many blood clots or abnormal blood clots, or the blood clots don't break down like they should. These blood clots can be dangerous and may cause other health problems.

Blood clots can form in, or travel to, the blood vessels in the limbs, lungs, brain, heart, and kidneys. The types of problems blood clots can cause will depend on where they are:

• Deep vein thrombosis (DVT) is a blood clot in a deep vein, usually in the lower leg, thigh, or pelvis. It can block a vein and cause damage to your leg.
• A pulmonary embolism (PE) can happen when a DVT breaks off and travels through the bloodstream to the lungs. A PE, especially if it is large, can damage your lungs and prevent your other organs from getting enough oxygen.
• Cerebral venous sinus thrombosis (CVST) is a rare blood clot in the venous sinuses in your brain. Normally the venous sinuses drain blood from your brain. CVST blocks the blood from draining and can cause a hemorrhagic stroke.
• Blood clots in other parts of the body can cause problems such as an ischemic stroke, a heart attack, kidney problems, kidney failure, and pregnancy-related problems.

Certain factors can raise your risk of developing blood clots:

• Atherosclerosis
• Atrial fibrillation
• Being overweight or having obesity
• Cancer and cancer treatments
• Certain genetic disorders
• Certain surgeries
• COVID-19
• Diabetes
• Family history of blood clots
• Overweight and obesity
• Pregnancy and giving birth
• Serious injuries
• Some medicines, including birth control pills
• Smoking
• Staying in one position for a long time, such as being in the hospital or taking a long car or plane ride

The symptoms for blood clots can be different, depending on where the blood clot is:

• In the abdomen: Abdominal pain, nausea and vomiting
• In an arm or leg: Sudden or gradual pain, swelling, tenderness, and warmth
• In the lungs: Shortness of breath, pain with deep breathing, rapid breathing, and increased heart rate
• In the brain: Trouble speaking, vision problems, seizures, weakness on one side of the body, and sudden severe headache
• In the heart: Chest pain, sweating, shortness of breath, and pain in the left arm

To find out if you have one or more blood clots, your health care provider:

• Will do a physical exam.
• Will take your medical history, which includes asking about your symptoms.
• May order blood tests, including a D-dimer test.
• May order imaging tests, such as
  • Ultrasound.
  • X-rays of the veins (venography) or blood vessels (angiography) that are taken after you get an injection of special dye. The dye shows up on the x-ray and allows the provider to see how the blood flows.
  • CT Scan.

Treatments for blood clots depend on where the blood clot is located and how severe it is. Treatments may include:

• Blood thinners.
• Other medicines, including thrombolytics. Thrombolytics are medicines that dissolve blood clots. They are usually used where the blood clots are severe.
• Surgery and other procedures to remove the blood clots

You may be able to help prevent blood clots by:

• Moving around as soon as possible after having been confined to your bed, such as after surgery, illness, or injury
• Getting up and moving around every few hours when you have to sit for long periods of time, for example if you are on a long flight or car trip
• Wearing compression stockings after surgery or during a long flight
• Regular physical activity
• Not smoking
• Staying at a healthy weight

Some people at high risk may need to take blood thinners to prevent blood clots.

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. Cholesterol is also found in foods from animal sources, such as egg yolks, meat, and cheese.

If you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque. Plaque sticks to the walls of your arteries. This buildup of plaque is known as atherosclerosis. It can lead to coronary artery disease, a condition in which your coronary arteries become narrow or even blocked.

HDL, LDL, and VLDL are lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. Different types of lipoproteins have different purposes:

• HDL stands for high-density lipoprotein. It is sometimes called "good" cholesterol because it helps your body get rid of cholesterol. It carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
• LDL stands for low-density lipoprotein. It is sometimes called "bad" cholesterol because a high LDL level leads to the buildup of plaque in your arteries.
• VLDL stands for very low-density lipoprotein. Some people also call VLDL a "bad" cholesterol because it too contributes to the buildup of plaque in your arteries. But VLDL and LDL are different; VLDL mainly carries triglycerides and LDL mainly carries cholesterol.

The most common cause of high cholesterol is an unhealthy lifestyle. This can include:

• Unhealthy eating habits, such as eating lots of saturated fats. These fats are found in red meats, full-fat dairy products, chocolate, some baked goods, and many deep-fried and processed foods. Eating too much saturated fat can raise your LDL (bad) cholesterol.
• Lack of physical activity, with lots of sitting and little exercise. This lowers your HDL (good) cholesterol.
• Smoking, which lowers HDL cholesterol, especially in women. It also raises your LDL cholesterol.
• Stress, which may raise levels of certain hormones such as corticosteroids. These can cause your body to make more cholesterol.
• Drinking too much alcohol, which can raise your total cholesterol level.

Genetics may also cause people to have high cholesterol. For example, familial hypercholesterolemia (FH) is an inherited condition that causes very high levels of cholesterol in the blood. Other medical conditions and certain medicines may also raise LDL cholesterol levels or lower HDL cholesterol levels.

A variety of things can raise your risk of high cholesterol:

• Age. Your cholesterol levels tend to rise as you get older. Even though it is less common, younger people, including children and teens, can also have high cholesterol.
• Sex. Between ages 20 and 39, men have a greater risk of high total cholesterol than women. But after menopause, a woman's risk goes up. This happens because menopause lowers levels of female hormones that may protect against high blood cholesterol.
• Family history. High blood cholesterol can run in families.
• Other health conditions. Conditions such as diabetes, chronic kidney disease, HIV, and lupus can raise your risk of high cholesterol.
• Medicines. Certain medicines can raise your level of LDL cholesterol or lower your level of HDL cholesterol, including:
  • Steroids
  • Some chemotherapy medicines
  • Medicines taken after an organ transplant
  • Medicines for certain heart conditions
  • Certain acne medicines
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high cholesterol. For example, Asian Americans are more likely to have high levels of LDL cholesterol than other groups. And non-Hispanic White people are more likely than other groups to have high levels of total cholesterol.
• Weight. Being overweight or having obesity raises your cholesterol level.

Undiagnosed or untreated high blood cholesterol can lead to serious health problems:

• If you have large deposits of plaque in your arteries, an area of plaque can rupture (break open). This can cause a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow in a coronary artery.
• If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, it can cause angina (chest pain) or a heart attack.
• Plaque also can build up in other arteries in your body, including the arteries that bring oxygen-rich blood to your brain and limbs. This can lead to problems such as carotid artery disease, stroke, and peripheral arterial disease.

There are usually no signs or symptoms that you have high cholesterol. A blood test can measure your cholesterol levels. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are ages 20 to 65::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people over age 65:

• They should be tested every year

You can lower your cholesterol through heart-healthy lifestyle changes. They include a heart-healthy eating plan, weight management, and regular physical activity.

If the lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering medicines available, including statins. If you take medicines to lower your cholesterol, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder that interferes with your daily life.

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:

• Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
• Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
• Frontotemporal disorders, which cause changes to certain parts of the brain:
  • Changes in the frontal lobe lead to behavioral symptoms
  • Changes in the temporal lobe lead to language and emotional disorders
• Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
• Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including:

• Creutzfeldt-Jakob disease, a rare brain disorder
• Huntington's disease, an inherited, progressive brain disease
• Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
• HIV-associated dementia (HAD)

Certain factors can raise your risk for developing dementia, including:

• Aging. This is the biggest risk factor for dementia.
• Smoking
• Uncontrolled diabetes
• High blood pressure
• Drinking too much alcohol
• Having close family members who have dementia

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:

• Get lost in a familiar neighborhood
• Use unusual words to refer to familiar objects
• Forget the name of a close family member or friend
• Forget old memories
• Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Tests of your thinking, memory, and language abilities
• Other tests, such as blood tests, genetic tests, and brain scans
• A mental health evaluation to see whether a mental disorder is contributing to your symptoms

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:

• Medicines, which may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
• Occupational therapy to help find ways to more easily do everyday activities
• Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy to reduce anxiety and improve well-being

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.

Gangrene is the death of tissues in your body. It happens when a part of your body loses its blood supply. Gangrene can happen on the surface of the body, such as on the skin, or inside the body, in muscles or organs. Causes include:

• Serious injuries
• Problems with blood circulation, such as atherosclerosis and peripheral arterial disease
• Diabetes

Skin symptoms may include a blue or black color, pain, numbness, and sores that produce a foul-smelling discharge. If the gangrene is internal, you may run a fever and feel unwell, and the area may be swollen and painful.

Gangrene is a serious condition. It needs immediate attention. Treatment includes surgery, antibiotics, and oxygen therapy. In severe cases an amputation may be necessary.

Each year almost 800,000 Americans have a heart attack. A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. But if you do get quick treatment, you may be able to prevent or limit damage to the heart muscle. That's why it's important to know the symptoms of a heart attack and call 911 if you or someone else is having them. You should call, even if you are not sure that it is a heart attack.

The most common symptoms in men and women are:

• Chest discomfort. It is often in center or left side of the chest. It usually lasts more than a few minutes. It may go away and come back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion.
• Shortness of breath. Sometimes this is your only symptom. You may get it before or during the chest discomfort. It can happen when you are resting or doing a little bit of physical activity.
• Discomfort in the upper body. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.

You may also have other symptoms, such as nausea, vomiting, dizziness, and lightheadedness. You may break out in a cold sweat. Sometimes women will have different symptoms then men. For example, they are more likely to feel tired for no reason.

The most common cause of heart attacks is coronary artery disease (CAD). With CAD, there is a buildup of cholesterol and other material, called plaque, on their inner walls or the arteries. This is atherosclerosis. It can build up for years. Eventually an area of plaque can rupture (break open). A blood clot can form around the plaque and block the artery.

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery.

At the hospital, health care providers make a diagnosis based on your symptoms, blood tests, and different heart health tests. Treatments may include medicines and medical procedures such as coronary angioplasty. After a heart attack, cardiac rehabilitation and lifestyle changes can help you recover.

NIH: National Heart, Lung, and Blood Institute