We all often hear things like 'high cholesterol' and 'blocked blood vessels'. But have you ever wondered how this actually happens inside our bodies? Our blood vessels are like the roads in our bodies for blood circulation. These roads carry oxygen-rich, clean blood from our heart to the organs throughout our bodies. Imagine, what happens if these roads gradually become clogged with fat and debris? That's what we call atherosclerosis in medicine.
Simply put, what is atherosclerosis?
Atherosclerosis is the gradual buildup of fat, cholesterol, calcium, and other substances inside the walls of our blood vessels (especially arteries) to form a 'plaque' . This is called 'atheroma' in medical terms. As this plaque gradually grows, the blood vessel wall thickens and hardens. We call this "hardening of the blood vessels" or "hardening of the blood vessels".
The scary thing about this is that this process happens very quietly, without any symptoms in the early stages. You may not notice any changes for years. But over time, this plaque grows and narrows the lumen (the space through which blood flows) inside the blood vessel.
Imagine a four-lane road being reduced to one lane due to traffic congestion. Blood flow is greatly reduced. This means that our organs are deprived of the oxygen and nutrients they need. What's even more dangerous is that this blood vessel can suddenly rupture due to the fast-moving blood flow. When that happens, our bodies form a blood clot to heal the wound.
If a narrowed blood vessel is like a blocked road, a blood clot is like an obstacle in the middle of that road. It can completely stop the flow of blood.
What happens when blood flow is blocked in this way? It depends on where the clot forms. For example, if it occurs in a coronary artery that supplies blood to the heart, the heart will not get enough oxygen, causing a heart attack .
How common is this condition?
Atherosclerosis is actually a very common condition. Complications caused by the buildup of fat in the arteries, such as heart attacks and strokes, are the leading cause of death worldwide. Surveys show that many middle-aged people have the condition, but about half of them don't even know it.
What are the symptoms of this?
As we mentioned earlier, there are no symptoms in the early stages. Symptoms start to appear when a blood vessel becomes more than 70% blocked. Most people only find out they have this condition after an emergency, such as a heart attack or stroke.
Depending on where the blood vessel is blocked, symptoms can appear in different parts of the body.
| Affected body part | Possible symptoms |
|---|---|
| Heart (Coronary Artery Disease) |
|
| Digestive system (Mesenteric Ischemia) |
|
| Legs and feet (Peripheral Artery Disease) |
|
| Kidneys (Renal Artery Stenosis) |
|
| Brain (Carotid Artery Disease) |
|
Why do blood vessels become blocked like this? What are the causes?
Researchers believe that there are several main causes of atherosclerosis.
- Increased levels of bad cholesterol (LDL) and triglycerides.
- Use of tobacco products (smoking).
- High blood pressure.
- Diabetes.
These factors can damage the delicate lining inside our blood vessels (endothelium). This damage is what starts the process of atherosclerosis. This damage doesn't happen overnight, but over a very long period of time.
Let's look at the steps of this process in detail.
This is a process that has been going on for years. These are the main steps.
1. Endothelial damage: Things like high cholesterol, toxins in cigarettes, and high blood pressure can damage the inner lining of blood vessels. When this damage occurs, white blood cells are attracted to the area. These cells accumulate and cause inflammation inside the blood vessel.
2. Fatty streak formation: This is the first visible sign of atherosclerosis. White blood cells that have arrived at the site of damage try to remove the cholesterol particles by engulfing them. These cholesterol-filled cells are called 'foam cells'. When they die, they leave a yellow streak or spot on the blood vessel wall.
3. Plaque enlargement: As dead cells and other debris continue to accumulate, the small fatty plaque gradually grows into a larger plaque. Then, a fibrous cap made of smooth muscle cells forms around this plaque. This prevents pieces of the plaque from breaking off and pooling in the blood vessels. As this plaque grows larger, the space for blood to flow becomes narrower.
4. Plaque rupture: This is the most dangerous case. The plaque that surrounds the plaque can suddenly burst. When this happens, a blood clot forms at that location. This blood clot completely blocks the blood vessel, stopping the flow of blood. This is what causes a heart attack or stroke.
What are the risk factors for this?
There are many risk factors that contribute to the development of atherosclerosis. Some of these we can change, but some, like age, we cannot.
| Risk factor | Description |
|---|---|
| Age and gender | Men over the age of 45 and women over the age of 55 are at higher risk. |
| Family history | If someone in your immediate family has had heart disease (before the age of 45 for a man, before the age of 55 for a woman), you are also at higher risk. |
| Diabetes | High blood sugar levels damage blood vessels. |
| High blood pressure (Hypertension) | When pressure increases, the risk of blood vessels being damaged and fat being deposited increases. |
| High cholesterol (Hyperlipidemia) | The main reason is especially the increase in bad cholesterol (LDL) levels. |
| Smoking | The chemicals in cigarettes directly damage blood vessels. |
| Not exercising | Lack of physical activity leads to obesity, high cholesterol, and high blood pressure. |
| Unhealthy diet | Eating a diet high in saturated fat, trans fat, salt, and sugar. |
What are the possible complications of atherosclerosis?
Impaired blood circulation can lead to a number of serious complications. The main ones are:
- Coronary artery disease
- Heart attack
- Abnormal heart rhythms (Arrhythmia)
- Heart failure
- Stroke
- Transient ischemic attack (TIA)
- Peripheral artery disease
- Chronic kidney disease (CKD)
- Weakening of blood vessels, causing them to bulge (aneurysms) and burst.
Early diagnosis and treatment of this condition can prevent or delay these dangerous complications.
How to diagnose this disease?
Your doctor will follow several steps to diagnose this condition or calculate your risk for it.
1. A complete physical examination: This involves using a stethoscope to listen to your heart and the sound of blood flowing through your blood vessels. For example, if you hear a "whooshing" sound ("bruit") when listening to the carotid arteries in your neck, it could be a sign of a blood clot in the artery.
2. Asking about your medical history and family history: This information can help assess your risk.
3. Asking about your lifestyle: Asking about things like whether you smoke and what your diet is like.
4. Ordering blood tests: These can provide a lot of information about your cholesterol levels, sugar levels, and heart function.
Tests to confirm the condition
Sometimes, further tests are needed to confirm the diagnosis and plan treatment.
- Angiography: A test that uses special X-rays and dye to see exactly where and how much blood vessels are blocked.
- ECG (Electrocardiogram): Measures the electrical activity, rate, and rhythm of the heart.
- Echocardiogram: Takes pictures of the heart's valves and chambers to see how well the heart is pumping blood.
- Exercise stress test: Your heart rate is measured while you exercise (walking on a treadmill).
- Ultrasound Scan: This test is used to check the thickness of the blood vessels in the neck (Carotid ultrasound) or abdomen (Abdominal ultrasound) and whether they have fatty deposits.
- CT scan: This scan takes pictures of the inside of the body and can identify thickening and narrowing of large blood vessels.
How is it treated?
Treatment for atherosclerosis includes lifestyle changes, medications, and, if necessary, surgery or other treatments. Your doctor will develop a treatment plan that is best for you.
1. Lifestyle changes
These are the most important things. These changes can greatly reduce the risk of complications.
- Avoid all tobacco products. If you smoke, quit immediately.
- Adopt a heart-healthy diet. It's best to eat a Mediterranean diet that includes plenty of vegetables, fruits, legumes, fish, and healthy fats like olive oil, and less red meat and processed foods.
- Exercise daily. Start with short walks and work up to exercising for at least 30 minutes a day, most days of the week.
2. Medicines (types of medicines)
Medications can help control risk factors for fat accumulation. Your doctor may recommend:
- Cholesterol-lowering medications (e.g., statins).
- Blood pressure lowering medication.
- Medicines that control blood sugar levels.
- Medications that prevent blood clotting (e.g., aspirin) may be prescribed.
3. Treatment methods and surgeries
If the blood vessels are severely blocked or the risk of complications is high, you may need to resort to these types of treatments.
- Angioplasty and Stent placement: A procedure in which a small balloon is inserted into a blocked blood vessel, inflated to widen the vessel, and a small mesh-like tube (stent) is inserted to prevent it from closing again.
- Coronary Artery Bypass Grafting (CABG): A procedure to bypass a blocked blood vessel and create a new blood vessel using a piece of blood taken from another part of the body.
What should you do?
Don't panic if you find out you have this condition. The most important thing is to work closely with your doctor.
- Go to the clinics at the scheduled time as he or she tells you.
- Check your blood pressure, cholesterol, and sugar levels regularly and keep them under control.
- If any new symptoms appear or existing symptoms change, tell your doctor immediately.
- Take care of your mental health too. It's normal to feel anxious and scared when living with a condition like this. Talk to your family, friends, or a counselor about it if necessary.
When should you go to the Emergency Treatment Unit (ETU)?
If you or someone near you experiences symptoms of a heart attack (severe chest pain, difficulty breathing, pain radiating down the left arm) or a stroke (drooping on one side of the face, difficulty speaking, loss of consciousness on one side of the body) , immediately call 1990 for an ambulance or go to the nearest hospital Emergency Department (ETU). These are emergencies that require immediate treatment.
Take-Home Message
- Atherosclerosis is a silent, but very dangerous condition that develops inside the blood vessels.
- High cholesterol, high blood pressure, diabetes, and smoking are the main risk factors.
- This risk can be greatly reduced by a good diet, regular exercise, and avoiding smoking.
- If you are at risk, it is very important to continue to have medical checkups, even if you do not have any symptoms.
- Don't ignore the symptoms of a heart attack or stroke. It's an emergency. Seek medical attention immediately.
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