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Atherosclerosis … one disease, several faces!

Updated: Aug 10, 2021

Everybody has heard about heart attacks, strokes and clotted leg arteries, but few people realise it is all pretty much the same thing simply affecting different parts of the body. The disease is called atherosclerosis; the thickening and calcification of arterial walls, causing decreased blood flow to wherever the artery is leading. When a heart artery clogs up completely, the result is a heart attack, when the same thing happens in the brain artery, we call it a stroke, and when a leg artery is occluded, we get black feet and toes, better known as gangrene. Other organs can also be affected, such as the intestine, or the pelvic arteries, which causes sexual impotence in certain cases.

Sometimes the problem occurs only in the heart, whilst in others it is just in the legs, but in many patients we do find it in different places at the same time. The good news is, modern technology has made it quite easy to screen for the presence of atherosclerosis and treatment has also seen tremendous progress – if the patient makes it to the doctor in time!

The journey starts with a symptom. This is mostly pain in the area where blood flow and oxygen delivery is being decreased: chest pain is the red flag for coronary artery disease, leg pain is the symptom of leg arteries being occluded and stomach pain can be induced by diseased abdominal vessels. Even impotence can be caused by atherosclerosis of specific pelvic arteries.

Cardio-Vascular centres use high tech equipment to evaluate all the vessels of the body and report the damage: where is it exactly and how bad is it! The Eco-doppler examination is the best known to most of us. Ultrasound waves produce clear pictures of our arteries, so for example, the extent of protruding, calcified plaques can be measured accurately in the vessels going to our brain. In addition, the actual blood flow can be analysed and quantified, providing a good picture of the actual problem. Angio-CT scans of coronary arteries, or body arteries, are also very accurate in showing where exactly the problem lies.

For early detection and assessment of risk level, doctors use the IMT measurement of the carotid artery (neck artery), which gives a reliable prognosis of the patient's risk to develop significant atherosclerosis in the future. The same applies to the ABI measurement (Ankle Brachial Index of blood pressure) performed on arm and leg arteries. The results of these simple tests help formulate individual risk profiles leading to the optimisation of risk factors derived from our personal life style and our genetic predisposition. As for the risk factors that we can influence ourselves, they are no secret and are surely the most widely publicised in medical and lifestyle literature. There is hardly anyone who is not aware of the dangers of smoking, obesity and lack of physical exercise. Elevated blood pressure, sugar levels (diabetes) and cholesterol levels are medical risk factors regularly screened by doctors, because optimisation of treatment will significantly help to reduce the risk for atherosclerosis. As for the genetic predisposition, it can be determined in certain cases but cannot be changed – at least not today.

The treatment also involves high tech equipment. Endovascular procedures are the gold standard in most cases nowadays. Instead of opening the chest surgically for a coronary bypass operation, the cardiologists/radiologists enter the arteries through a small puncture in the wrist or groin. They then use small, straw-like catheters and wires to navigate to the calcified plaque lesion, open the narrowed area with a balloon and insert a stent. The same kind of procedure is performed in the case of other atherosclerotic arteries, for example in the leg or neck.

Patients show a high tolerance for these procedures, primarily because the length of stay in hospital is typically only one day, and there is no convalescence period involved due to the minimal invasive approach.

Nevertheless, it is always best to opt for early detection and prevention, rather than fixing the damage. Optimal control of chronic diseases, such as diabetes, high blood pressure and cholesterol, are important measures in reducing the risk of developing atherosclerotic disease, or its progression. An improved lifestyle, fresh healthy food, moderate physical exercise and eliminating unnecessary toxins from our daily habits is not just a nagging “must” prescribed by the doctor, but a way to embrace life and health. You will be rewarded with more energy, resulting in better work performance and a more satisfying enjoyment of activities with friends and family.

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