Arteriosclerosis, literally meaning "hardening of the arteries", is an umbrella term for a

vascular disorder Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in thi ...

characterized by abnormal thickening, hardening, and loss of elasticity of the walls of

arteries An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...

; this process gradually restricts the blood flow to one's organs and tissues and can lead to severe health risks brought on by

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...

, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques,

cholesterol Cholesterol is the principal sterol of all higher animals, distributed in body Tissue (biology), tissues, especially the brain and spinal cord, and in Animal fat, animal fats and oils. Cholesterol is biosynthesis, biosynthesized by all anima ...

, and some other substances in and on the artery walls (it can be brought on by

smoking Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

, a bad diet, or many genetic factors). Atherosclerosis is the primary cause of

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...

(CAD) and

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

, with multiple genetic and environmental contributions. Genetic-epidemiologic studies have identified a long list of genetic and non-genetic risk factors for CAD. However, such studies indicate that family history is the most significant independent risk factor.

Signs and symptoms

The signs and symptoms of arteriosclerosis depend on the vessel affected by the disease. If affecting cerebral or ophthalmic vessels, as in

cerebrovascular accident Stroke is a medical condition in which poor blood flow to a part of the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop ...

s or transient ischemic attacks, signs and symptoms may include sudden weakness, facial or lower limb numbness, confusion, difficulty understanding speech, and problems seeing. If affecting coronary vessels, as in coronary artery disease (including

acute myocardial ischemia A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom is retro ...

or a "heart attack"), signs and symptoms may include chest pain.

Pathophysiology

The

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals. Types There is no de ...

s of arteriosclerosis begin as the

intima The tunica intima (Neo-Latin "inner coat"), or intima for short, is the innermost tunica (layer) of an artery or vein. It is made up of one layer of endothelial cells (and macrophages in areas of disturbed blood flow), and is supported by an int ...

(innermost layer of blood vessel wall) of an artery start to fill up with the deposition of cellular wastes. As these start to mature, they can take different forms of arteriosclerosis. All are linked through common features such as the stiffening of arterial vessels, thickening of arterial walls and the degenerative nature of the disease. *

Arteriolosclerosis Arteriolosclerosis is a form of cardiovascular disease involving hardening and loss of elasticity of arterioles or small arteries and is most often associated with hypertension and diabetes mellitus. Types include hyaline arteriolosclerosis and h ...

, unlike atherosclerosis, is a sclerosis that only affects small arteries and arterioles, which carry nutrients and blood to the cells. *

Atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...

is the narrowing of arteries from a buildup of plaque, usually made up of cholesterol, fatty substances, cellular waste products, calcium, and fibrin, inside the arteries. This affects large and medium-sized arteries; however, its positioning varies person to person. *

Monckeberg's arteriosclerosis Mönckeberg's arteriosclerosis, or Mönckeberg's sclerosis, is a non-inflammatory form of arteriosclerosis (artery hardening), which differs from atherosclerosis traditionally. Calcium deposits are found in the muscular middle layer of the wall ...

or medial calcific sclerosis is seen mostly in the elderly, commonly in arteries of the extremities. * Hyperplastic: Hyperplastic arteriosclerosis refers to the type of arteriosclerosis that affects large and medium-sized arteries. * Hyaline type: Hyaline arteriosclerosis, also referred to as arterial hyalinosis and arteriolar hyalinosis, refers to lesions that are caused by the deposition of homogenous

hyaline A hyaline substance is one with a glassy appearance. The word is derived from , and . Histopathology Hyaline cartilage is named after its glassy appearance on fresh gross pathology. On light microscopy of H&E stained slides, the extracellula ...

in the small arteries and arterioles.

Diagnosis

Diagnosis of an individual suspected of having arteriosclerosis can be based on a

physical exam In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions ...

blood test A blood test is a medical laboratory, laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose ...

, EKG and the results of these tests (among other exams).

Treatment

Treatment is often in the form of preventive measures of prophylaxis. Medical therapy is often prescribed to help prevent arteriosclerosis for underlying conditions, such as medications for the treatment of high cholesterol (e.g.,

statin Statins (or HMG-CoA reductase inhibitors) are a class of medications that lower cholesterol. They are prescribed typically to people who are at high risk of cardiovascular disease. Low-density lipoprotein (LDL) carriers of cholesterol play ...

cholesterol absorption inhibitor Cholesterol absorption inhibitors are a class of compounds that prevent the uptake of cholesterol from the small intestine into the circulatory system. Most of these molecules are monobactams but show no antibiotic activity. An example is ezetimi ...

s), medications to treat high blood pressure (e.g.,

ACE inhibitors Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of hypertension, high blood pressure and heart failure. This class of medicine works by causing relaxation of blood vessels as ...

angiotensin II receptor blocker Angiotensin II receptor blockers (ARBs), formally angiotensin II receptor type 1 (AT1) antagonists, also known as angiotensin receptor blockers, angiotensin II receptor antagonists, or AT1 receptor antagonists, are a group of pharmaceuticals tha ...

s), and antiplatelet medications. Lifestyle changes are also advised, such as increasing exercise, stopping smoking, and moderating alcohol intake. Captopril skeletal

There are a variety of types of surgery: *

Angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive procedure, minimally invasive endovascular surgery, endovascular Medical procedure, procedure used to widen narrowed or obstructe ...

and stent placement: A catheter is first inserted into the blocked or narrowed part of the artery, followed by a second one with a deflated balloon that is passed through the catheter into the narrowed area. The balloon is then inflated, pushing the deposits back against the arterial walls, and then a mesh tube is usually left behind to prevent the artery from retightening. *

Coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage"), is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest ...

: This surgery creates a new pathway for blood to flow to the heart. The surgeon attaches a healthy piece of vein to the coronary artery, just above and below the blockage to allow bypass. *

Endarterectomy Endarterectomy is a surgical procedure to remove the atheromatous ''plaque'' material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall. It was firs ...

: This is the general procedure for the surgical removal of plaque from the artery that has become narrowed or blocked. *

Thrombolytic therapy Thrombolysis, also called fibrinolytic therapy, is the breakdown ( lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massiv ...

: This is a treatment used to break up masses of plaque inside the arteries via intravenous clot-dissolving medicine.

Epidemiology

In 2008, the US had an estimate of 16 million cases of atherosclerotic

heart disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...

and 5.8 million strokes. Cardiovascular diseases that were caused by arteriosclerosis also caused almost 812,000 deaths in 2008, more than any other cause, including

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

. About 1.2 million Americans are predicted to have a heart attack each year.

History

The diagnostics and clinical implications of this disease were not recognized until the 20th century. Many cases have been observed and recorded, and Jean Lobstein coined the term ''arteriosclerosis'' while he was analyzing the composition of calcified arterial lesions. The name "arteriosclerosis" is derived the Greek words ἀρτηρία (''artēría'', artery) and σκληρωτικός (''sklērōtikós'', hardened).

References

External links

{{Authority control Vascular diseases Medical conditions related to obesity