Arteriosclerosis, or “hardening of the arteries,” is the most common disease of the arteries. It is a diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened.
Atherosclerosis primarily affects the intima of the large and medium-sized arteries, causing changes that include the accumulation of lipids (atheromas), calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of the artery. Although the pathologic processes of arteriosclerosis and atherosclerosis differ, rarely does one occur without the other, and the terms often are used interchangeably. The most common direct results of atherosclerosis in the arteries include narrowing (stenosis) of the lumen and obstruction by thrombosis, aneurysm, ulceration, and rupture; ischemia and necrosis occur if the supply of blood, nutrients, and oxygen is severely and permanently disrupted.
Atherosclerosis can develop anywhere in the body but is most common in bifurcation or branch areas of blood vessels. Atherosclerotic lesions are of two types: fatty streaks (composed of lipids and elongated smooth muscle cells) and fibrous plaques (predominantly found in the abdominal aorta and coronary, popliteal, and internal carotid arteries).
Risk Factors
Many risk factors are associated with atherosclerosis; the greater the number of risk factors, the greater the likelihood of developing the disease. Recent studies have reported the prevalence of atherosclerosis in women is the same, if not higher, than in men, and that female gender is an independent risk factor for peripheral arterial disease (PAD).
Clinical features depend on the tissue or organ affected: heart (angina and myocardial infarction due to coronary atherosclerosis), brain (transient ischemic attacks and stroke due to cerebrovascular disease), and peripheral vessels (includes hypertension and symptoms of aneurysm of the aorta, renovascular disease, atherosclerotic lesions of the extremities). See specific condition for greater detail.
The management of atherosclerosis involves modification of risk factors, a controlled exercise program to improve circulation and its functioning capacity, medication therapy, and interventional or surgical graft procedures (inflow or outflow procedures). Current evidence-based guidelines established by the American College of Cardiology and the American Heart Association (ACC/AHA) recommend 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) for first-line use in patients with PAD for secondary prevention and cardiovascular risk reduction. These statins may include medications such as atorvastatin (Lipitor), lovastatin (Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), and rosuvastatin (Crestor). Several other classes of medications used to reduce lipid levels include bile acid sequestrants (cholestyramine [Questran], colesevelam [WelChol], colestipol [Colestid]), nicotinic acid (niacin [Niacor, Niaspan]), fibric acid inhibitors (gemfibrozil [Lopid], fenofibrate [Tricor]), and cholesterol absorption inhibitors (ezetimibe [Zetia]). Patients receiving long-term therapy with these medications require close monitoring.
Several radiologic techniques are important adjunctive therapies to surgical procedures. They include arteriography, percutaneous transluminal angioplasty, and stents and stent grafts.
For more information, see Chapter 30 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.