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atherosclerosis(ath?e-ro?skle-ro'sis ) [ athero- + sclerosis]
The initial pathological changes, called fatty streaks, are visible on the endothelial surfaces of major blood vessels by the age of 10. These lesions may progress to thickening of the lining of arteries (a process called intimal thickening) if risk factors for atherosclerosis are not addressed. Whether these lesions in turn progress to advanced lesions, called fibrous plaques, depends on hemodynamic forces (e.g., hypertension) and abnormal plasma levels of lipoproteins (e.g., high levels of total and LDL cholesterol; low levels of HDL cholesterol). Ultimately, arteries affected by the disease may become nearly completely blocked, a condition that causes ischemia. If a plaque within a blood vessel suddenly ruptures, the blood vessel may close and organs or tissues may infarct.See: myocardial infarction; peripheral vascular disease; stroke
Risk factors for atherosclerosis include use of tobacco, diabetes mellitus, elevated blood lipid concentrations, hypertension, family history, male gender, menopause, microalbuminuria, chronic kidney disease, age, sedentary lifestyle, and obesity. The role of vascular inflammation due to chronic infections or elevated homocysteine levels are topics of active research.
Symptoms may develop in any organ system with a blood supply diminished by atherosclerosis. These symptoms commonly include angina pectoris, intermittent claudication, strokes, transient ischemic attacks, and renal insufficiency.
Treatment includes regular exercise, stopping smoking, and a dietary regimen of low-cholesterol and low-fat foods. Medical treatment of hypertension, lipid disorders, and diabetes mellitus is also helpful. Angioplasty, atherectomy, or arterial bypass graft operations are beneficial for some patients.
The patient and family are taught about risk factors associated with atherosclerosis, and the health care professionals help the patient modify these factors. Patients who smoke cigarettes are encouraged to enroll in smoking cessation programs. Community-based plans and programs to change sedentary activity patterns, reduce stress, control obesity, and decrease saturated fat intake to control triglyceride and cholesterol levels are explored with the patient. The nurse or other health care professional refers the patient for medical treatment to control hypertension and diabetes mellitus and supports the patient's efforts to cooperate with lifestyle and health care changes. Regular exercise of a type and extent appropriate for the patient's health and adequate rest are prescribed. The patient is informed of the need for long-term follow-up care to prevent a variety of body system complications.