Arteriosclerosis

Arteriosclerosis is a chronic disorder of the arteries. It is also known as vascular calcification or arterial calcification as certain blood vessels, the arteries, become hardened and lose their elasticity (“calcified”).

Arteriosclerosis occurs when the cholesterol contained in the blood is deposited on blood vessel walls, causing inflammation.  
 
When immune cells are involved, this build-up of cholesterol and blood component deposits is known as atherosclerosis. The build-up of deposits in arterial walls is known as arteriosclerosis.

Arteriosclerosis progresses slowly and has no noticeable symptoms for several years. It can cause health problems with age.

People with arteriosclerosis are at high risk of cardiovascular diseases, such as a heart attack or stroke. 

At first, arteriosclerosis does not usually have any symptoms. Over time, however, it can cause cardiovascular diseases.

The way in which arteriosclerosis manifests itself depends on the blood vessels in which the deposits have formed and the organs or areas of the body to which the blood flow is restricted as a result. 

What secondary diseases are possible and what are their symptoms?

If the heart’s blood vessels are affected, this can cause for example heart failure, i.e. the heart does not work as efficiently as it normally does. This sometimes has no or only mild symptoms.

However, it can also significantly impair physical performance. Possible symptoms include fatigue, shortness of breath, chest pain and palpitations. In the event of severe heart failure, even normal everyday activities become difficult, for example climbing a few steps or walking for longer distances.

If the coronary arteries become narrowed due to arteriosclerosis, this results in coronary heart disease (CHD). People then often experience a shortness of breath and chest pain (angina pectoris) when exerting themselves. If a blood clot completely seals such a narrowed blood vessel, this results in a heart attack.

Arteriosclerosis can also cause peripheral artery disease (PAD). This occurs when the blood vessels in the legs become narrowed, resulting in circulatory disorders and pain when walking. In the advanced stage, PAD can result in leg amputation.

Arteriosclerosis can also affect the blood vessels in the kidneys, resulting in high blood pressure, renal insufficiency or kidney failure.  

Certain high cholesterol levels can increase the risk of arteriosclerosis.

What is HDL cholesterol?

HDL stands for high-density lipoprotein and refers to a high-density combination of lipids and proteins. HDL transports cholesterol from the tissues and the blood back to the liver. It protects the blood vessels by keeping the amount of free cholesterol in them low.

High HDL cholesterol levels are therefore associated with a lower risk of cardiovascular diseases and thus desirable. Very high HDL levels, on the other hand, are not good as they are suspected of increasing the risk of cardiovascular diseases.

What is LDL cholesterol?

LDL stands for low-density lipoprotein and refers to a low-density combination of lipids and proteins. High LDL levels in the blood are associated with an increased risk of cardiovascular diseases.

The understanding of why high LDL cholesterol affects the risk of cardiovascular diseases has changed in recent years.

Previously, experts believed that too much cholesterol was deposited on blood vessel walls. Today, they know that this is not quite true. Instead, cholesterol promotes the undesired development of inflammation sites in the blood vessel walls. In people with high LDL cholesterol, such inflammation sites are more common, larger and can “calcify”.

A high LDL cholesterol level and a low HDL cholesterol level are regarded as risk factors for the development of arteriosclerosis and thus cardiovascular diseases.

These blood values can help assess a person’s risk. However, they are not the only factors in determining the risk of a person developing a cardiovascular disease.

There are many other factors that can have a negative impact, for example:

• high blood pressure 
• diabetes
• smoking  
• family history 
• obesity (severe overweight) 
• high inflammatory markers 
• lack of exercise 

The development of arteriosclerosis and the resultant cardiovascular diseases can be prevented through a healthy lifestyle.

The most important measures include: 

• healthy eating 
• regular exercise or sport  
• not smoking 

More information on how to promote a healthy heart can be found at gesundheitsinformation.de. 

Statutory health insurance holders aged 35 and over are entitled to a health check-up by their doctor every three years. People between the ages of 18 and 34 can have the check-up once.

This check-up aims to identify early indications of common conditions such as diabetes, kidney disease and cardiovascular diseases.

The check-up includes a blood test, which checks various things including the total cholesterol level.  

A high cholesterol level is associated with an increased risk of arteriosclerosis and can indicate an existing case of this.

However, arteriosclerosis cannot be definitively diagnosed on the basis of cholesterol levels. These can only provide an initial indication.

To obtain a definitive diagnosis, doctors also check blood values such as the blood sugar and use imaging techniques, such as ultrasound, computed tomography (CT) and magnetic resonance tomography (MRT).

Testing the cholesterol levels

Three types of cholesterol levels are determined: 

• LDL cholesterol 
• HDL cholesterol 
• Total cholesterol: This indicates how much cholesterol someone has in their blood overall. High total cholesterol levels tend to be unfavorable.  

Evaluating the cholesterol levels

When cholesterol levels are regarded as “too high” depends on a person’s overall risk of developing a cardiovascular disease in a given period of time.

This risk is determined on the basis of a special point system (score). The higher the score, the sooner the cholesterol values are regarded as “too high”.

People are often said to have high cholesterol (hypercholesterolemia) if the total cholesterol level or LDL cholesterol level exceeds the value defined as good. HDL cholesterol levels below this threshold are also considered to be unfavorable.

Cholesterol levels can be specified using two different units: in milligrams per deciliter (mg/dL) or in millimoles per liter (mmol/L).  

The following levels are considered to be “good” in healthy people:   

• Total cholesterol: levels below 200 mg/dL (5.2 mmol/L)  
• LDL cholesterol: levels below 100 mg/dL (2.6 mmol/L)  
• HDL cholesterol: levels over 40 mg/dL (1 mmol/L) for men and over 50 mg/dL (1.3 mmol/L) for women  

Some experts criticize these thresholds as they result in many people being classed as “ill”. Based on these levels, according to a study by the Robert Koch Institute, over half of all Germans had high cholesterol in 2010.

However, a high cholesterol level does not necessarily impair the health of the heart and circulatory system as other factors also play a role. 

At present, there is no cure for arteriosclerosis and the condition cannot be reversed. However, its development can be prevented and its progression can be slowed.  

The aim of treatment is to reduce the elevated risk of cardiovascular diseases to as normal a level as possible. In addition to the consistent treatment of underlying conditions such as diabetes and high blood pressure, various therapeutic measures are possible.

Lifestyle measures 

These include: 

• not smoking  
• eating healthily, especially consuming few saturated (animal) fats  
• getting plenty of exercise  
• losing excess weight 

Medication 

If the cholesterol levels cannot be sufficiently lowered through dietary changes and exercise, medication can be used.

For people who have never had a heart attack, stroke or other cardiovascular disease, there is only one group of drugs that has been thoroughly tested for this purpose: statins.

Surgery

If arteriosclerosis is already advanced and there is a risk of complications such as a heart attack, cardiac catheterization or heart surgery is usually required.

Depending on which blood vessels have become narrowed and the severity of the symptoms, various procedures are possible:

• Narrowed blood vessels can be expanded through the use of a catheter with a balloon on the tip and subsequently stabilized with a wire mesh tube (stent) if necessary.  
• Another option is bypass surgery, which uses one of the body’s own blood vessels or an artificial tube to bypass the critical blockage point. This ensures adequate blood flow. 

Arteriosclerosis and its consequences, such as coronary heart disease, are chronic (i.e. life-long) disorders.

However, this does not mean they have to take over people’s lives. People with a good understanding of their condition can help tailor their treatment accordingly and identify potential problems in good time.

People with cardiovascular problems sometimes feel like they have to instantly change everything about their life. In most cases though, this is unrealistic. It is better to make changes slowly.

People with arteriosclerosis do not have to feel guilty. Personal lifestyle is just one of many factors that can cause the condition.