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Arteriosclerosis is an abnormal condition associated with thickening and loss of elasticity in the walls of arteries. It is a generic term and also widely referred to as hardening of the arteries. Atherosclerosis is a type of arteriosclerosis associated with fatty (lipid) deposition in the walls of arteries. The fatty deposition is uncharacteristic of other forms of arteriosclerosis such as arteriolosclerosis seen with high blood pressure (hypertension) and the rare Monckeberg's sclerosis. Atherosclerosis is the most prevalent and most important of the several types of arteriosclerosis.
Atherosclerosis affects arteries throughout the body (i.e., arteries in the heart, brain, kidneys, and extremities). It causes more deaths in the US than the second and third leading causes of death (cancer and accidents) combined. It is the leading cause of morbidity and mortality worldwide in most other industrialized countries.
Risk: Risk factors for atherosclerosis are well known and include increased plasma cholesterol, cigarette smoking, hypertension, diabetes, obesity, age, sedentary lifestyle, male sex, and heredity. Incidence and Prevalence: Atherosclerosis is 4 to 5 times more prevalent in men than in women, although heart disease from atherosclerosis is the leading cause of death in women as well as men. Through menopause, women are protected because of female hormones. After menopause, however, the number of heart attacks and strokes increases in women who are not undergoing estrogen replacement therapy, although there is a 10- to 15-year lag time until these occur. |
Source: Medical Disability Advisor
History: Individuals with atherosclerosis may have symptoms associated with reduced arterial blood flow and oxygen delivery to one or more organs (ischemia). If ischemia is prolonged, it may result in death (necrosis) of cells. When an entire organ is affected, cell death is commonly known as infarction. Ischemia may be an acute or chronic condition, whereas infarction is only acute. Physical exam: There are many signs and symptoms of atherosclerosis. Physical exam may reveal a whistling sound (bruit) heard with a stethoscope placed directly over a narrowed but not completely closed artery. A diminished pulse may be felt in an artery beyond a narrowed segment of the vessel.
Examination of the small blood vessels (arterioles) in the retina of the eye with an ophthalmoscope is valuable for diagnosis. Atherosclerotic arterioles reflect light (emitted by the ophthalmoscope), giving them a "silver wire" appearance. Tests: Tests done on individuals with suspected or known atherosclerosis include measurement of the total blood cholesterol and the ratio of high-density lipoproteins (HDL) to low-density lipoproteins (LDL).
Plain x-rays may show calcium deposits in the walls of affected blood vessels that correspond to a diagnosis of atherosclerosis. X-rays with contrast material (angiography) allow visualization of the interior of arteries and permit both a definitive diagnosis of the disease and an assessment of its severity.
Doppler ultrasound, CT, and MRI are other (noninvasive) methods used to diagnose and assess the extent of atherosclerosis. |
Source: Medical Disability Advisor
Fundamental to the treatment of atherosclerosis and its consequences is risk factor modification. Cessation of cigarette smoking, lowering (high) blood pressure, controlling diabetes mellitus, exercise, attaining an optimal weight, and lowering plasma cholesterol to a normal level (generally less than 200 mg/dL) are lifestyle changes that can retard or reverse the progression of atherosclerosis. Six to 18 months of such lifestyle changes are necessary to assess whether or not the risk factor modification program is effective.
The three major sources of dietary cholesterol are egg yolks, animal fat, and red meats. In addition to reduction of dietary cholesterol intake, a cholesterol and LDL lowering drug belonging to a class of drugs known as statins is often prescribed if an individual has a total cholesterol above 200 mg/dL and an LDL (bad cholesterol) level above 130 mg/dL. Many individuals with atherosclerosis also have a low HDL (good cholesterol) level. HDL cholesterol may be increased with exercise and small amounts of alcohol, although niacin may also be administered.
In addition to the above therapeutic measures, postmenopausal women often receive oral estrogen replacement therapy in order to reduce the risk of atherosclerosis.
A small dose of aspirin (one-half adult aspirin or less daily) may also be given to individuals with atherosclerosis. The American Heart Association recommends that men 40 and over with two or more risk factors for atherosclerosis should take a low dose of aspirin daily.
Among individuals with atherosclerosis with localized obstructions that are potentially or actually causing ischemia, the obstruction may be removed surgically (endarterectomy), bypassed with another blood vessel (bypass surgery), displaced or "crushed" into the wall of the artery (angioplasty), vaporized with laser, drilled with a sharp rotating knife (atherosclerosis), or widened with a stent which serves as a brace to keep the artery open after it has been widened. |
Source: Medical Disability Advisor
| Atherosclerosis is a progressive disease. It is frequently associated with and complicated by one or more of the clinical problems from ischemia or infarction. It carries a high morbidity and mortality with coronary heart disease being the most frequent cause. However, some individuals may have regression of atherosclerosis related to lipid lowering associated with dietary changes or pharmacologic therapy. Several studies have shown that morbidity, progression, and mortality can be slowed through use of lipid lowering drugs for as little as 18 months of therapy. |
Source: Medical Disability Advisor
| There are a number of possible complications of atherosclerosis due primarily to ischemia or infarction of one or more organs nourished by atherosclerotic arteries. These complications include stroke, heart attack (myocardial infarction), narrowing (stenosis) of a kidney (renal) artery causing hypertension, decreased blood flow to the legs with leg pain when walking (claudication), and ballooning of an artery (aneurysm) especially of the abdominal aorta. |
Source: Medical Disability Advisor
| Work restrictions are not necessary for atherosclerosis itself but are often required for one of its complications. In addition, restrictions and accommodations may be needed for varying periods of time following a procedure to treat an atherosclerotic obstruction. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have increased plasma cholesterol?
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Is individual a smoker?
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Does individual have elevated blood pressure?
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Does individual have diabetes or obesity?
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How old is individual? Sex?
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What is family history for similar diseases?
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Were there symptoms of ischemia? Resulting in an infarction?
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On exam, was a bruit detected? Were any diminished pulses detected?
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Were there any changes in the retina of the eye?
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Was blood tested for cholesterol? Were both HDL and LDL testing done?
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Were plain x-rays taken? Angiography? Doppler ultrasound, CT, or MRI?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Has individual addressed correctable risk factors suck as cessation of cigarette smoking, lowering high blood pressure, controlling diabetes, attaining an optimal weight, lowering plasma cholesterol, and a regular exercise program?
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Has individual made the lifestyle changes for 6 to 18 months?
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Is individual on medication to lower cholesterol and LDL?
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If individual is postmenopausal, is she taking estrogen replacement?
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Is individual taking a small dose of aspirin daily?
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Has individual required any surgical procedures to keep any arteries open?
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Has individual had any other procedures to keep the arteries open?
Regarding prognosis:
- Does individual have any conditions that may affect ability to recover?
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Has individual had any complications such as a myocardial infarction?
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Are there complaints of transient ischemic attacks or any problems with movement, sight, or body weakness that may suggest a stroke?
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Does individual have intermittent claudication?
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Is individual's blood pressure normal or elevated?
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Source: Medical Disability Advisor
| CitedBoudi, F. Brian, and Chowdhury H. Ahsan. "Atherosclerosis." eMedicine. Eds. Alan D. Forker, et al. 4 Aug. 2009. Medscape. 2 Oct. 2009 <http://emedicine.medscape.com/article/150916-overview>.Singh, Vibhuti, Prakash C. Deedwania, and Rakesh K. Sharma. "Coronary Artery Atherosclerosis." eMedicine. Eds. George A. Stouffer, et al. 12 Aug. 2009. Medscape. 2 Oct. 2009 <http://emedicine.medscape.com/article/153647-overview>. |
Source: Medical Disability Advisor
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