Arteriosclerosis

Arteriosclerosis is a general term for conditions characterized by thickening, stiffening, and loss of elasticity of arterial walls, which increases vascular resistance and can reduce tissue perfusion. It is not a single disease but a family of processes affecting arteries.

The term encompasses several related conditions, including atherosclerosis (lipid deposition and plaque formation in the intimal layer of arteries), arteriolosclerosis (thickening of small arteries and arterioles, often seen with hypertension or diabetes), and medial calcific sclerosis, also known as Monckeberg sclerosis, which involves calcium deposition in the media of medium-sized arteries.

Pathophysiology involves structural changes such as fragmentation of elastic fibers, collagen deposition, smooth muscle cell proliferation, and calcification. These changes stiffen the arterial wall, diminish its ability to dampen pulsatile flow, raise systolic blood pressure, and compromise perfusion to organs and tissues.

Risk factors include aging, hypertension, hyperlipidemia, diabetes, smoking, obesity, and a family history of cardiovascular disease. The condition often progresses without symptoms until it causes complications in critical vessels.

Clinical features depend on which arteries are affected. Many individuals are asymptomatic, but when arteries supplying the heart, brain, or limbs are involved, symptoms can include chest pain (angina), transient ischemic attacks or stroke, claudication, or renal impairment. Hypertension can both contribute to and result from arteriosclerotic changes.

Diagnosis is frequently made incidentally through imaging done for other reasons. Noninvasive options include arterial ultrasound and Doppler studies, CT angiography, and MRI. Measurements of arterial stiffness, such as pulse wave velocity, can aid assessment.

Management focuses on risk factor modification and prevention of complications. This includes lifestyle changes, lipid-lowering therapy (statins), blood pressure control, glycemic management, and, in selected cases, antiplatelet therapy or revascularization procedures.