Vascular Surgery: Atherosclerosis

Atherosclerosis represents a buildup of cholesterol and calcium in an artery, resulting in “plaque” that progresses to block off the artery. This disease may affect any artery in the body and is often present in multiple locations. The most common locations for atherosclerosis are:

  • Arteries in the heart, known as coronary atherosclerosis;
  • Arteries that supply the legs, known as peripheral arterial disease (pad);
  • Arteries that supply the brain, known as carotid artery disease.

Advanced atherosclerosis in these areas can lead to heart attack, amputation or stroke. Less commonly atherosclerosis can affect arteries that supply the kidneys or the intestine, which may lead to dysfunction of those organs. Atherosclerosis of the arteries to the arms does occur but it is relatively rare.

Risk Factors for Atherosclerosis:

  • AGE: Atherosclerosis is part of the aging process. In general, men over 45 and women over 55 are believed to have an increased risk for atherosclerosis. It is unusual to have clinically significant atherosclerosis below the age of 50; however, by the time a person reaches 65 years of age, there is a 10-20% chance that s/he will have some manifestation atherosclerosis. This may be evidenced either by symptoms or upon examination. In most cases, atherosclerosis can be managed without surgery through the modification of factors that speed the progression of this condition.
  • HEREDITY: Atherosclerosis often runs in families, so it is important to know your family history of heart attack, stroke or amputation, or sudden death and discuss it with your primary care practitioner. Abnormalities of cholesterol (dyslipidemia) or blood sugar (diabetes) also run in families. Both of these conditions can increase the risk of developing atherosclerosis.
  • SMOKING: Smoking of any sort is the single most important modifiable risk factor for progression of atherosclerosis. Patients who smoke are at significantly increased risk of heart attack, stroke or amputation and people who continue to smoke are at higher risk than those who have stopped. The combination of smoking and diabetes is particularly detrimental. If you are found to have atherosclerosis of any sort, you should make every effort to stop smoking. There are a number of smoking cessation aids, medications, and counseling strategies that can improve your chances of quitting; however, the most important factor is the determination to quit.
  • HIGH CHOLESTEROL: Abnormally high levels of LDL (“bad cholesterol”) and triglycerides both increase the risk of atherosclerosis, while higher levels of HDL (“good cholesterol”) are beneficial. Goals for cholesterol levels vary with the number of risk factors each person has (age, hypertension, smoking, family history, HDL<40).

Targets for LDL are:

  • <130 mg/dl for ≥ two risk factors
  • <100 mg/dl for > two risk factors
  • <70 mg/dl for > two risk factors and diabetes or renal disease

Targets for triglycerides are:

  • <150 mg/dl.

Target for HDL is:

  • ≥ 40 mg/dl.
  • DIABETES: The presence of diabetes increases the risk of atherosclerosis. In general, individuals whose diabetes is well controlled can reduce their risk of stroke, heart attack, and death. “Good control” is defined as HgbA1C between 6 and 7. There is no evidence that suggests lower levels provide any additional benefits. Diabetics should not smoke as smoking further accelerates risks of atherosclerosis in diabetes.
  • HIGH BLOOD PRESSURE (HYPERTENSION): High blood pressure increases the risk of heart attack, stroke, and death. There isn’t much evidence that moderate elevations of blood pressure independently increase the progress of atherosclerosis; however, every effort should be made to control blood pressure to within medically established guidelines (140/90 or lower).
  • OBESITY: There is no direct evidence that obesity itself increases the development of atherosclerosis. However, obesity is associated with several risk factors (diabetes, cholesterol abnormalities) that are risk factors for atherosclerosis. In addition, obesity places added stress on the heart and lungs as well as muscles and joints and increases problems with venous disease. For these reasons, every effort should be made to avoid obesity. Body Mass Index (BMI) is the typical measure for obesity—individuals should target a BMI of less than 30.

Preventive Measures to Reduce Progression of Atherosclerosis

While you cannot reverse the aging process or choose your parents, there are a number of things that can be done to reduce the risk of progression of atherosclerosis. These include:

  • Stop smoking—smoking cessation is the single most important way to reduce atherosclerosis progression.
  • Control diabetes— speak with your primary care physician if this is a concern and don’t smoke.
  • Lower cholesterol—speak with your primary care physician if this is a concern.
  • Watch hypertension—take action to keep blood pressure within normal guidelines.
  • Reduce obesity—aim for a BMI of 30 or less.
  • Exercise regularly—including 45-90 minutes of exercise three to five times per week, even at modest levels, will help with weight reduction and can elevate levels of HDL (good cholesterol).
  • Enjoy a Mediterranean diet—learn more about the foods enjoyed in the Mediterranean that have health benefits and may reduce total cholesterol and LDL.
  • Medications—a variety of medications have been designed to reduce risk factors (such as lower cholesterol and triglycerides), each with their own indications, side effects, and complications. Plus, new drugs are being developed and tested every day. You should speak with your primary care practitioner to determine what medication, if any, is right for you.

Since diet and exercise are measures that most people can do on their own and are not associated with complications, this should be the first step, along with smoking cessation. If you are starting an exercise regimen for the first time, consult your primary care practitioner before beginning.