Atherosclerosis is a common foe, but it can be bested

Impotence, gangrene, dementia. These aren’t the most common results of the disease atherosclerosis, also known as hardened arteries, but they are possible effects. The more common complications are the more deadly: stroke and heart attack.

Hardened arteries is a bit of a misnomer: the smooth muscle cells that make up the vessels of our circulatory (vascular) system don’t themselves harden, but they do become encrusted, like poorly tended pipes in a house.

Fatty residue and calcium plaques build up inside artery walls, and as it gets worse, it can make your arteries so rigid and thick that blood can’t flow through them easily -- or at all.

When bits of this residue break off and travel through the bloodstream, they can enter the heart, brain, and other critical organs, sometimes with catastrophic results.

Untreated atherosclerosis can lead to vascular disease, the dangerous condition that is the driving force in many strokes, the number-one cause of heart attacks, and (as peripheral artery disease) the culprit behind a range of maladies including impotence and gangrene.

In short, atherosclerosis is the leading underlying cause of death in the United States.

Larry Goldstein, MDDuke neurologist Larry Goldstein, MD, adds that the conditions that create atherosclerosis can advance other illnesses, as well. “New research shows that blood vessel disease is the second major cause of dementia after Alzheimer’s disease,” he says, “and many people have both conditions. Risk factors for stroke and heart disease may also be risk factors for Alzheimer’s disease.”

Risk Reductions

Atherosclerosis is very rarely isolated to just one part of the body, says Duke vascular surgeon Jeffrey H. Lawson, MD, PhD.

“Plaque tends to be deposited throughout the vascular system in a process that takes many years, so symptoms in one area of the body -- the legs, heart, or kidneys, for example -- are usually a marker that other systems are at risk.”

Jeffrey H. Lawson, MD, PhDMost people with atherosclerosis don’t know they have it, so people with risk factors should be screened by a physician. Those factors include all the usual suspects: high cholesterol or triglyceride levels, smoking and secondhand smoke exposure, excess weight, advancing age, sedentary lifestyle, diabetes or insulin resistance, and high blood pressure.

And because there is evidence that atherosclerosis has a strong genetic component, a family history of the condition or of early-onset heart disease can also up your odds.

Different families have different patterns of disease, Lawson says, but in general, if a close relative suffers from atherosclerosis, there’s a good chance that you will develop it, as well.

As they say, you can’t pick your family -- and therefore your genetic risk for atherosclerosis -- but you can reduce or eliminate some of the other risk factors by making healthful lifestyle choices in terms of diet and exercise.

And because cigarette smoke exposure narrows and damages arteries, kicking the habit is particularly important. Research shows that cigarette smoke can significantly speed up the progression of atherosclerosis.

For patients diagnosed with atherosclerosis, the first order of business is lifestyle modification to reduce the risk of life-threatening complications. Other treatment options include cholesterol-lowering drugs such as statins or drugs that reduce the risk of blood clots.

Patients with advanced vascular disease may need surgical procedures that can help clean up or bypass major arteries or veins that have become dangerously narrowed or blocked.

The best way to determine your risk for atherosclerosis is through regular visits with your primary care physician, says Lawson. He or she can diagnose the condition on an outpatient basis using one or more non-invasive techniques -- and make recommendations to head off related medical conditions before they occur.

“Identifying those at risk and making appropriate interventions early on can have a profound impact on the disease process later on,” Lawson says.

Keeping the Flow Going

Because atherosclerosis is a systemic disease, vascular specialists look at patients as a whole package, Lawson says. Research at Duke is broadening the spectrum of treatment strategies to choose from; recent updates include:

Genomic analysis

Like many diseases, atherosclerosis varies from patient to patient. A first-in-man study, led by Lawson, examined and characterized genes that are activated in diseased arteries. The goal of such research is to tailor treatment to the genetic type of atherosclerosis in each patient.

Biotherapy

A handful of studies are looking at therapies that involve injecting stem cells into muscle tissue to promote the growth of new blood vessels (angiogenesis) around diseased arteries in patients who aren’t candidates for traditional surgeries.

New drugs

Duke investigators are working with an international team to study new drugs that may prevent blood clots -- a common problem in people with atheroslerosis -- as well as drugs to lower cholesterol and control blood sugar in these patients.

New tools

Lawson says that miniaturized intravascular devices are part of a rapidly growing field of technologies for treating vascular disease. Used to reach blood vessels that couldn’t be reached even five years ago, many of these devices are less invasive than traditional surgical treatments.

New understanding

Duke researchers are investigating possible genetic causes of brain vascular disease that can lead to dementia. The results may provide clues leading to new treatments to reduce not only stroke, but also vascular dementia.