Cardiovascular disease

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Arteriosclerosis – the signs , symptoms and treatments

Arteriosclerosis

Arteriosclerosis

Atherosclerosis is a potentially serious condition where arteries become clogged with fatty substances called plaques, or atheroma.

These plaques cause the arteries to harden and narrow, restricting the blood flow and oxygen supply to vital organs, and increasing the risk of blood clots that could potentially block the flow of blood to the heart or brain.

Atherosclerosis doesn’t tend to have any symptoms at first, and many people may be unaware they have it, but it can eventually cause life-threatening problems such as heart attacks and strokes if it gets worse.

However, the condition is largely preventable with a healthy lifestyle, and treatment can help reduce the risk of serious problems occurring.

 

Health risks of atherosclerosis

If left to get worse, atherosclerosis can potentially lead to a number of serious conditions known as cardiovascular disease (CVD). There won’t usually be any symptoms until CVD develops.

Types of CVD include:

coronary heart disease – the main arteries that supply your heart (the coronary arteries) become clogged with plaques

angina – short periods of tight, dull or heavy chest pain caused by coronary heart disease, which may precede a heart attack

heart attacks – where the blood supply to your heart is blocked, causing sudden crushing or indigestion-like chest pain that can radiate to nearby areas, as well as shortness of breath and dizziness

strokes – where the blood supply to your brain is interrupted, causing the face to droop to one side, weakness on one side of the body, and slurred speech

transient ischaemic attacks (TIAs) – where there are temporary symptoms of a stroke

peripheral arterial disease – where the blood supply to your legs is blocked, causing leg pain when walking

Click on the links above for more information about these conditions, including what the main symptoms and risks are.

Who’s at risk of atherosclerosis?

Exactly why and how arteries become clogged is unclear.

It can happen to anyone, although the following things can increase your risk:

increasing age

smoking

an unhealthy, high-fat diet

lack of exercise

being overweight or obese

regularly drinking excessive amounts of alcohol

other conditions, including high blood pressure, high cholesterol and diabetes

a family history of atherosclerosis and CVD

being of south Asian, African or African-Caribbean descent

You can’t do anything about some of these factors, but by tackling things such as an unhealthy diet and a lack of exercise, you can help reduce your risk of atherosclerosis and CVD.

Read more about the risk factors for CVD.

Testing for atherosclerosis

Speak to your GP if you’re worried you may be at a high risk of atherosclerosis.

If you’re between the ages of 40 and 74, you should have an NHS Health Check every five years, which will include tests to find out if you’re at risk of atherosclerosis and CVD.

Your GP or practice nurse can work out your level of risk by taking into account factors such as:

your age, gender and ethnic group

your weight and height

if you smoke or have previously smoked

if you have a family history of CVD

your blood pressure and cholesterol levels

if you have certain long-term conditions

Depending on your result, you may be advised to make lifestyle changes, consider taking medication, or have further tests to check for atherosclerosis and CVD.

Reduce your risk of atherosclerosis

Making healthy lifestyle changes can reduce your risk of developing atherosclerosis and may help stop it getting worse.

The main ways you can reduce your risk are:

stop smoking – you can call the NHS Smokefree helpline for advice on 0300 123 1044 or ask your GP about stop smoking treatments; read more advice about stopping smoking

have a healthy diet – avoid foods that are high in saturated fats, salt or sugar, and aim to eat five portions of fruit and vegetables a day; read more healthy diet advice

exercise regularly – aim for at least 150 minutes of moderate aerobic activity such as cycling or fast walking every week, and strength exercises on at least two days a week

maintain a healthy weight – aim for a body mass index (BMI) of 18.5 to 24.9; use the BMI calculator to work out your BMI and read advice about losing weight

moderate your alcohol consumption – men and women are advised not to regularly drink more than 14 alcohol units a week; get tips on cutting down on alcohol

Click on the links above for more information. You can also read more specific advice about preventing CVD.

Treatments for atherosclerosis

There aren’t currently any treatments that can reverse atherosclerosis, but the healthy lifestyle changes suggested above may help stop it getting worse.

Sometimes additional treatment to reduce the risk of problems like heart attacks and strokes may also be recommended, such as:

statins for high cholesterol – read more about treating high cholesterol

medicines for high blood pressure – read more about treating high blood pressure

medicines to reduce the risk of blood clots – such as low-dose aspirin or clopidogrel

dietary changes and medication for diabetes – read more about treating type 1 diabetes and treating type 2 diabetes

a procedure to widen or bypass an affected artery – such as a coronary angioplasty, a coronary artery bypass graft, or a carotid endarterectomy

Click on the links above for more information about what these treatments involve.

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Regularly skipping breakfast linked to hardening of the arteries

Breakfast and your arteries

Breakfast and your arteries

“Skipping breakfast may be linked to poor heart health,” The Guardian reports. Researchers from Spain found that people who regularly skipped breakfast were more likely to have atherosclerosis – hardening and thickening of the arteries due to a build-up of fatty deposits known as plaques.

Atherosclerosis doesn’t usually cause any noticeable symptoms at first but can eventually lead to life-threatening problems, such as heart attacks and strokes, if it gets worse.

The researchers looked at the breakfast habits and artery health of around 4,000 middle-aged bank workers who were not known to have heart disease. They found those who skipped breakfast were more likely to have plaques than those who ate a breakfast containing at least a fifth of their daily calories – this would be 500kcal or more for a man whose daily intake was the recommended 2,500kcal.

The study is planning to follow up the participants to see what happens to their arteries over time.

This study can’t say for certain whether skipping breakfast was affecting artery health directly, as both were assessed at the same time. However, skipping breakfast did seem to be a habit shared by people who also tended to be unhealthy in other ways, such as being more likely to be a smoker or to have a higher body mass index (BMI).

While skipping breakfast may seem a tempting option if you’re trying to lose weight, it’s counterproductive if you find yourself having unhealthy snacks and overeating during the rest of the day.

 

Where did the story come from?

The study was carried out by researchers from the Centro Nacional de Investigaciones Cardiovasculares Carlos III, Santander Bank, and other hospitals and research centres in Spain and the US. It was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Santander, the Instituto de Salud Carlos III and the European Regional Development Fund.

The study was published in the peer-reviewed Journal of the American College of Cardiology.

The research was covered well by The Guardian, which pointed out limitations and explained that skipping breakfast was not likely to be affecting heart health directly; instead, it was likely to be a marker for other unhealthy behaviours.

The Mail Online suggested that skipping breakfast “triggered the same emergency response in the body as starvation”, but the study itself didn’t assess this. Also, its headline stated that skipping breakfast to lose weight was the problem, but not all of the participants who skipped breakfast did so to lose weight.

The Daily Telegraph took a more cautious approach, explaining there may be a potential link between skipping breakfast and heart attacks but that additional research with long-term follow-up is probably required to confirm or disprove it.

 

What kind of research was this?

People who skip breakfast are thought to be at greater risk of heart disease. However, no studies have so far looked at whether breakfast habits are linked to the early build-up of fatty tissue in the arteries (atherosclerosis) before a person starts to experience symptoms. Atherosclerosis is an early sign of heart disease.

The current study was a cross-sectional analysis looking at whether people who skipped breakfast were more likely than those who ate breakfast to have atherosclerosis that was not yet causing any symptoms of heart disease.

The analysis was part of the ongoing Progression of Early Subclinical Atherosclerosis (PESA) study, which will follow the participants to see whose atherosclerosis progresses. This initial analysis cannot tell us whether breakfast habits directly caused the atherosclerosis seen, as both the people’s habits and their fatty tissue build-up were measured at the same time.

 

What did the research involve?

Researchers recruited 4,082 adults aged 40 to 54 who worked at the headquarters of Santander Bank in Madrid. To be eligible, participants could not have heart or kidney disease, could not be morbidly obese (BMI of 40 or more) and could not have a serious disease that could lead to death in the next six years.

They reported their breakfast habits over 15 days by filling out a detailed computerised questionnaire about what and when they ate and drank, and the researchers looked at their arteries to see if they showed signs of fatty tissue build-up. The results were then analysed to see whether breakfast habits were linked to artery health.

The researchers used the questionnaire information to calculate what percentage of their daily energy intake the participants consumed at breakfast. Anything eaten before 10am was considered to be breakfast, and they were grouped into those who consumed:

more than 20% of their daily energy intake at breakfast (“high-energy breakfast”)

5-20% of their daily energy intake at breakfast (“low-energy breakfast”)

less than 5% of their total energy intake at breakfast (“skipped breakfast”)

The energy level for skipping breakfast was equivalent to just having an orange juice or coffee.

The researchers used ultrasound to assess whether people had fatty build-ups in major arteries in the neck (carotid arteries), the major artery leading from the heart through the abdomen (infrarenal abdominal aorta) and major arteries in the groin (iliofemoral arteries). They also assessed the level of calcium in the walls of the arteries supplying the heart, as this is a sign of fatty deposits.

This identified people who had signs of atherosclerosis either in any of the arteries, in the arteries supplying the heart or in multiple (four or more) sites.

They then looked at whether people with different breakfast habits were more or less likely to have atherosclerosis or other unhealthy outcomes, such as being overweight or having high blood pressure. In their analyses, they accounted for potential confounders such as:

age

education level

physical activity level

smoking status

dietary characteristics (such as whether

they were dieting to lose weight)

What were the basic results?

Only 3% of the participants skipped breakfast. Most (69%) had a low-energy breakfast, and 28% had a high-energy breakfast. Those who skipped breakfast were more likely to:

be male

be smokers

have changed their diet to try to lose weight in the past year

consume most of their calories at lunch

have a more unhealthy diet (higher in calories, animal protein and cholesterol; and lower in fibre and carbohydrates)

Overall, about 63% of participants showed some signs of atherosclerosis, and it was more common among people who skipped breakfast than those who did not.

Once the researchers took into account other factors that could have affected the results, people who skipped breakfast were more likely to have atherosclerosis at multiple sites or in the arteries not feeding the heart.

 

How did the researchers interpret the results?

They concluded that skipping breakfast was associated with an increased likelihood of having fatty tissue build-up in multiple arteries or in arteries not feeding the heart. This increase was found to be independent of other risk factors for heart disease.

 

Conclusion

This study found a link between skipping breakfast and fatty tissue build-up in the arteries – an early sign of heart disease.

However, because it assessed people’s diets and artery health at the same point in time, and fatty deposits build up gradually in arteries, we can’t say their breakfast habits directly influenced their artery health. Also, as breakfast habits were only assessed over 15 days, we can’t be sure they were representative of lifelong patterns.

It looks like people who skip breakfast tend to have other unhealthy habits, such as smoking and eating more. While the researchers did try to account for the impact of these other factors, it’s possible they still affected the results.

But overall, it looks like skipping breakfast tends to be a sign of someone whose habits may put them at risk of heart disease.

In general, while this study can’t prove that eating breakfast will reduce the risk of heart disease, eating a healthy breakfast is in line with current UK guidance from the National Institute for Health and Care Excellence (NICE). The advice is part of its guidance about preventing excessive weight gain.

NICE recommends eating breakfast, without increasing overall daily calorie intake, as one way to help prevent excess weight gain. This means you shouldn’t just eat breakfast without considering your overall calorie consumption – cut down elsewhere if you need to.

What you eat at breakfast is also likely to be important. NICE recommends that breakfast should reflect existing healthy eating advice. So for example, opt for unsweetened wholegrain cereals or bread, lower-fat milk and a portion of fruit, rather than a fry-up.

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What is an embolism?

blocked artery

blocked artery

An embolism is a blocked artery caused by a foreign body, such as a blood clot or an air bubble.

The body’s tissues and organs need oxygen, which is transported around the body in the bloodstream.

If the blood supply to a major organ – such as the brain, heart or lungs – is blocked, the organ will lose some or all of its function.

Two of the most serious conditions caused by an embolism are:

stroke – where the blood supply to the brain is cut off

pulmonary embolism – where a foreign body blocks the artery that carries blood from the heart to the lungs (the pulmonary artery)

 

Symptoms of an embolism

The symptoms of an embolism depend on the particular type of embolism involved.

The main symptoms of a stroke are drooping of the face, weakness or numbness in one arm, and slurred speech or an inability to talk at all.

Dial 999 immediately to ask for an ambulance if you suspect that you or someone else is having a stroke.

If you have a pulmonary embolism you’ll have a sharp or stabbing chest pain that starts suddenly or comes on gradually. Shortness of breath, a cough and feeling faint or dizzy, or passing out are also common symptoms.

Deep vein thrombosis (DVT) (see below) sometimes doesn’t cause any symptoms. However, symptoms can include:

pain, swelling and tenderness in one of your legs (usually your calf)

a heavy ache in the affected area

warm skin in the area of the clot

red skin, particularly at the back of your leg below the knee

Get immediate medical help if you have pain, swelling and tenderness in your leg and you develop breathlessness and chest pain.

You may have a DVT that’s developed into a pulmonary embolism.

Divers should always be carefully monitored by their colleagues and supervisors so any air or gas embolism can be identified and treated immediately. Read about the warning signs of an air embolism.

Causes

A foreign body is any object or substance which shouldn’t be in your blood. Foreign bodies that cause embolisms are known as emboli – a single emboli is called an embolus.

Some common causes of an embolism are outlined below.

Blood clots

Blood contains natural clotting agents which help prevent you bleeding excessively when you cut yourself.

Certain health conditions – such as obesity, heart disease, cancer and pregnancy – can cause blood clots to form inside your veins even where there’s no bleeding.

A clot can travel in the bloodstream before it gets stuck and starts to block the blood flow to an organ or a limb.

Deep vein thrombosis (DVT), a blood clot in the deep veins of your leg, is one of the main causes of pulmonary embolisms.

Fat

A fracture to a long bone, such as a thigh bone, can lead to fat particles within the bone being released into the bloodstream. Fat particles can also sometimes develop following severe burns or as a complication of bone surgery.

Air

Embolisms can also occur if air bubbles or other gases enter the bloodstream.

Air embolisms are a particular concern for scuba divers. If a diver swims to the surface too quickly, the change in pressure can cause nitrogen bubbles to form in their bloodstream and become trapped in a blood vessel. This blockage can cause decompression sickness, which is often referred to as “the bends”.

Cholesterol

In people with severe atherosclerosis (narrowed arteries caused by a build-up of cholesterol), small pieces of cholesterol can sometimes break away from the side of a blood vessel, resulting in an embolism.

Amniotic fluid

In rare cases, amniotic fluid – which surrounds and protects a baby inside the womb – can leak into the mother’s blood vessels during labour, causing a blockage. This can lead to breathing problems, a drop in blood pressure and loss of consciousness.

Risk factors

Your risk of getting an embolism is increased if you:

are overweight or obese (have a body mass index (BMI) of 30 or more)

are pregnant

are 60 years of age or over

smoke

have heart disease

are immobile for long periods of time

Treating embolisms

How an embolism is treated will depend on:

what caused the blockage

the size of the blockage

where the blockage is in the body

A surgical procedure called an embolectomy is sometimes carried out to remove an obstruction. During the operation, the surgeon makes a cut in the affected artery so that the foreign body causing the blockage can be sucked out in a process known as aspiration.

Medication may be used to dissolve embolisms (thrombolysis) caused by blood clots. Anticoagulant medication, such as warfarin, heparin and low-dose aspirin, can help make the blood less sticky and stop further clots forming.

Embolisms caused by air bubbles are usually treated in a hyperbaric chamber. The air pressure inside the chamber is higher than the normal air pressure outside, which helps reduce the size of the air bubbles inside the diver’s body.

Preventing embolisms

It isn’t always possible to prevent embolisms, but there are things you can do to significantly reduce your risk. For example, you can:

eat a healthy diet – low in fat, high in fibre, including whole grains and plenty of fruit and vegetables (at least five portions a day)

limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day

lose weight if you’re overweight or obese, using a combination of regular exercise and a calorie-controlled diet

stop smoking, if you smoke

exercise for a minimum of 150 minutes a week (read more about the physical activity guidelines for adults)

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Varicose veins – an overview

Varicose veins

Varicose veins

Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. They may be blue or dark purple and are often lumpy, bulging or twisted in appearance.

Other symptoms include:

aching, heavy and uncomfortable legs

swollen feet and ankles

burning or throbbing in your legs

muscle cramp in your legs, particularly at night

dry, itchy and thin skin over the affected vein

The symptoms are usually worse during warm weather or if you’ve been standing up for long periods of time. They may improve when you walk around or if you rest and raise your legs.

When to see your GP

If you have varicose veins and they don’t cause you any discomfort, you may not need to visit your GP. Varicose veins are rarely a serious condition and they don’t usually require treatment.

However, speak to your GP if:

your varicose veins are causing you pain or discomfort

the skin over your veins is sore and irritated

the aching in your legs is causing irritation at night and disturbing your sleep

Your GP can diagnose varicose veins based on these symptoms, although further tests may be carried out.

Read about diagnosing varicose veins.

Causes of varicose veins

Varicose veins develop when the small valves inside the veins stop working properly.

In a healthy vein, blood flows smoothly to the heart. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through.

If the valves weaken or are damaged, the blood can flow backwards and collect in the vein, eventually causing it to be swollen and enlarged (varicose).

Certain things can increase your chances of developing varicose veins, such as:

being female

having a close family member with varicose veins

being older

being overweight

having a job that involves long periods of standing

being pregnant

other conditions

Read about the causes of varicose veins.

Treating varicose veins

If treatment is necessary, your doctor may first recommend up to six months of using compression stockings, taking regular exercise and elevating the affected area when resting.

If your varicose veins are still causing you pain or discomfort – or they cause complications – they can be treated in several ways. The most common treatment options include:

endothermal ablation – where heat is used to seal affected veins

sclerotherapy – this uses special foam to close the veins

ligation and stripping – the affected veins are surgically removed

It’s unlikely you’ll receive treatment on the NHS for cosmetic reasons – you’ll have to pay for cosmetic treatment privately.

If you do feel you require treatment, it might help if you print out treatment options for varicose veins to discuss with your GP.

Read about:

Treating varicose veins

Complications of varicose veins

Preventing varicose veins

There’s little evidence to suggest you can stop varicose veins getting worse, or completely prevent new ones developing.

However, there are ways to ease symptoms of existing varicose veins, such as:

avoiding standing or sitting still for long periods and trying to move around every 30 minutes

taking regular breaks throughout the day, raising the legs on pillows while resting to ease discomfort

exercising regularly – this can improve circulation and help maintain a healthy weight

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Spontaneous Coronary Artery Dissection – important new research – BREAKING

Spontaneous Coronary Artery Dissection

Spontaneous Coronary Artery Dissection

A team of scientists and clinicians from the NIHR Leicester Biomedical Research Centre (formerly Leicester Cardiovascular Biomedical Research Unit) has received a cheque for £25,000 from the Beat SCAD charity to continue its ground breaking research into the cardiovascular disease, Spontaneous Coronary Artery Dissection (SCAD).

SCAD is a rare and unpredictable event resulting from a bruise forming in the wall of a coronary artery. This leads to a sudden, unexpected heart attack. The condition can affect all ages and both sexes, but predominantly afflicts young otherwise fit women, sometimes around the time of pregnancy. Sadly some cases of SCAD are fatal.

Becks Breslin, 36, who experienced a SCAD in March 2012, prompted the UK’s first scientific study into the condition. Becks used internet forums and social media to connect with other patients who had survived a SCAD and she approached Dr David Adlam of the Leicester Cardiovascular Biomedical Research Unit (LCBRU), now part of the NIHR Leicester Biomedical Research Centre (BRC), where together they established the first UK study of SCAD patients.

Becks and a group of patients established the Beat SCAD charity to raise awareness of SCAD, support SCAD patients and raise funds for research into the condition. Highlights have included walks, cake sales and an annual conference attended by over 100 SCAD-survivors and their families, plus numerous individual and team challenges completed by patients, family members, friends and work colleagues.

Becks said: “The SCAD community possesses an incredible strength and great determination to support one another and work towards finding answers about SCAD. The Beat SCAD Trustees are extremely happy to present this donation to the Leicester team on behalf of the SCAD community who have been working incredibly hard to fund raise.”

Dr Adlam said: “On behalf of the research team at Leicester’s Hospitals and the University of Leicester, I would like to thank Becks and everyone at the Beat SCAD charity for their support and hard work in raising the funds to continue with this important area of research.”

Since the study’s inception in 2015, more than 500 patients have signed up to the registry. The results of the study will have a major impact on understanding this rare but devastating condition.