Atherosclerosis is a leading cause of cardiovascular complications worldwide, often leading to ischemic heart disease and stroke, peripheral artery disease and myocardial infarction. Atherosclerosis is a systemic disease affecting the cardiovascular system. It is characterized by formation of plaques in the arterial wall containing retained lipids, inflammatory cells, apoptotic cells and increased extracellular matrix (ECM) protein formation. Over time, the plaque hardens which narrows the arteries and restricts blood flow. The biological composition of the plaque determines the risk of plaque rupture. Acute plaque rupture can cause local thrombosis which leads to partial- or total occlusion of the affected artery. If this happens in one of the two major arteries supplying blood to the heart, the result is often a heart attack. Conversely, when plaque rupture happens in the arteries leading to the brain it can cause a stroke. Atherosclerosis in the coronary artery leads to coronary artery/heart disease (CAD/CHD), which is one of the most common cardiovascular diseases caused by limited blood supply to the heart.
How many suffer from atherosclerosis?
Atherosclerosis is a very common and asymptomatic condition: it is therefore difficult to accurately determine incidence. However, as mentioned above, atherosclerosis can lead to major cardiovascular events. In the Western world, more than 370.000 people die every year from CAD/CHD, and approximately 800.000 people suffer from stroke annually, resulting in more than 140.000 deaths. Additionally, 735.000 Americans have a heart attack, and it is estimated that 75% of myocardial infarctions happens due to plaque rupture. Atherosclerosis therefore constitutes a major health concern.
How is atherosclerosis diagnosed?
Atherosclerosis is commonly assessed by computed tomography angiography. Cardiac magnetic resonance imaging is also frequently being implemented in diagnosis and risk assessment of plaque rupture. Atherosclerosis can also be assessed invasively by angiography but is not recommended as a screening tool. Blood-based biomarkers are also implemented in diagnosis, such as C-reactive protein (CRP), lipids and lipoproteins.
How is atherosclerosis treated?
The best treatment for atherosclerosis is to treat risk factors, especially elevated LDL, blood pressure and diabetes. Exercise and healthy dietary habits are also important to reduce risk. Statins are the main treatment options for lowering LDL levels. To control blood pressure multiple drug classes are implemented, most commonly including angiotensin-converting enzyme (ACEs) inhibitors and angiotensin II receptor blockers (ARBs). Clinical treatment of atherosclerosis includes bypass surgery and insertion of stents.
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