Atherosclerosis

Disease Description (Causes and Symptoms)

• Definition summary: Atherosclerosis is a systemic arterial disease in which cholesterol, lipids, cellular debris, and other substances accumulate in the intima of the arterial wall, forming atheromas (atherosclerotic plaques), causing blood vessels to narrow (stenosis), or causing thrombi to form when plaques rupture and block blood flow.
• Major causes and risk factors: Multiple factors, including dyslipidemia (especially elevated LDL cholesterol), hypertension, diabetes, smoking, obesity, age (aging), family history, lack of exercise, and chronic inflammation.
• Pathophysiology (brief): Endothelial injury → lipid deposition and infiltration of inflammatory cells → fibrous plaque formation and calcification → luminal stenosis or, when a plaque ruptures, acute thrombus formation resulting in acute perfusion impairment.
• Major symptoms: Often progresses without symptoms. When symptoms occur, they vary depending on the affected area.
  • Coronary artery involvement: Chest pain (angina), acute myocardial infarction
  • Cerebrovascular involvement: Transient ischemic attack (TIA), cerebral infarction (hemiplegia, speech impairment, visual field impairment, etc.)
  • Peripheral artery involvement: Intermittent claudication (leg pain when walking), numbness and sensory abnormalities in the lower limbs, tissue ischemia (necrosis and ulcers)
  • Kidney and other organ involvement: Reduced function or temporary dysfunction of the affected organ

Treatment Methods

• Lifestyle modifications (the basic first-line treatment for all patients)
  • Smoking cessation (the single most important measure), weight loss, regular aerobic exercise (a program appropriate for the cardiovascular system), a low-saturated-fat and low-salt diet (a Mediterranean diet is recommended), and limiting alcohol consumption.
• Drug treatment (depending on risk and the affected area)
  • Lipid management: High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–40 mg) are the foundation of treatment. The target LDL-C level is set according to the patient's risk; very low targets are recommended for high-risk patients. If statins are insufficient, adding ezetimibe or considering PCSK9 inhibitors (e.g., evolocumab, alirocumab) may be appropriate.
  • Antiplatelet agents: Aspirin (generally 75–100 mg) or clopidogrel for symptomatic disease or coronary/peripheral revascularization. After stent placement, short-term or long-term dual antiplatelet therapy (DAPT) is used according to guidelines. For asymptomatic atherosclerosis alone, the decision should be individualized.
  • Blood pressure and diabetes control: Strict blood pressure management with ACE inhibitors/ARBs, calcium channel blockers, and other medications. Patients with diabetes should use medications tailored to their blood glucose and HbA1c targets (when necessary, SGLT2 inhibitors or GLP-1 agonists may help protect the cardiovascular system and kidneys).
  • Other: In severe peripheral artery disease, medications such as pentoxifylline may be considered to relieve pain and improve exercise capacity (recommendations vary by country).
• Interventional/surgical treatment
  • Coronary arteries: Percutaneous coronary intervention (PCI, balloon angioplasty + stent), coronary artery bypass grafting (CABG), and other procedures.
  • Carotid artery lesions: Carotid endarterectomy (CEA) or carotid artery stenting (determined according to the presence of symptoms and the degree of stenosis).
  • Peripheral arteries: Balloon angioplasty, stenting, vascular bypass surgery, and, in cases of severe necrosis, consideration of amputation.
  • Acute phase of cerebral infarction: For ischemic cerebral infarction, thrombolysis (when indicated) or mechanical thrombectomy (endovascular treatment).
• Monitoring
  • Regular lipid tests, monitoring of liver function and muscle symptoms (with statins), blood pressure and blood glucose management, and lesion follow-up with imaging (ultrasound, CT, MR, and Doppler).

Precautions (Points to Note, Risk of Complications, and Self-Care Considerations)

• Emergency signs: Sudden chest pain, shortness of breath, sudden speech impairment, hemiplegia, or visual field impairment (suspected stroke), or sudden severe pain, pallor, or coldness in a lower limb (acute peripheral artery occlusion) require an immediate visit to the emergency department.
• Medication-related: Statins may cause muscle pain, myopathy, and elevated liver enzymes — contact a doctor if abnormalities such as muscle pain or cola-colored urine occur. Antiplatelet agents increase the risk of bleeding (consult a doctor if severe bleeding, significant bruising, or black stools occur).
• Self-care: Continue taking medications as prescribed, stop smoking, exercise regularly (follow an exercise prescription after consulting a doctor), manage weight and diet, and complete regular tests (lipids, blood pressure, blood glucose, etc.).
• Possible complications: Myocardial infarction, cerebral infarction (stroke), peripheral gangrene and amputation, aortic aneurysm and rupture, and fatal bleeding (related to anticoagulant/antiplatelet treatment).

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/materials to prepare
  • A list of currently used medications (names, doses, and dosing times) and a record of recent changes
  • History of allergies (especially medication and contrast-media allergies)
  • Records of previous surgeries and procedures (e.g., stent placement, bypass surgery, carotid artery surgery)
  • Recent test results: Lipid tests (LDL, HDL, TG), HbA1c, kidney function, liver function, and recent electrocardiogram, chest imaging, and vascular imaging (CT/MR angiography, Doppler) results
  • Symptom diary: When symptoms occur, their duration, triggers (during exercise/at rest), relieving factors, pain intensity, and location
  • Lifestyle information: Smoking status (duration/amount), alcohol consumption, exercise habits, and eating patterns
• Examples of records useful to prepare for the outpatient visit (including questions)
  • Onset and changes in symptoms: "When did the symptoms begin? How far can you walk before your legs start to hurt?"
  • Experience of emergency symptoms: "Have you recently had chest pain, shortness of breath, or temporary speech impairment?"
  • Medication adherence: "Are you taking your prescribed medications regularly? Have you experienced any side effects?"

Examples of General Questions to Ask the Doctor

• What are the main side effects of this medication, and what should I do if they occur?
• What is my target LDL level, and which medications do you recommend to achieve it?
• What is the first lifestyle change I should make?
• How often should follow-up tests (lipid panel, imaging, etc.) be performed?
• If my symptoms worsen, when should I visit the emergency department?

Examples of Disease-Specific Questions

• Regarding the degree of stenosis and treatment plan:
  • "What is the degree of stenosis (%) in my blood vessels (e.g., carotid, coronary, or lower-limb arteries), and is medication sufficient in my current condition, or is a procedure or surgery recommended?"
• Regarding lipid management and medication alternatives:
  • "I have severe muscle pain when taking statins. Can alternative medications (e.g., ezetimibe or PCSK9 inhibitors) be used? What about the cost, injections, and side effects?"
• Specialized question for peripheral artery disease (walking impairment) (optional):
  • "My intermittent claudication is severe. What exercise rehabilitation programs or medication treatments (e.g., exercise therapy, rehabilitation, or drug therapy) are recommended in combination with vascular intervention?"

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Note: The information above is general medical information. Individual diagnosis and treatment are determined based on the evaluation and test results provided by the attending physician.