Atherosclerosis: How to Recognize and Effectively Treat Vascular Disease

What is Atherosclerosis: A Hidden Threat to Blood Vessels

Atherosclerosis is a chronic inflammatory disease of the arteries in which atherosclerotic plaques form on their inner walls. These plaques, consisting of cholesterol, calcium, and fibrous tissue, gradually enlarge, narrowing the vascular lumen and impeding blood flow [6]. This leads to an inadequate supply of oxygen to organs.

The process of plaque formation is inflammatory in nature, activating immune cells [6]. Atherosclerosis is a systemic disease affecting arteries throughout the body. Key risk factors include high blood pressure (hypertension), elevated cholesterol levels, diabetes mellitus, smoking, obesity, and a sedentary lifestyle. It has been noted that even conditions such as atopic dermatitis may be associated with an increased risk of hypertension, indirectly increasing the risk of atherosclerosis [5].

Symptoms of Atherosclerosis: When is it Time to See a Doctor?

Atherosclerosis is often asymptomatic in the early stages, manifesting only when a vessel is significantly narrowed or blocked. Symptoms depend on the affected arteries:

• Heart (coronary arteries): Angina pectoris (chest pain or discomfort upon exertion), shortness of breath, fatigue.
• Brain (cerebral arteries): Transient ischemic attacks (TIAs) or stroke (weakness, numbness, speech/vision impairment, dizziness).
• Lower extremities: Intermittent claudication (leg pain when walking), numbness, coldness, non-healing wounds.
• Kidneys: Hard-to-control high blood pressure.

Importantly, symptoms can be atypical or masked. For example, in patients with chronic obstructive pulmonary disease (COPD), shortness of breath and chest discomfort are often attributed to lung disease. However, studies show that up to 78% of COPD patients have undiagnosed coronary artery disease caused by atherosclerosis, even without typical angina [2]. This underscores the need for thorough diagnosis in high-risk groups.

Atherosclerosis and Comorbidities: Non-Obvious Connections

Atherosclerosis is closely linked to a number of chronic conditions, particularly those of an inflammatory nature.

• Chronic Obstructive Pulmonary Disease (COPD): Coronary artery disease (CAD) frequently coexists with COPD, remaining unrecognized. Symptoms may be mistakenly attributed to pulmonary disease, delaying the diagnosis of cardiovascular problems [2]. The high prevalence of undiagnosed CAD (78%) among COPD patients necessitates screening [2].
• Autoimmune Diseases: Systemic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) significantly accelerate the development of atherosclerosis. Chronic inflammation is a powerful factor promoting the formation and destabilization of atherosclerotic plaques [6]. Patients with RA and SLE have increased mortality due to cardiovascular disease. Studies show an increased prevalence of carotid plaques in such patients even after accounting for traditional risk factors [7]. Disease duration correlates with the presence of atherosclerosis [7]. Managing the underlying autoimmune disease and reducing systemic inflammation are critically important.

Modern Diagnosis of Atherosclerosis: From Detection to Assessment

Early and accurate diagnosis of atherosclerosis is critical to preventing complications. The approach includes:

• Anamnesis and Examination: Gathering information about symptoms and risk factors.
• Laboratory Tests: Cholesterol levels (LDL, HDL), triglycerides, glucose, C-reactive protein.
• Instrumental Methods:
  • Coronary Angiography: The "gold standard" for evaluating coronary arteries [2].
  • Coronary CT Angiography: Visualization of stenosis and plaques [2].
  • Chest CT Calcium Scoring: Assessment of calcium in the coronary arteries, a marker of atherosclerosis, useful for detecting undiagnosed CAD in COPD patients [2].
  • Carotid Ultrasound: Detecting plaques and assessing intima-media thickness as an indicator of systemic atherosclerosis [7].
  • ECG, Echocardiography, Stress Tests: Evaluating heart function and detecting ischemia.

Comprehensive Treatment of Atherosclerosis: Strategies and Prospects

Treatment for atherosclerosis aims to slow progression, reduce symptoms, and prevent complications. The approach is comprehensive:

• Lifestyle Changes: Balanced diet, regular physical activity, smoking cessation, weight control.
• Drug Therapy:
  • Statins: Lowering LDL, stabilizing plaques, reducing inflammation.
  • Antiplatelet Agents: Preventing blood clots.
  • Antihypertensive Agents: Blood pressure control.
  • Blood Sugar Control Medications: For patients with diabetes.
• Management of Comorbidities: Effective treatment of COPD, rheumatoid arthritis, or SLE is critically important as they accelerate atherosclerosis [2, 6, 7]. In atrial fibrillation, which frequently accompanies cardiovascular disease, anticoagulant therapy is necessary to prevent stroke, taking into account scales such as CHA2DS2-VASc and using DOACs [4].
• Invasive and Surgical Methods: For significant narrowing: angioplasty and stenting, coronary artery bypass grafting (CABG), endarterectomy.

Future prospects include further study of inflammatory mechanisms and the development of new targeted drugs.

Sources

1. Artemisinins in autoimmune diseases: effects and mechanisms in systemic lupus erythematosus and rheumatoid arthritis. British journal of pharmacology, 2025. https://pubmed.ncbi.nlm.nih.gov/40474495/
2. Undiagnosed Coronary Artery Disease in Patients with COPD. Journal of clinical medicine, 2026. https://pubmed.ncbi.nlm.nih.gov/41827313/
3. Plasma cell leukemia and hyperviscosity syndrome. Southern medical journal, 1990. https://pubmed.ncbi.nlm.nih.gov/2196691/
4. Updates on the Management of Atrial Fibrillation. The American journal of nursing, 2026. https://pubmed.ncbi.nlm.nih.gov/42162989/
5. Association between atopic dermatitis and hypertension: a systematic review and meta-analysis. The British journal of dermatology, 2022. https://pubmed.ncbi.nlm.nih.gov/34319589/
6. Atherogenesis in rheumatology. Lupus, 2006. https://pubmed.ncbi.nlm.nih.gov/16634362/
7. Subclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. The American journal of medicine, 2008. https://pubmed.ncbi.nlm.nih.gov/18926167/
8. Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis. The Journal of rheumatology, 2021. https://pubmed.ncbi.nlm.nih.gov/32358156/

The information presented in the article is for reference purposes only and cannot serve as a basis for self-diagnosis or treatment. Always consult a qualified physician for an accurate diagnosis and an individual treatment plan.