Atherosclerosis affects blood vessels and its consequences can be serious, affecting various organs and systems in the body. This disease process develops gradually and can cause several health problems if it is not diagnosed and treated in time.

What is atherosclerosis?

Atherosclerosis is a chronic disease that affects the arteries, causing their walls to thicken, become less flexible, and narrow. It is formed when fatty deposits or plaques, consisting of cholesterol, calcium, fat, blood cells and connective tissue, accumulate on the inner walls of the arteries. These plaques (atheroma) gradually block blood flow, increasing the risk of serious health problems such as cardiovascular disease.

How does atherosclerosis develop?

• Endothelial damage: Atherosclerosis begins with damage to the endothelium (the inner layer of the artery), which can be caused by high blood pressure, smoking, high cholesterol, or diabetes. The damaged endothelium is no longer able to effectively regulate blood flow, causing inflammatory reactions and promoting the accumulation of blood cells and cholesterol.
• Formation of fatty streaks: after damage to the endothelium, fatty streaks begin to form, consisting of cholesterol and macrophages (inflammatory cells). At this stage, there are usually no symptoms, and the arteries may still be relatively free.
• Plaque (atheroma) formation: fatty streaks continue to thicken, forming atheroma - accumulation of cholesterol and other substances in the artery wall. Atheromas contain a central core with cholesterol and an outer fibrous cap that may begin to obstruct blood flow, but there are no serious symptoms yet.
• Plate destabilization: the cap of the atheroma can become unstable, especially due to inflammation, which can lead to its rupture. Rupture releases the contents of the plaque into the bloodstream, creating a risk of clot formation.
• Clot formation: when the plaque ruptures, a blood clot can form on the surface of the plaque, which can completely block the artery. This can lead to serious complications such as myocardial infarction (heart attack) or stroke.
• Calcification: part of the atheroma may calcify, making it harder and less elastic. This process can further impair blood flow and increase the risk of cardiovascular disease.

How does atherosclerosis affect the body?

• Narrowing of blood vessels: Atherosclerosis begins with damage to the inner layer of blood vessels, which can be related to factors such as high cholesterol, high blood pressure, smoking and diabetes. Over time, fatty deposits accumulate on these lesions, creating plaques that narrow the blood vessels. This restricts blood flow, which can lead to various complications.
• Effects on the heart:

  • Coronary heart disease (CHD): if the coronary arteries are affected, it can cause angina (chest pain) or a heart attack, when blood flow to the heart is significantly reduced.
  • Heart failure: reduced blood supply can cause the heart to weaken and fail, when the heart is unable to pump blood effectively.
• Effects on the brain:

  • Stroke: if the arteries in the brain are narrowed or blocked, it can cause a stroke, which can cause severe brain damage and even death.
  • Transient ischemic attacks (TIAs): these temporary episodes of interruption of blood flow can serve as a warning of a possible stroke.
• Organ damage: atherosclerosis can also negatively affect other organs, causing serious health problems.
• Kidney function:

  • Renal artery disease: reduced blood flow to the kidneys can lead to kidney failure and increased blood pressure, which in turn can lead to further health problems.
• Foot and limb health:

  • Peripheral artery disease (PAD): narrowed arteries in the legs can cause pain, cramps, or even ulcers that don't heal well. In severe cases, amputation may be necessary.

Formation of blood clots

The development of atherosclerosis can lead to blood clots, when plaques rupture and blood clots form to protect damaged blood vessels. These clots can completely block blood flow, causing:

• Heart attacks: when blood flow to the heart muscle is interrupted, the heart muscle does not receive enough oxygen, which can cause heart tissue damage or death.
• Stroke: when blood flow to the brain is interrupted, brain tissue is deprived of oxygen, which can cause serious damage or death.

Chronic diseases and their complications

Atherosclerosis is closely related to chronic diseases such as diabetes and hypertension. These diseases not only increase the risk of developing atherosclerosis, but can also accelerate its progression, creating a vicious circle in which each disease worsens the condition of the other.

Diabetes

People with diabetes, especially type 2 diabetes, have a significantly increased risk of developing atherosclerosis. Elevated blood glucose levels can damage the endothelial cells (inner layer) of blood vessels, making blood vessels more susceptible to plaque formation.

• Endothelial dysfunction: chronically high sugar levels damage the endothelium, reducing its ability to regulate blood vessel tone and prevent blood clots.
• Promotion of inflammatory processes: diabetes increases the level of inflammatory markers in the body, which contribute to the formation and instability of atherosclerotic plaques.
• Dyslipidemia: diabetic patients often have elevated levels of LDL ("bad") cholesterol and triglycerides, as well as decreased levels of HDL ("good") cholesterol, which contribute to plaque formation.

Hypertension

High blood pressure puts extra pressure on the blood vessel walls, causing mechanical damage to the endothelium. These damages make blood vessels more susceptible to the accumulation of cholesterol and other atherogenic substances.

• Endothelial damage:  increased pressure can create microcracks in the walls of blood vessels, facilitating the formation of atherosclerotic plaques.
• Thickening of blood vessel walls: hypertension can cause hypertrophy of the vascular muscle layer, reducing the lumen and restricting blood flow.
• Oxidative stress: high blood pressure promotes the production of free radicals, which can damage cells and increase inflammation.

The vicious circle between diabetes and hypertension

Diabetes and hypertension often occur together, and they can intensify each other's negative effects on blood vessels.

• Insulin resistance and hypertension: the insulin resistance characteristic of type 2 diabetes may contribute to the development of hypertension because insulin affects vascular tone and kidney function.
• Kidney damage: both diabetes and hypertension can damage the kidneys, which in turn can raise blood pressure and impair blood sugar control.
• Metabolic syndrome: the combination of obesity, hypertension, high sugar and cholesterol levels further increase the risk of atherosclerosis.

Effect on the progression of atherosclerosis

• Accelerated plaque formation: diabetes and hypertension promote faster and more aggressive plaque formation in blood vessels.
• Slab Instability: these diseases can make atherosclerotic plaques more unstable and susceptible to rupture, which increases the risk of heart attack or stroke.
• Damage to a small artery: diabetes particularly affects small vessels leading to microvascular complications such as diabetic retinopathy and nephropathy.

The importance of prevention

• Glucose level control: effective blood sugar regulation can reduce blood vessel damage.
• Blood pressure control: treating and maintaining hypertension within a normal range reduces the risk of endothelial damage.
• Lifestyle changes: a healthy diet, exercise and smoking cessation are essential steps to reduce risk.

Causes of atherosclerosis

The development of atherosclerosis is a complex process influenced by several factors.

Accumulation of cholesterol:

• Low-density lipoproteins (LDL): known as "bad" cholesterol, they contribute to the formation of plaque in the arteries.
• High-density lipoproteins (HDL): "good" cholesterol helps remove LDL from the blood.

Damage to blood vessel walls:

• High blood pressure: damages blood vessel walls, making them more susceptible to plaque formation.
• Smoking: nicotine and other chemical compounds damage the endothelium of blood vessels.
• Diabetes: high blood sugar levels damage blood vessel walls.

Inflammatory processes:

• Chronic inflammation in the body can contribute to the development of atherosclerosis. Inflammation can occur for a variety of reasons, such as infections, autoimmune diseases, or even chronic stress.

Risk factors:

• Certain factors increase the likelihood of developing atherosclerosis.

Age and gender:

• Age: Arteries can naturally become stiffer with age.
• Gender: men often develop atherosclerosis earlier than women. After menopause, women's risk increases.

Genetic predisposition:

• Family history: if there is a family history of heart disease, the risk is higher.
• Genetic mutations: some genetic changes can affect cholesterol metabolism.

Lifestyle factors:

• Smoking: damages blood vessels and increases LDL levels.
• Unhealthy diet: a diet rich in saturated fat and trans fat increases the level of "bad" cholesterol.
• A sedentary lifestyle: lack of physical activity reduces the level of "good" cholesterol.
• Obesity: abdominal obesity in particular increases the risk.
• Alcohol abuse: can increase blood pressure and LDL levels.

Chronic diseases:

• Hypertension: damage blood vessel walls.
• Diabetes: raises LDL and lowers HDL.
• Hyperlipidemia: increased levels of fat and cholesterol in the blood.

Symptoms that cannot be ignored

Atherosclerosis often develops without obvious symptoms until serious problems arise. However, there are some signs to look out for.

Chest pain (angina):

• Chest pain or pressure: usually occurs with physical exertion or stress.
• Pain can radiate from: on the neck, shoulders, arms or back.

Shortness of breath:

• During physical activity: difficulty in breathing may indicate a narrowing of the heart's blood vessels.
• At rest: in more severe cases, shortness of breath may also appear while resting.

Fatigue and weakness:

• Constant fatigue: organs do not receive enough oxygen.
• Reduced physical endurance: you get tired quickly doing daily activities.

Leg pain and cramps:

• Peripheral artery disease: Atherosclerosis in the arteries of the legs can cause pain when walking.
• Cold legs or feet: due to reduced blood flow.

Neurological symptoms:

• Dizziness and confusion: may indicate reduced blood flow to the brain.
• Transient ischemic attacks: temporary stroke symptoms such as slurred speech or weakness on one side of the body.

How is atherosclerosis diagnosed?

Medical history and physical examination:

• Medical history: the doctor will ask about symptoms, lifestyle and family history.
• Physical examination: will listen to the heartbeat, check the pulse and blood pressure.

Laboratory tests:

• Blood tests: for determination of cholesterol, triglycerides and sugar levels.
• C-reactive protein (CRP): an inflammatory marker that may be elevated.

Imaging methods:

• Ultrasound: evaluates blood flow and the presence of plaques in the arteries.
• Angiography: uses contrast material and X-rays to see the inside of blood vessels.
• Coronary calcium scan: evaluates calcium deposits in the arteries of the heart.
• Magnetic resonance angiography (MRA): will provide detailed images of blood vessels without radiation.

Functional tests:

• Stress test: assesses heart function during exercise.
• Electrocardiogram (ECG): records the electrical activity of the heart.

Complications of atherosclerosis

If left untreated, atherosclerosis can lead to serious health problems.

Coronary heart disease:

• Heart attack (myocardial infarction): complete blockage of blood flow in the heart artery.
• Heart rhythm disorders: irregular heartbeat can occur due to damage to heart tissue.
• Heart failure: the heart cannot pump blood efficiently.

Stroke:

• Ischemic stroke: A blood clot blocks blood flow to the brain.
• Hemorrhagic stroke: rupture of blood vessels in the brain, often due to high blood pressure.

Peripheral artery disease:

• Narrowing of the blood vessels of the legs and arms: causes pain, cramps and even tissue damage.
• Gangrene: severe cases may require amputation.

Aneurysm:

• Dilation of the blood vessel wall: can occur in the aorta or other large vessels.
• Risk of rupture: A ruptured aneurysm is a life-threatening condition.

Treatment options

Atherosclerosis treatment is aimed at stopping the progression of the disease, reducing symptoms and preventing complications.

Lifestyle changes

Nutrition:

• Reduce consumption of saturated and trans fats: they increase the level of "bad" cholesterol.
• Increase your fiber intake: helps reduce cholesterol levels.
• Limit your salt intake: lowers blood pressure.
• Choose healthy fats: monounsaturated and polyunsaturated fats, such as olive oil and fish oil.

Physical activities:

• Regular exercise: at least 150 minutes of moderate activity per week.
• Aerobic exercises: walking, running, swimming, cycling.

Quitting bad habits:

• Smoking cessation: significantly reduces the risk of complications.
• Limiting alcohol consumption: moderation is key.

Surgical and invasive procedures

Angioplasty and stenting:

• Procedure: narrowed arteries are dilated with a balloon and secured with a stent.
• Purpose: restore blood flow to the affected artery.

Coronary bypass surgery:

• Procedure: creates a bypass around the blocked part of the artery using healthy blood vessels from other parts of the body.
• Purpose: improve blood flow to the heart.

Endarterectomy:

• Procedure: surgical removal of plaques from the artery wall.
• Usually carried out: in the carotid arteries to prevent stroke.

Thrombolytic therapy:

• Purpose: dissolve blood clots that block blood flow.
• Suitable for: in emergencies such as an acute heart attack or stroke.

How to prevent atherosclerosis?

Regular medical check-ups:

• Cholesterol level: get checked regularly, especially after age 40.
• Blood pressure: should be checked at least once a year.
• Blood sugar levels: for early detection of diabetes.

Healthy lifestyle:

• Balanced diet: rich in fruits, vegetables, whole grains and lean proteins.
• Physical activities: regular and appropriate for your age and health.
• Weight management: maintain a healthy body weight.

Stress controls:

• Relaxation techniques: meditation, yoga, breathing exercises.
• Time management: to avoid overwork and burnout.
• Social support: talking to friends and family can help reduce stress.

Education:

• Knowledge of the disease: the more you know, the better you can take care of yourself.
• Be aware of the symptoms: early recognition of the signs can prevent complications.

Conclusion

Atherosclerosis is a serious disease that can affect anyone. But the good news is that much can be done to prevent or control it. A healthy lifestyle, regular medical check-ups and awareness are the keys to cardiovascular health.

Remember that small changes every day can make a big difference. Start with small steps, such as choosing fruits and vegetables over unhealthy snacks, going for a walk, quitting smoking, or limiting alcohol. Your heart and blood vessels will thank you.

Additional resources

• Latvian Society of Cardiology: www.kardiologs.lv – Information on cardiovascular diseases and specialist contacts.
• Ministry of Health: official recommendations and programs to promote heart health.
• Latvian Diabetes Association: information about diabetes and its relationship to heart disease.