ATHEROSCLEROSIS

Atherosclerosis causes narrowing in the blood vessels. The inner walls of arteries and veins can become damaged. This causes scarring where the damage has healed. Conditions such as diabetes cause a weakening of the vessel walls, making them prone to damage. Hypertension (high blood pressure) damages the vessels because the blood is pumped through with greater force. Fatty deposits and cholesterol stick to the damaged areas. These areas are called plaques. Plaques narrow the opening in the vessel. Blood flow through narrowed vessels is impeded. Small blood clots can form and plug the vessel. This stops blood flow through the vessel. In the heart this means that the heart muscle does not get enough oxygen, causing pain called angina. If oxygen is not delivered for excessive amounts of time, that part of the muscle dies. This is called a myocardial infarction or a heart attack. In the brain, lack of oxygen causes strokes.

Atherosclerosis is responsible for most of the coronary artery disease in the United States. The coronary arteries are the vessels that deliver blood to the heart muscle. Heart disease from atherosclerosis is the most common cause of death in the United States. Atherosclerosis of the vessels of the brain may cause strokes. Strokes are the third leading cause of death.

There are no symptoms of atherosclerosis until there is heart disease or damage to other organs. There are several risk factors for heart disease. Persons at risk are:

• Men
• Women after menopause who are not taking an estrogen replacement
• Persons older than 55 years
• Persons with a family history of heart disease
• Persons who smoke
• Persons who are overweight
• Persons with diabetes
• Persons with hypertension (high blood pressure)
• Persons with a high cholesterol level
• Sedentary persons (those who do not exercise regularly)
• Persons who have diets high in fat and cholesterol

Modification of risk factors is the best approach to managing atherosclerosis and coronary artery disease. You cannot change your age, sex, or family history of heart disease, but you can change many of the other factors.

The goal of treatment is to keep atherosclerosis from progressing. Depending on the risk factors, medications may be needed. It is extremely important to take the medicines on time every day. Modifying one's diet to include low-fat and low-cholesterol foods can help considerably. The diet should include high-fiber foods (oat bran, for example) and fruits and vegetables. Taking vitamin C and vitamin E supplements helps ease blood flow in the arteries. An aspirin a day may be prescribed. Aerobic exercise is recommended. The doctor may perform an exercise stress test to determine whether the heart is fit enough for exercise. Exercise should be started easily, and it should be stopped if symptoms develop.

• Stop smoking.
• Lose weight if you are overweight.
• Control your blood sugar if you have diabetes. Keep your blood sugar concentration as close to normal as possible through careful monitoring and attention to taking your medications.
• Monitor your blood pressure closely, and take your medication as directed if you have hypertension.
• Choose low-fat, low-cholesterol foods, and take prescribed cholesterol-lowering medications on a regular basis.
• Exercise. Aerobic exercise such as bicycling, swimming, and walking or jogging is needed for 30 minutes a day 3 or 4 days a week to help maintain fitness and lower risk.

• If you have new or worsening chest pain, shortness of breath, fainting, or changes in your ability to speak, swallow, see, or move your limbs.

The American Heart Association has information on atherosclerosis and other heart conditions. Call 1-800-242-8721 and ask for the literature department.




Stages of development in progression of atherosclerosis. A, Smooth muscle cell proliferation. B, Raised fibrous plaque. C, Complicated lesion. (From Lewis SM, Collier IC, Heitkemper MM: Medical-surgical nursing: assessment and management of clinical problem, ed 4, 1995, St Louis. Used by permission.)

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