Life style measures to tackle atherosclerosis
Many studies have shown that lifestyle can affect risk for coronary heart disease and stroke. Although these studies have not looked in particular at arterial disease in the legs and the aorta, it would seem sensible to follow this advice for these conditions as well - after all the arteries are all exposed to the same risks.
Cigarette smoking
Tobacco smoking releases nicotine into the lungs and bloodstream. Nicotine stimulates the brain to release natural chemicals that, in regular smokers, produce the feelings of comfort and satisfaction. But cigarette smoke contains a number of chemicals which damage the delicate inner lining of arteries leading to the development of atheroma. Lifetime cigarette smoking doubles the risk of coronary heart disease - this is related to the duration and amount of smoking. The risks fall immediately on stopping smoking but may take many years to be fully reversed. Stopping smoking after a heart attack reduces the risks of death and a further heart attack by 40%. Smoking cessation in patients with intermittent claudication approximately doubles their 10-year survival rates (82% in those who stop vs 46% in those who do not stop).
Diet
Studies on the population suggest that diets high in saturated fats, low in fruit an d vegetables and high in salt increase the risks of arterial disease.
 | Fats - dietary saturated fats determine blood cholesterol levels in the population. There are 2 types of cholesterol. LDL-cholesterol is bad for you whereas HDL-cholesterol is protective. Sticking to diets that limit the amount of fats that you eat will help to reduce blood cholesterol levels. |
| Salt - this is linked with blood pressure. Patients who cut down on their salt intake will lower their blood pressure. |
| Fruit, vegetables and vitamins - fruit and vegetables are protective against coronary heart disease. They are rich in protective substances called 'antioxidants' (e.g. beta-carotene, vitamin C and vitamin E). There is some evidence that they may help reduce blood pressure. |
| Oily fish - eating oily fish (e.g. mackerel and sardines) may protect against coronary heart disease. |
Body weight
Body mass index (BMI) is your body weight in kilograms divided by the square of your height in metres. Ideally it should be in the range 18.5 - 25. Being overweight (BMI > 25) or obese (BMI > 30) is strongly associated with an increased risk of atherosclerosis. Even weight loss that still leaves you with a BMI greater than 25 is useful. This applies more so to diabetic patients.
Physical activity
According to recommendations, adults should undertake 30 minutes of moderate intensity activity (e.g. brisk walking, cycling or heavy house-work) on at least 5 days of the week. Physical activity reduces the risk of coronary heart disease.
Alcohol
Drinking too much for you is bad. Fortunately, drinking small amounts of alcohol may be beneficial. The Government recommends, however, that drinking simply to lower risk is not sensible.
Medicines
In order to lessen the chance of a blood clot (thrombosis) forming in the arteries in your body, your doctor may give you 'anti-platelet' treatment. This may be aspirin (75 mg per day) or a drug called clopidogrel (75 mg per day). These drugs make the platelets in your blood less sticky. Large studies have shown that these drugs lessen the chances of a heart attack or stroke if you suffer from arterial disease.
Drugs may be needed to control your blood pressure and cholesterol levels. For cholesterol the group of drugs called statins are most commonly used - they can be combined with a new drug (ezetrol) to enhance the cholesterol lowering effect by preventing the absorption of fats by the gut. For high triglycerides a group of drugs called fibrates may be used. Your doctor will determine the best drugs for you based on blood tests. Recent guidelines from the British Hypertension Society state that all patients up to the age of 80 years with a total cholesterol of more than 3.5 mmol/L should be on a statin.
Hyperhomocysteinaemia is a risk factor in younger patients and is treated with folate supplements. This is still under study.
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