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Unclogging ArteriesAtherosclerosis is a major U.S. health problem. There are exciting new treatments—but prevention is keyJust as heavy traffic makes it harder to move your car down the highway, atherosclerosis—clogged arteries—makes it more difficult for your heart to pump blood through your body. And the medical problem is almost as widespread as the highway one: heart disease, most commonly caused by atherosclerosis, affects one in five Americans.Atherosclerosis is a buildup of plaque (which includes cholesterol and other fatty substances) inside the walls of the artery, says D. Lynn Morris, M.D., chief of cardiology at Lehigh Valley Hospital and Health Network. “This happens for many different reasons,” he says. “Some, such as age and genetic makeup, you can’t control. But many risk factors can be modified with changes in lifestyle.” Atherosclerosis is a long, gradual process, and in the early stages there are no symptoms. Eventually, depending on the location of the blocked or narrowed arteries, the reduced blood flow causes chest pain or heart attack, stroke or serious circulatory problems in the legs. If you have a family history of atherosclerosis or are feeling chest, arm or neck discomfort or shortness of breath, Morris says, call your doctor for a physical and a risk factor assessment. Diagnosis typically starts with a treadmill test to monitor blood flow during exercise. If a problem is detected, the next step is catheterization, which gives the doctor an inside look at the blood vessels. And if there is a blockage? “If it’s not severe, we begin with lifestyle change alone,” Morris says. “A low-fat diet paired with exercise and smoking cessation may be enough. We also have a range of medications to control cholesterol, blood pressure and diabetes, all of which contribute to atherosclerosis.” More serious blockages call for more aggressive treatment. Most often, that means angioplasty. A catheter with a deflated balloon on its tip is threaded into the artery, then the balloon is inflated to compress the plaque against the artery walls. In about 85 percent of cases, a stent (a tiny wire mesh tube) is inserted to help keep the artery open. Even with such “insurance,” however, there’s a 30 to 40 percent chance that a treated artery will re-narrow. A new radiation technique is addressing that problem (see Esther Ratzell’s story, above). And Lehigh Valley Hospital cardiologists are helping research other new approaches, Morris says, including drug-coated stents to prevent plaque regrowth. If there are multiple blockages or if the artery is too hardened or inaccessible, bypass surgery is the answer, says Michael Sinclair, M.D., chief of cardiac surgery at Lehigh Valley Hospital and Health Network. Traditional open-heart surgery involves stopping the heart and putting the patient on a heart-lung machine. “Research now suggests that while this procedure clearly saves lives, there are drawbacks including potential memory loss,” Sinclair says. He and his colleagues have a new technique, called “beating heart” surgery, in which they operate without stopping the heart. Risks appear to be lower and recovery quicker. With all these high-tech treatment options, do you really need to be concerned about atherosclerosis? The answer to that, Morris says, is a resounding “Yes!” “This is such a widespread disease, everyone should be concerned,” he says. “And to a great extent, it is preventable. My message is this: Know your risks, seek treatment early—and practice a heart-healthy lifestyle, all life long.”
Want to Know More about your heart disease risk? For a questionnaire,
call 610-402-CARE. This page last updated 2/12/08 04:08 PM
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