Medical Management of Vascular Conditions
Vascular system overview
The blood vascular system is also called the circulatory system. It is 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.
Another vascular system of the body is the lymphatic system. The lymph vessels carry lymphatic fluid, a clear fluid containing water and blood cells. The lymphatic system helps to protect and maintain the body’s fluid environment. It does this by filtering and draining lymph away from each part of the body.
Together, the blood and lymphatic systems are the body’s transport systems. They supply all of the body’s organs and tissues with:
Waste product removal
Many other functions
Any conditions that affect the vascular system may affect the organs supplied by a particular vascular network. For example, a blockage in the heart’s coronary arteries may cause a heart attack.
What causes vascular conditions and 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.
The following 3 vascular diseases are among the main causes of illness and death in the U.S:
Heart attack (coronary artery disease)
Stroke (cerebrovascular disease),
Loss of limb or use of limb (peripheral arterial disease)
These 3 vascular diseases can all be linked to the same cause, atherosclerosis. This is a build-up of plaque in the inner lining of an artery. Plaque is made up of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. These 3 vascular diseases are all linked to the same risk factors.
Atherosclerosis is a progressive, long-term (chronic) vascular disease that affects the whole body. It particularly affects the major blood supply to the brain (carotid arteries), the blood supply to the heart (coronary arteries), and the peripheral arteries.
Experts don’t know exactly how atherosclerosis begins or what causes it. Atherosclerosis may start as early as childhood. But the disease has can progress quickly. With this condition, fatty deposits collect along the inner layer of the arteries. If the disease progresses, plaque may form. This thickening narrows the arteries. It can decrease blood flow or completely block blood flow to organs and other body tissues and structures.
Having atherosclerosis in any one of these areas is a strong sign that you may have this condition 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.
As a result, management of risk factors should be optimized to control the progression of vascular disease conditions caused by atherosclerosis. Studies have shown that making lifestyle changes can stop, and even reverse, the progression of atherosclerosis.
Vascular conditions and diseases may involve more than 1 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 doctors in internal medicine, interventional radiology, cardiology, and other specialties.
What are the risk factors for vascular diseases?
A risk factor is anything that may increase your chance of developing a disease. Different diseases have different risk factors. Modifiable risk factors that are linked with major vascular conditions are:
High levels of fats in the blood (hyperlipidemia), such as cholesterol and triglycerides
High blood pressure
Lack of exercise
Diet high in saturated fat
Although these risk factors increase your risk, they do not necessarily cause the disease. Some people with 1 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 appropriate actions. This includes changing some behaviors and being clinically monitored for the disease.
How can risk factors be medically managed?
Medical management of vascular conditions most often includes managing certain risk factors, such as diabetes, hyperlipidemia, smoking, and high blood pressure. Here’s an overview of managing these 4 risk factors:
Diabetes alone, without the other risk factors, speeds up the rate of atherosclerosis formation.
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.
What is hemoglobin A1c?
Hemoglobin is a substance found inside red blood cells. It carries oxygen to all the cells in the body. Hemoglobin can also 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 there is in the bloodstream, the more glucose will be attached to the hemoglobin. A hemoglobin A1c blood test will be able to figure out your average glucose level over 2 to 3 months. High hemoglobin A1c levels are linked to a greater increased risk for cardiovascular disease.
Your provider will figure out the best medicine and care for your specific condition. Diabetes may be managed with diet and exercise alone, or with medicines. These include oral antihyperglycemic medicines or insulin.
Hyperlipidemia is high levels of fats (lipids) in the blood. There are 2 main types of fats in the blood, cholesterol and triglycerides. Cholesterol is an essential component found in all human cell membranes. Triglycerides are needed to help move energy from food into body cells.
High levels of LDL (“bad”) cholesterol are one of the causes of altered structure of the innermost layer of the artery's wall. High LDL levels are linked to atherosclerotic plaque formation. This fatty material becomes hardened, blocking the artery and stopping blood flow.
Your cholesterol levels may rise and fall 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, and suggest 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 particular condition.
Fat-lowering therapy may be recommended to help reduce the progression of atherosclerotic disease. 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 optimal goal for your LDL cholesterol can depend on other risk factors. Your healthcare provider will consider your individual risk factors to help figure out what is best for you. Recommendations for other types of fats in the blood include:
Your provider may find that you need medicine to stay at a certain cholesterol level, as well as making diet and exercise changes. There are a few types of medicines, such as statins, used to decrease cholesterol. Studies have shown that certain statins can:
Decrease the thickness of the carotid artery wall
Increase the size of the artery opening (lumen)
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 has been shown to help speed up the progression of atherosclerotic disease. It is one of the strongest risk factors in the development of peripheral artery disease. Smoking is linked to lower rate of successful outcomes in vascular surgical interventions, a higher amputation rate, and a greater number of heart attacks and strokes. Smoking is also linked to a lower survival rate from heart attacks and strokes.
The effects of tobacco include:
Narrowing of blood vessels (as blood vessels become smaller, blood pressure is raised)
Higher carbon monoxide levels in the bloodstream, which impairs oxygen transport
Speeds up the process of atherosclerosis
Higher risk of blocked leg arteries (there is a 30% to 50% increase when you smoking ½ a pack per day)
Cause of heart attacks, strokes, or death
Lower chance of successful surgery
Greater risk for amputation
Quitting smoking has been shown to decrease the progression of the atherosclerotic process.
Current guidelines advise all smokers to quit. If you can’t quit smoking, your provider may refer you to a specialist. A specialist may recommend educational materials, behavior modification counseling, medicines, and follow-up care. Other methods may also include support groups or individual counseling, learning new coping skills, sessions with a specialist for a prescribed period of time, or nicotine replacement therapy. Medicines may also be used.
Steps to stop smoking include:
Get rid of all cigarettes and ash trays before you quit
Seek family and friends for support
Avoid social situations that make you want to smoke
Ask your provider for a referral to a specialist for help quitting smoking
Most insurance plans cover medicines and services to help you quit smoking. In some states, Medicaid will also include coverage for medicines.
Weight gain has also 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 develop faster.
High blood pressure for adults is defined as:
Pre-hypertension is defined as:
Normal blood pressure is defined as:
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. A person who normally has a lower than usual blood pressure may be considered hypertensive with lower blood pressure measurements than 140/90.
Weight loss, regular physical exercise, and a balanced diet are effective in lowering high blood pressure. A weight loss of about 5% of your total body weight may lower your blood pressure and help make blood pressure medicines more effective. Getting 2 ½ hours each week of moderate-intensity aerobic physical activity (such as brisk walking, pushing a lawn mower, ballroom dancing, or water aerobics) can help lower your risk of high blood pressure.
Blood pressure medicines may be used to help control high blood pressure. Your provider will prescribe the appropriate medicines for your situation. There are several types of medicines that act in different ways to lower blood pressure.