Patients
What is arteriosclerosis?
Arteriosclerosis is a chronic inflammatory disease of our arteries and is one of the most common causes of death worldwide, as it triggers complications such as heart attack, heart failure, stroke and peripheral arterial occlusive disease.
Previously, arteriosclerosis was thought to be simply a process of hardening of the arteries, accompanied by secondary narrowing that could eventually lead to complete blockage. Thanks to intensive research on arteriosclerosis in recent decades, we now know that it is a complex, chronic inflammatory disease of our arteries.
During the course of arteriosclerosis, deposits form, so-called
atherosclerotic plaques, in the artery walls. These plaques contain cholesterol (especially LDL cholesterol and its oxidized form) and other lipids, as well as inflammatory cells. This process begins many years before symptoms appear.
What happens in an artery as atherosclerosis develops?
The first step in atherosclerosis is activation of the inner lining of the blood vessels, called the endothelium. This can be triggered by factors such as high LDL cholesterol levels (sometimes called “bad cholesterol”), high blood pressure, smoking, and diabetes. As a result, LDL cholesterol can enter the artery wall. Inflammatory blood cells are also attracted; they attach to the endothelium and migrate into the vessel wall, where they trigger inflammation. These cholesterol deposits and inflammatory responses lead to plaque formation in the artery wall.
As the plaque grows, the artery wall changes, and the space inside the blood vessel through which blood flows can narrow, reducing blood flow. When this happens in the arteries supplying the heart, it causes the typical symptoms of coronary artery disease, namely angina or chest pain, especially during physical activity, when the body needs more oxygen.
Alternatively, plaques can become fragile and unstable. An unstable lesion may eventually rupture. This triggers the formation of a blood clot that can suddenly block an artery. If this happens in a coronary artery, it causes a heart attack. If it happens in an artery supplying blood to the brain, it can cause a stroke .
How can I reduce my risk?
Many factors influence the development of atherosclerosis. Some cannot be changed, such as age or genetic predisposition, while others can be managed. These include LDL cholesterol, blood pressure, diabetes, smoking, body weight, physical activity, and diet. A healthy lifestyle that includes regular physical activity and a balanced diet, avoiding smoking, and maintaining a healthy body weight can help reduce cardiovascular risk. Medicines may also help control risk factors such as high LDL cholesterol, high blood pressure, or diabetes, if needed. Regular health checkups can help identify and manage cardiovascular risk factors early. It is important to remember that overall cardiovascular risk depends on a combination of factors, not just one risk factor alone.
How is atherosclerosis treated?
Given the important role of LDL cholesterol in the development and progression of atherosclerosis, medicines that lower LDL cholesterol levels – such as statins, ezetimibe, and PCSK9 inhibitors – are the cornerstone of current treatment for reducing the risk of cardiovascular events.
Treatment also includes carefully managing other cardiovascular risk factors, including high blood pressure, diabetes, smoking, excess weight, physical inactivity, and an unhealthy diet. Treatment is tailored to each individual and may include lifestyle changes as well as appropriate medicines.
Why is further research into atherosclerosis important?
Even when LDL cholesterol is lowered very effectively, some people still face a high risk of heart attack and stroke. This is because atherosclerosis is caused not only by LDL cholesterol, but also by inflammation, the body's immune system, and other factors. Since we do not yet fully understand the exact processes that drive the development of atherosclerotic lesions, further research is important. The aim is to develop additional treatment options to further reduce the risk of heart attack and stroke in people who remain at high risk despite optimal control of their LDL cholesterol levels.