Is fat deposited inside your blood vessels? (Atherosclerosis) Let's talk about this!

Sometimes, you may have a big problem developing inside your body without even realizing it. Today, we are going to talk about a condition that silently affects the body, but can be very dangerous. This is what we call "atherosclerosis". Imagine, your blood vessels are like water pipes, what happens if these pipes get clogged with dirt, that is, fat? That is what happens in this case too. Although this is a bit of a serious story, if we understand it properly, we can do a lot to avoid it.

What is atherosclerosis? Simply put...

Simply put, atherosclerosis is the gradual buildup of fat, cholesterol, calcium, and other substances inside the walls of your arteries, forming a "plaque" (atheroma). Arteries are the blood vessels that carry oxygen-rich blood from our heart to the rest of our bodies. As this plaque builds up, the walls of the arteries gradually thicken and harden. This is also called "hardening of the arteries" or "atherosclerosis."

In the beginning, this happens very quietly. You may not notice any symptoms for a while. But as this plaque gradually grows, the space for blood to flow inside the artery, that is, the opening (lumen) inside the channel, narrows. Just like when dirt gets stuck in a water pipe, the water path becomes narrower. What happens then? The amount of blood that reaches our organs and tissues decreases. Not only that, but as the blood continues to flow rapidly, this plaque can break off, or its surface can be scratched. If that happens, a blood clot can form there.

Think of it this way: a narrowed artery is like a four-lane road reduced to a single lane. But a blood clot is like a roadblock in the middle of that road. It can completely stop the flow of blood.

The effect on the body depends on where the blood clot forms. For example, if this type of blockage occurs in the coronary arteries that supply blood to the heart, the heart can be deprived of oxygen and a heart attack can occur.

How common is this condition called atherosclerosis?

This is actually a very common condition. The complications caused by this buildup of plaque, especially heart attacks and strokes, are the leading causes of death worldwide.

According to the US National Institutes of Health, about half of people between the ages of 45 and 84 have atherosclerosis, but they don't know it. We need to be concerned about this situation in our country as well.

What are the symptoms of this?

Often, symptoms do not appear until an artery is severely narrowed, more than 70% blocked, or completely blocked. Most people only find out they have these deposits (plaque) after a medical emergency, such as a heart attack or stroke.

If the artery becomes more than 70% blocked, you may start to experience symptoms. Depending on where the blocked artery is located, symptoms can appear in different parts of the body.

Heart-related (Coronary Artery Disease - CAD)

When this condition occurs in the arteries that supply blood to the heart, it is called Coronary Artery Disease (CAD). This can lead to a heart attack.

You may feel things like this:

• Difficulty breathing even when doing light work (Dyspnea).
• Chest pain or discomfort (angina). This can feel like a squeezing or squeezing sensation in the chest.
• Pain in the back, shoulders, neck, arms, or abdomen.
• Dizziness, feeling lightheaded.
• Heart palpitations.
• Extreme fatigue, exhaustion.
• Nausea and vomiting, similar to indigestion.

Digestive system (Mesenteric Ischemia)

This condition (mesenteric ischemia) can occur if blood flow to parts of the digestive system is reduced.

• Pain or cramping in the stomach, especially in the abdomen, after eating.
• Bloating, nausea, vomiting.
• Diarrhea.
• Weight loss due to food fear, which is a fear of pain when eating.

Legs and feet (Peripheral Artery Disease - PAD)

Peripheral artery disease (PAD) is a condition in which blood flow in the arteries that supply blood to the limbs is reduced.

• Intermittent claudication is a pain that feels like the muscles in your legs are rolling, especially when you walk. This will subside after you sit for a while and rest, but will come back when you walk.
• Burning and aching in the legs and toes when at rest, especially when lying down.
• Skin color changes (e.g., redness).
• Cold feet.
• Frequent infections of the skin and soft tissues of the legs, feet.
• Non-healing wounds on the feet and toes.

Renal Artery Stenosis

Renal artery stenosis can cause symptoms such as:

• High blood pressure that cannot be controlled despite the use of several medications.
• Change in the frequency of urination.
• Swelling (Edema).
• Drowsiness, fatigue.
• Dry, itchy, or numb skin.
• Headache.
• Weight loss for no reason.
• Nausea, vomiting, or loss of appetite.

Brain-related (Carotid Artery Disease)

If this condition occurs in the carotid arteries in the neck, which supply blood to the brain, the first symptoms may be a transient ischemic attack (TIA) or stroke.

• Dizziness.
• Sagging of one side of the face.
• Loss of sensation on one side of the body, muscle weakness.
• Severe headache.
• Slurring of words while speaking, difficulty forming words.
• Loss of vision in one eye. It may feel like a black curtain falls in front of the eye.

Why does atherosclerosis develop? What are the causes?

Researchers believe there are several main reasons for this:

• Increased levels of harmful LDL cholesterol and triglycerides in the blood.
• Use of tobacco products (smoking, smokeless tobacco).
• High blood pressure (Hypertension).
• Diabetes (Diabetes Mellitus).

These factors can damage the inner lining of your arteries (endothelium). That's when atherosclerosis begins to develop. This damage usually happens gradually, over time.

How does this happen, what are the stages?

Atherosclerosis develops over many years and has several main stages:

1. Endothelial damage and immune response: When the endothelium of the artery is damaged, a chemical reaction begins. This causes white blood cells to gather at the site of damage. These cells gather and cause inflammation inside the artery.

2. Fatty streaks: This is the first visible sign of atherosclerosis. The damaged area looks like a yellow streak or spot, and is made up of dead "foam cells." Foam cells are white blood cells that have eaten cholesterol in an attempt to remove it. As these foam cells continue to function, they further damage the endothelium.

3. Plaque Growth: As dead foam cells and other debris continue to accumulate, the fatty streak gradually becomes a larger plaque. A fibrous cap of smooth muscle cells forms over this plaque. This prevents the plaque from breaking off and collecting in the bloodstream. As the plaque grows, the lumen (the space through which blood flows) in the artery narrows.

4. Plaque rupture or erosion: In this stage, the fibrous cap on top of the plaque ruptures, or the endothelium cells surrounding the plaque are damaged. Either way, a blood clot forms. That clot blocks blood flow and causes a heart attack or stroke.

What are the risk factors for this?

There are many risk factors that can affect the development of atherosclerosis. Some of these you can change, but some, like age, you can't.

Risk factors are:

• Being men over 45 years of age.
• Being a woman over the age of 55.
• If someone in the family (a close male relative before the age of 45, or a close female relative before the age of 55) has developed cardiovascular disease .
• Diabetes (Diabetes Mellitus).
• High blood pressure (Hypertension).
• Hyperlipidemia, especially high levels of bad LDL cholesterol or a special lipoprotein called Lipoprotein (a).
• Metabolic syndrome.
• Smoking or use of other tobacco products.
• Lack of physical activity.
• Eating a diet high in saturated fat, trans fat, sodium (salt), and sugar.

What complications can this cause?

Atherosclerosis disrupts the normal functioning of our cardiovascular system. This can limit or completely block blood flow to various parts of the body, especially the heart and brain. Complications that can occur due to this reduced blood flow include:

• Carotid artery disease.
• Coronary artery disease.
• Heart attack.
• Heartbeat irregularities (Arrhythmia).
• Heart failure.
• Mesenteric ischemia.
• Peripheral artery disease.
• Chronic kidney disease (CKD).
• Renal artery stenosis.
• Stroke.
• Transient ischemic attack (TIA).
• Weakening and bulging of the artery walls (aneurysms) and their rupture.

Early recognition and treatment of this condition can prevent or delay such serious complications.

How is this diagnosed? What tests do doctors do?

To find out if you have atherosclerosis, or your risk of developing it, a doctor will do the following:

• A complete physical examination will be performed. This will include listening to your heart and the sound of blood flowing through your arteries with a stethoscope. For example, they will check for a "bruit" sound in the carotid arteries in your neck. This sound can indicate the presence of plaque.
• Your medical history and family history will be asked. This information can give you an idea of ​​your risk for atherosclerosis and its complications.
• They will ask about your lifestyle. They may ask about habits such as whether you use tobacco products or have ever done so.
• Blood tests are ordered. These heart-related blood tests can tell you a lot about your cholesterol levels and heart function.

What other tests will be done?

The doctor may order other tests to confirm the presence of atherosclerosis and plan treatment. These include:

• Angiography: This uses special X-rays and contrast dye to find and measure blockages in the arteries.
• Ankle-brachial index: This measures blood flow in your limbs by comparing the blood pressure in your ankle and arm.
• Chest X-ray: This takes pictures of the inside of the chest.
• CT scan (Computed Tomography scan): This scan takes pictures of the inside of the body and can see if large arteries are blocked or narrowed.
• Heart MRI (Magnetic Resonance Imaging): This test can show problems with blood flow in the arteries.
• Echocardiogram (Echo): An echo takes pictures of the heart's valves and chambers and measures how well the heart is pumping blood.
• ECG (Electrocardiogram or EKG): The ECG measures the electrical activity, rate, and rhythm of the heart.
• Exercise stress test: A test that measures heart function while you are physically active.
• Carotid ultrasound: This takes ultrasound images of the carotid arteries in the neck. It can detect whether these arteries are narrowed or blocked as they carry blood to the brain.
• Abdominal ultrasound: This ultrasound examines the aorta, the large artery in the abdomen, to see if it has a bulge (abdominal aortic aneurysm) or plaque.

How is this treated?

Atherosclerosis is treated with lifestyle changes, medications, and sometimes surgery or other medical procedures . Depending on where you have atherosclerosis, you may see a cardiologist, nephrologist, neurologist, or vascular surgeon.

Your doctors will create a treatment plan based on your needs. The goals of treatment are usually to:

• Reducing the risk of blood clots.
• Preventing complications like a heart attack or stroke.
• Reducing symptoms.
• Helping you adopt a diet that is good for your heart and blood vessels.
• Preventing or stopping the formation of plaque inside the arteries.
• Improving blood flow, either by widening the arteries or bypassing blockages.

Lifestyle changes

Lifestyle changes can reduce the risk of complications. Your doctor will create a plan that is right for you. In general, you can do the following:

• Avoid all tobacco products (including smoking and vaping). This is the most important thing you can do.
• Follow a heart-healthy diet, such as the Mediterranean diet , which means eating more vegetables, fruits, legumes, whole grains, fish, and olive oil.
• Exercise daily. Start with a short walk and work up to exercising for at least 30 minutes a day, several days a week.

Medications

Medications can help control risk factors for plaque buildup and slow the progression of atherosclerosis. Your doctor may prescribe medications to lower blood pressure, lower cholesterol, control blood sugar levels, and prevent blood clots.

Procedures or Surgeries

There are various medical and surgical procedures that can help people with severely blocked arteries or those at high risk of complications. Common treatment options include:

• Angioplasty: This involves inserting a balloon-like device into the narrowed artery and inflating it to widen the artery.
• Atherectomy: This involves cutting and removing plaque from inside the artery.
• Carotid endarterectomy: A surgical procedure to remove plaque from the carotid arteries in the neck.
• Coronary artery bypass grafting (CABG): This procedure creates new pathways for blood to flow around blocked arteries in the heart.
• Peripheral artery bypass surgery: Creates new pathways for blood to bypass blocked arteries in the limbs.
• Stent placement: After angioplasty, a small mesh-like stent is placed to keep the artery from narrowing again.
• Vascular disease bypass: This is also a surgery to bypass blockages.

Can atherosclerosis be prevented?

It may not be possible to completely prevent it. But you can reduce your risk and lessen the impact of the disease. Here are some things you can do:

• Eat foods low in saturated fat, trans fat, cholesterol, sodium (salt), and sugar.
• Engage in regular physical activity. Start with a short walk and work up to 30 minutes a day, several days a week.
• Maintain a healthy weight for you. Ask your doctor what that is.
• Manage other health conditions, especially diabetes mellitus, hypertension, and high cholesterol.
• Do not use tobacco products.
• Have a medical checkup once a year.

What should you expect when living with this condition? How do you take care of yourself?

If diagnosed and treated early, many people with atherosclerosis can live the lives they love. But the disease can cause medical emergencies, and it can be fatal. So it's important to be aware of your risks and work with your doctor to reduce them.

Work closely with your doctor. They will check on your condition regularly and tell you how often you should see them. Keep all your appointments and be proactive about your health. Tell your doctor right away if you notice any new or changing symptoms. Early treatment can reduce the risk of life-threatening complications.

Also, think about your mental health. It's normal to feel anxious about what the future holds. It can be overwhelming to make lifestyle changes. But don't let those feelings stop you from enjoying life.

• Share your feelings with a counselor or support group.
• Connect with others who have cardiovascular disease. You can share experiences and learn from each other.
• Talk to your family and friends about the lifestyle changes you are making. Explain to them why these changes are important to you, and ask for their support in making them happen.

When should you go to an Emergency Treatment Unit (ETU) ?

If you or someone you know is having symptoms of a heart attack, stroke, or TIA , call 911 or your local emergency number immediately. These are medical emergencies that require immediate treatment.

What questions should you ask your doctor?

Some questions you can ask your doctor:

• What is the best treatment for me?
• What should my blood pressure and cholesterol levels be?
• When should I start checking my children's cholesterol?
• Can you recommend a program to help me quit smoking?

Final Take-Home Message

Atherosclerosis is a common condition that many people face. But your doctor is here to help you manage it and live your best life. During your annual checkup, they will assess your risk of developing atherosclerosis and explain what you can do to reduce it. Don't be afraid to ask for help in following your doctor's advice. They can suggest resources that you may need. Remember, a healthy lifestyle and following your doctor's advice will go a long way in protecting you from this serious condition.

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