Atherosclerosis (Fatty Plaques Narrowing Arteries)

Everyday in South Africa, there are approximately 130 deaths due to a heart attack and around 240 deaths due to a stroke. Broadly referred to as cardiovascular diseases, it is a major health problem in South Africa and is expected to rise significantly in younger adults by 2030. One of the leading causes of cardiovascular disease is atherosclerosis, which in turn is largely caused by uncontrolled hypertension (high blood pressure), diabetes mellitus, high cholesterol levels, and tobacco smoking, among a host of other causes.

What is atherosclerosis?

Atherosclerosis is a chronic condition where there is hardening and narrowing of arteries due to the buildup of plaque on the inner walls. These plaques are composed of fatty substances like cholesterol, calcium and other substances. As the plaque grows and hardens, it impedes the flow of blood through the artery.

Although atherosclerosis is a preventable and manageable condition, it can potentially lead to life-threatening complications if ignored. Atherosclerosis is a leading cause of cardiovascular problems worldwide, significantly contributing to heart attacks, strokes, and peripheral artery disease.

Causes of Atherosclerosis

Atherosclerosis begins when the inner lining of the arteries, known as the endothelium, becomes damaged. Fatty substances like cholesterol and other substances such as calcium gradually build up at this site and grow to form the plaque. Factors that can lead to damage of the inner lining of the artery include:

• High Cholesterol: Elevated levels of low-density lipoprotein (LDL) cholesterol can accumulate on the arterial walls, forming plaques.
• High Blood Pressure: Chronic hypertension can stress and damage the arterial walls, making them more susceptible to plaque buildup.
• Smoking: Tobacco use contributes to endothelial damage and accelerates plaque formation.
• Diabetes: High blood sugar levels can damage blood vessels and increase the risk of atherosclerosis.
• Obesity: Excess body weight often correlates with higher cholesterol levels, hypertension, and diabetes, all of which are risk factors.
• Sedentary Lifestyle: Lack of physical activity can lead to poor cardiovascular health, increasing the likelihood of atherosclerosis.
• Inflammation: Chronic inflammation, as seen in conditions like rheumatoid arthritis or lupus, can also damage arteries.

Symptoms of Atherosclerosis

In the early stages of atherosclerosis, there is little to no signs and symptoms. You may have atherosclerotic plaques growing for years and even decades before symptoms become evident. When symptoms do arise, it can vary depending on the affected organ and size of the plaque. Although atherosclerosis can affect any artery, it is most serious when it affects blood flow to the vital organs like the heart or brain.

Heart (Coronary Arteries)

The coronary arteries carry oxygen-rich blood to the heart muscle. When it becomes occluded with a plaque, blood flow is reduced to the heart. Symptoms may arise in episodes during periods of exertion, which is known as angina pectoris. However, if there is a complete blockage then it can damage the heart muscle (myocardium). This is known as a myocardial infarction or commonly referred to as a heart attack.

• Chest pain
• Arm, neck and even jaw pain, usually on the left side.
• Shortness of breath
• Fatigue

Brain (Carotid Arteries)

The carotid arteries carry oxygen-rich blood to the brain. When it becomes narrowed, oxygen supply is reduce to the brain. This may not always be evident in the early stages until there is an increased demand for oxygen. It can cause momentary episodes of reduced oxygen supply to the brain known as a transient ischaemic attack (TIA). If there is a complete blockage, it can lead to  damage of the brain tissue. This is known as a cerebrovascular accident (CVA) which is commonly referred as a stroke.

• Sudden numbness or weakness, especially on one side of the body.
• Difficulty speaking.
• Vision problems.
• Dizziness.
• Confusion.

Other Affected Areas

Atherosclerosis can affect any organ or area of the body.

Apart from the heart and brain, atherosclerosis also commonly affects the limbs (arms or legs) which is known as peripheral artery disease (PAD). It can lead to limb pain, especially when walking, numbness and the limbs feel cold to touch. Peripheral artery disease can lead to serious complications with tissue death that even require amputation.

Another organ that may also be affected is the kidney. The reduced blood flow due to atherosclerosis can affect kidney function and even contribute to high blood pressure, since the kidneys play an integral role in regulating blood pressure. It may eventually lead to chronic kidney disease and possibly kidney failure.

Complications of Atherosclerosis

If untreated, atherosclerosis can lead to severe complications, including:

• Heart Attack: Caused by the complete blockage of coronary arteries.
• Stroke: Resulting from obstruction or rupture in the carotid or cerebral arteries.
• Aneurysms: Abnormal arterial bulging that can rupture and cause life-threatening bleeding.
• Peripheral Artery Disease (PAD): Leads to reduced blood flow to limbs, potentially causing gangrene.
• Chronic Kidney Disease: Due to restricted blood flow in renal arteries.

Treatment Options

The treatment of atherosclerosis involves lifestyle changes, medications, and sometimes surgical interventions.

Lifestyle Changes

• Change to a heart-healthy diet, which is abundant in fresh fruits, raw and partially cooked vegetables, whole grains, and lean proteins. Limit the intake of animal protein, especially fatty red meat.
• Engage in regular physical activity of at least 150 minutes of moderate exercise per week. Always consult with a doctor before starting an exercise program.
• Quitting smoking and limiting alcohol intake.
• Managing stress effectively.

Medications

• Statins: To lower LDL cholesterol levels.
• Antiplatelet Drugs: Such as aspirin, to prevent blood clots.
• Blood Pressure Medication: Including ACE inhibitors or beta-blockers to reduce high blood pressure.
• Diabetes Management: Medications or insulin to control blood sugar levels.

Surgical Procedures

• Angioplasty and Stenting: To open blocked arteries and keep them open with a stent.
• Bypass Surgery: Creating a new path for blood flow around a blocked artery.
• Endarterectomy: Removing plaque from the walls of arteries.

Preventing Atherosclerosis

There are many lifestyle changes and drugs that can prevent atherosclerosis or at least limit its development.

• Healthy Diet: Focus on low-saturated-fat, low-cholesterol foods, and incorporate omega-3 fatty acids.
• Regular Exercise: Improves circulation, reduces LDL cholesterol, and strengthens the heart.
• Weight Management: Maintaining a healthy weight lowers the risk of diabetes and hypertension.
• Routine Health Checkups: Monitoring cholesterol, blood pressure, and blood sugar levels helps detect and manage risk factors early.
• Avoiding Tobacco: Eliminating smoking reduces vascular damage.