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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 is the underlying cause of the majority of cardiovascular events (Roger, Heron). It is the leading cause of morbidity and mortality worldwide in most industrialized countries.
Incidence and Prevalence: Thirty-seven percent of men and 35% of women were living with cardiovascular disease in 2008. Over 800,000 people in the US died that year of cardiovascular disease (CVD), 52% were women. Men aged 35 - 75 are more likely to have a heart attack or fatal coronary heart disease, but after age 75 women outpace men in fatal events. At any age, women are more likely to die of their condition and less aware of their risk compared to their male counterparts (Roger). The use of hormone replacement therapy to reduce the risk of heart disease is controversial and complex. Initiating HRT at or shortly after the onset of menopause may reduce the risk of atherosclerosis over time in some women (Villablanca). |
Source: Medical Disability Advisor
| Conventional risk factors for atherosclerosis are well known and include increased plasma cholesterol, cigarette smoking, hypertension, diabetes, obesity, age, sedentary lifestyle, and heredity (Yusuf). |
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 area of tissue 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 can be 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 blood lipids.
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, treating high blood pressure, controlling diabetes mellitus, participating in exercise, attaining an optimal weight, and lowering plasma lipids are key. Intensive treatment and lifestyle changes 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; however saturated fat intake is more important in determining lipid levels, since humans convert saturated fat to cholesterol. 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 cholesterol (“bad” cholesterol) level above 130 mg/dL. Many individuals with atherosclerosis also have a low HDL cholesterol (“good” cholesterol) level. HDL cholesterol may be increased with exercise and small amounts of alcohol, although niacin may also be administered.
A small dose of aspirin (one-half adult aspirin or less daily; e.g. 81mg) 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), or displaced or "crushed" into the wall of the artery with a balloon-tip catheter (angioplasty), with or without stent placement, 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 is no specific rehabilitation for atherosclerosis. There may be a rehab program for those with complications (such as heart attack, stroke or leg amputation). |
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 or ultimate loss of the kidney, decreased blood flow to the legs with leg pain when walking (claudication) or ultimate leg amputation, decrease blood flow to the intestines (mesenteric ischemia), 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. Risk: Risk Factors for atherosclerosis are both conventional and unconventional factors. For more information, refer to "Disease and Injury Causation," pages 238-239.
Risk from an occupation would be reflected at the underlying arteriosclerosis or atherosclerosis end organ effect (e.g. heart disease, renal failure). For example, there is some data about increased urinary levels of certain elements in patients with Peripheral Arterial Disease. Occupations with high level of these elemental exposures should be avoided in patients with Peripheral Vascular Disease (Qaseem). Capacity: Capacity will be determined by the underlying affected end organ disease. Tolerance: Tolerance will be determined by psychosocial factors that surround the underlying illness. |
Source: Medical Disability Advisor
| In the absence of complicated disease requiring surgical intervention, treatment should place the individual at MMI within 30 to 90 days. |
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:
- How was atherosclerosis diagnosed? Was there a serious event (i.e. heart attack, stroke, abdominal aneurysm rupture) that lead to the diagnosis and that is the current cause of disability? That event, or the surgery to treat it, is what is controlling the disability, and that section of the guidelines should be used.
Regarding treatment:
- Has individual addressed correctable risk factors such 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 these lifestyle and risk factor changes for 6 to 18 months?
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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 other conditions that may affect ability to recover?
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Source: Medical Disability Advisor
| CitedBoudi, F Brian , and Chowdhury H. Ahsan. "Coronary Artery Atherosclerosis." eMedicine. Ed. Yasmine Subhi Ali. 30 Nov. 2012. Medscape. 7 Jan. 2012 <http://emedicine.medscape.com/article/153647-overview>.Heron, M. "Deaths: Leading causes for 2008." National Vital Statistics Reports 60 (6) (2008): 1-94. Melhorn, J. Mark, and William Ackerman, eds. Disease and Injury Causation, Guides to the Evaluation of. AMA Press, 2008. Qaseem, A. "Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians." Annals of Internal Medicine 146 (2007): 454-458. Roger, V. L. , et al. "Executive summary: heart disease and stroke statistics--2012 update: a report from the American Heart Association." Circulation 125 (1) (2012): 188-197. Villablanca, A. C. "Atherosclerosis and sex hormones: current concepts." Clinical Evidence 119 12 (2010): 493-513. Yusuf, S. , et al. "Atherosclerosis and sex hormones: current concepts." Circulation 104 (22) (2001): 2746-2753. |
Source: Medical Disability Advisor
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