Medical Care of Vascular Diseases
Vascular system overview
The blood vascular system is also called the circulatory system. It's made up of arteries,
veins, and capillaries. Capillaries are tiny blood vessels between arteries and veins.
They bring oxygen-rich blood to the body. The heart pumps blood through this network
of blood vessels all over the body.
The blood vessels supply all of the body’s organs and tissues with:
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Oxygen
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Nutrients
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Waste product removal
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Fluid balance
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Many other functions
Any diseases that affect the vessels may affect the organs supplied by those vessels.
For example, a blockage in the heart’s coronary arteries may cause a heart attack.
What causes vascular diseases?
A vascular disease is a condition that affects the arteries or veins. Most often,
vascular disease affects blood flow. This happens because the blood vessels become
blocked or weakened. Or it happens because the valves in the veins get damaged. Organs
and other body structures may be damaged by vascular disease if blood flow is decreased
or fully blocked.
These 3 vascular diseases are among the main causes of illness and death in the U.S:
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Heart attack (coronary artery disease)
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Stroke (cerebrovascular disease)
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Loss of limb or use of limb (peripheral arterial disease)
These 3 diseases can all be linked to the same cause: atherosclerosis. This is a buildup
of plaque in the inner lining of an artery. Plaque is made up of fatty substances,
cholesterol, cell waste products, calcium, and fibrin. These 3 vascular diseases are
all linked to the same risk factors.
Atherosclerosis is a long-term (chronic) vascular disease that gets worse over time
and affects the whole body. It affects the
How does atherosclerosis start?
Experts don’t know exactly how atherosclerosis begins or what causes it. It may start
as early as childhood. But it can get worse quickly. With this disease, fatty deposits
collect along the inner layer of the arteries. If it gets worse, plaque may form.
This thickens and narrows the arteries. It can decrease or fully block blood flow
to organs and other body tissues.
Having atherosclerosis in any one of these areas is a strong sign that you may have
this disease in other parts of your body. Atherosclerosis in the arteries of the heart
can cause a heart attack. Atherosclerosis of the arteries to the brain can cause a
stroke. And atherosclerosis of the leg arteries can cause a blockage. A blockage can
reduce blood flow. This can cause leg pain, or ulcers or wounds that don’t heal. Surgery
to remove the foot or leg (amputation) may be needed.
It's important to manage your risk factors to help control vascular diseases caused
by atherosclerosis. Studies have shown that making lifestyle changes can stop, and
even reverse, the progression of atherosclerosis.
Vascular diseases may include more than one of the body's systems at a time. Because
of this, many types of doctors treat vascular problems. Specialists in vascular medicine
or surgery work closely with other doctors. These include doctors in internal medicine,
interventional radiology, cardiology, and other specialties.
Who is at risk for vascular diseases?
A risk factor is anything that may increase your chance of having a disease. Different
diseases have different risk factors. Risk factors that are linked with major vascular
diseases are:
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Diabetes
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High levels of fats in the blood (hyperlipidemia), such as cholesterol and triglycerides
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Smoking
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High blood pressure
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Obesity
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Lack of exercise
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Diet high in saturated fat
Although these factors increase your risk, they don't necessarily cause the disease.
Some people with one or more risk factors never develop the disease. Other people
have the disease and have no known risk factors. Knowing your risk factors for any
disease can help guide you to take actions. This includes changing some habits and
being checked for the disease.
How can risk factors be managed?
Medical care of vascular diseases most often includes managing certain risk factors,
such as diabetes, smoking, high cholesterol, and high blood pressure. Here’s an overview
of managing these 4 risk factors:
Diabetes
Diabetes alone, without the other risk factors, speeds up the rate of atherosclerosis.
High blood sugar (blood glucose) levels are linked to a greater risk of heart disease
and stroke. Your blood glucose levels should be in the range of 70 mg/dL to 130 mg/dL
before meals. A blood test called hemoglobin A1c can check if glucose levels have
been controlled. This test averages your blood glucose levels over a few months. A
hemoglobin A1c level of less than 7% is desired.
Hemoglobin is a substance found inside red blood cells. It carries oxygen to all the
cells in the body. Hemoglobin can attach itself to glucose.
When too much glucose stays in your bloodstream for a long time, it will attach itself
to the hemoglobin inside the red blood cells. The more glucose in the bloodstream,
the more glucose will be attached to the hemoglobin. A hemoglobin A1c blood test will
be able to show your average glucose level over 2 to 3 months. High hemoglobin A1c
levels are linked to a higher risk for cardiovascular disease.
Your provider will figure out the best medicine and care for your condition. Diabetes
may be managed with diet and exercise alone, or with medicines. These include oral
medicines that lower blood sugar, or insulin.
High cholesterol
High cholesterol or hyperlipidemia is high levels of fats (lipids) in the blood. There
are 2 main types of fats in the blood. They are cholesterol and triglycerides. Cholesterol
is an essential part of all human cells. Triglycerides are needed to help move energy
from food into body cells.
High levels of LDL (bad) cholesterol are one of the causes of changes to the inner
layer of the artery's wall. High LDL levels are linked to plaque forming. This plaque
becomes hard, blocking the artery and stopping blood flow.
Your cholesterol levels may rise and fall. This is based on the types of fat you eat,
the amount of exercise you do, and your weight. Your healthcare provider may advise
you to make changes in your diet. They may advise an exercise and weight-loss plan
that’s right for you. In some cases, you may have a family history of high fat levels
in the blood. Your provider will advise the best treatment for your needs.
Fat-lowering therapy may be advised to help reduce the progression of atherosclerosis.
Your LDL level should be less than 130 mg/dL. But if you have a higher risk for heart
disease, an LDL of below 100 is ideal. The best goal for your LDL cholesterol can
depend on other risk factors. Your healthcare provider will consider your own risk
factors to help figure out what is best for you. Healthy levels of other types of
fats in the blood are:
You may need medicine to stay at a healthy cholesterol level. And you may need to
make diet and exercise changes. There are a few types of medicines used to decrease
cholesterol. One type of medicine is statins. Studies have shown that some statins
can:
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Reduce the thickness of the carotid artery wall
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Increase the size of the artery opening (lumen)
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Reduce vascular inflammation (believed to be a cause of atherosclerosis)
Atherosclerosis may progress to the point of narrowing or blocking blood vessels.
Another type of medicine may be used to prevent narrowing or blockage caused by blood
clots. These medicines help prevent clots from forming inside blood vessels. These
include aspirin and some prescription medicines.
Smoking
Smoking has been shown to help speed up the progression of atherosclerosis. It's one
of the strongest risk factors for peripheral artery disease. Smoking is linked to
lower rate of good results in vascular surgery, a higher amputation rate, and a higher
number of heart attacks and strokes. Smoking is linked to a lower survival rate from
heart attacks and strokes.
The effects of tobacco include:
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Narrowing of blood vessels (as blood vessels become smaller, blood pressure is raised)
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Increase in carbon monoxide levels in the bloodstream, which impairs oxygen transport
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Blood clots
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Atherosclerosis
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Higher risk of blocked leg arteries (there is a 30% to 50% increase when you're smoking
½ a pack per day)
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Heart attacks, strokes, or death
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Worse surgery outcomes
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Greater risk for amputation
Quitting smoking has been shown to decrease the progression of the atherosclerosis.
Current guidelines advise all smokers to quit. If you can’t quit smoking, your provider
may refer you to a specialist. A specialist may advise:
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Behavior change counseling
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Support groups
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Individual counseling
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Learning new coping skills
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Nicotine replacement therapy
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Medicines
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Follow-up care
Steps to stop smoking include the following:
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Get rid of all cigarettes and ash trays before you quit.
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Talk with family and friends for support.
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Stay away from social events that make you want to smoke.
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Ask your provider for a referral to a specialist to help you quit.
Most insurance plans cover medicines and services to help you quit smoking. In some
states, Medicaid will include coverage for medicines.
Weight gain has been shown to be minimal after 1 year of not smoking. The benefits
of quitting smoking outweigh the effects of weight gain.
High blood pressure
High blood pressure affects the structure of the artery wall. It makes atherosclerosis
happen faster.
Blood pressure measurements are given as 2 numbers. Systolic blood pressure is the
upper number. This is the pressure when the heart contracts. Diastolic blood pressure
is the lower number. This is the pressure when the heart relaxes between beats.
Blood pressure is defined as normal, elevated, or stage 1 or stage 2 high blood pressure:
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Normal blood pressure. This is systolic of less than 120 and diastolic of less than 80 (120/80)
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Elevated blood pressure. This is systolic of 120 to 129 and diastolic less than 80
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Stage 1 high blood pressure. This is systolic is 130 to 139 or diastolic between 80 to 89
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Stage 2 high blood pressure. This is when systolic is 140 or higher or the diastolic is 90 or higher
These numbers should be used as a guide only. Having a single elevated blood pressure
measurement is not necessarily a sign of a problem. Your provider will want to see
multiple blood pressure measurements over a few days or weeks before making a diagnosis
of high blood pressure and starting treatment.
Weight loss, regular exercise, and a healthy diet work well to lower high blood pressure.
A weight loss of about 5% of your total body weight may lower your blood pressure.
This can also help make blood pressure medicines work better. Getting 2½ hours each
week of moderate aerobic physical activity can help lower your risk of high blood
pressure. This includes things like brisk walking, pushing a lawn mower, ballroom
dancing, or water aerobics.
Blood pressure medicines may be used to help control high blood pressure. Your provider
will prescribe the right medicines for your needs. There are several types of medicines
that act in different ways to lower blood pressure.