Atherosclerosis

Atherosclerosis happens when a fatty substance called plaque builds up inside your arteries. There are typically few noticeable symptoms until the situation becomes dire and you experience catastrophic complications such as a heart attack, stroke, or blood clot.

Many people don’t worry about their heart until they’ve had a health scare, but taking steps to prevent heart disease before a scare occurs can reduce your chances of developing serious complications.

Atherosclerosis is a common condition, but it’s also largely preventable. You can reduce your risk of atherosclerosis by adopting healthy lifestyle habits like exercising regularly, avoiding or quitting smoking, and eating a heart-healthy diet.

Stay with us as we examine what causes atherosclerosis, potential complications, and ways you can keep your heart healthy throughout your life.

Atherosclerosis

Atherosclerosis contributes to about half of all deaths in Western countries, including the United States. Globally, it causes about 10 million deaths per year.

Atherosclerosis is characterized by the build-up of plaque inside your blood vessels. It can lead to stenosis, which is a narrowing of your artery walls.

Plaque is a fatty substance made up of:

• Fats

• Cholesterol

• Fibery Proteins

• Calcium

Plaque build-up often doesn’t cause symptoms, but it can block blood flow to vital organs like your heart. 

Coronary artery disease occurs when atherosclerosis affects the arteries supplying blood to your heart.

The Difference Between Atherosclerosis and Arteriosclerosis

The terms atherosclerosis and arteriosclerosis sound similar but are slightly different in meaning. Atherosclerosis is a type of arteriosclerosis. It refers to the build-up of plaque in blood vessels. Arteriosclerosis refers to the loss of flexibility and hardening of the arteries that carry blood away from your heart. 

Atherosclerosis is often referred to as a silent killer, since symptoms often don’t appear or are minimal until it causes severe cardiovascular disease or other complications.

Symptoms of Atherosclerosis 

Atherosclerosis symptoms can depend on which arteries are blocked and the severity of your blockage. For many people, it progresses silently.

People with coronary artery disease, or narrowing of the blood vessels supplying their heart, may develop symptoms such as:

• Chest pain that often gets worse with stress or physical activity (angina)

• Cold sweats

• Extreme tiredness

People with atherosclerosis in other locations may develop:

• Pain, aching, heaviness, or cramping in their legs when climbing stairs or with physical activity

• Cognitive changes such as problems with memory or processing speed

• Visual problems

• Erectile dysfunction

• Severe pain following meals

• Weight loss

• Diarrhea

Many potential complications of atherosclerosis can be life-threatening. They include the following.

Heart Attack

A heart attack occurs suddenly when an atherosclerotic plaque in one of the arteries to your heart ruptures. It can cause symptoms such as:

• Chest pain, pressure, or tightness

• Pain that spreads to your shoulder, arm, neck, or back

• Cold sweats

• Fatigue

• Heartburn

• Indigestion

• Shortness of breath

• Nausea

• Loss of consciousness

• Sudden death

Blood Clots

If plaque ruptures from one of your arteries, it can cause a blood clot to travel through your bloodstream to cause problems elsewhere. This blood clot can cut off blood flow to your vital organs or limbs.

Peripheral Artery Disease

Peripheral artery disease is a narrowing of one of the arteries that carries blood to your limbs. It most commonly affects your legs.

Symptoms can include:

• Leg or buttock pain with exercise

• Hair loss on your legs or feet

• Numbness or weakness in your legs

• Brittle or slow-growing toenails

• Ulcers on your legs and feet

• Pale or blue skin, which may be harder to spot on darker skin tones

• Muscle loss

Stroke and TIA

A blood clot that reaches your brain can cause a stroke.

Symptoms of a stroke include sudden:

• Numbness or weakness, often on one side of your body or face

• Confusion

• Trouble seeing in one or both eyes

• Severe headache

• Trouble moving

• Speech difficulty

A transient ischemic attack (TIA) is also called a “mini stroke”. The symptoms can be similar but usually only last a few minutes and resolve within 24 hours.

Erectile Dysfunction

Erectile dysfunction is when you can’t achieve an erection firm enough for sexual intercourse or masturbation. Atherosclerosis in the pelvis and other blood vessel problems are among the potential causes.

Aortic Aneurysm

An aortic aneurysm is when part of the main blood vessel carrying blood away from your heart bulges outward. This blood vessel is called your aorta. 

An aortic aneurysm often doesn’t cause symptoms, but it can lead to severe, sudden bleeding from a ruptured aneurysm. A ruptured aneurysm has a high risk of death.

If symptoms of an aortic aneurysm do appear, they might include:

• Difficulty breathing

• Loss of appetite

• Pain in your neck, jaw, chest, stomach, back, or shoulder

• Throbbing or pulsating around your stomach

• Shortness of breath

• Swelling in your face or limbs

Atherosclerosis is characterized by the build-up of plaque inside your arteries. It develops due to damage to the innermost layer of your arteries — the endothelium. It’s a form of vascular disease, which is a broad term for conditions that affect your blood vessels.

Causes of Atherosclerosis 

Atherosclerosis is caused by damage to your arteries that triggers a cascade of events that leads to plaque build-up. 

Once your endothelium is damaged, your body produces inflammation as a defense mechanism. This inflammation can cause cholesterol and other substances to collect along the site of the damage.

Damage to your your arteries can develop for many reasons such as:

• High blood pressure

• Chronically high blood sugar levels in the case of diabetes

• Diet high in cholesterol and saturated fat

• Some inflammatory diseases such as rheumatoid arthritis that lead to chronic inflammation

• Increased age

Risk factors for atherosclerosis can be divided into modifiable and nonmodifiable, depending on whether they’re under your control.

Risk Factors for Atherosclerosis

The following are some of the modifiable and nonmodifiable risk factors for atherosclerosis.

Non-Modifiable Risk Factors

Non-modifiable risk factors for atherosclerosis include:

• Increasing age, with the highest risk after ages 45 in men and 55 in women

• Being assigned male at birth

• Family history, especially having a genetic disorder called familial hypercholesterolemia

• Having an underlying inflammatory disease such as psoriasis or rheumatoid arthritis

Modifiable Risk Factors

The following risk factors may be controllable or somewhat controllable:

• Eating a diet high in saturated fat

• Smoking

• Diabetes

• High blood pressure

• Chronic kidney disease

• High cholesterol

• Physical inactivity

• Obesity

• High-stress lifestyle

The diagnostic process for atherosclerosis often starts by visiting your primary healthcare provider. If you’re diagnosed with atherosclerosis, they may refer you to a cardiologist or other specialist. A cardiologist specializes in cardiology, which is the study of your heart and blood vessels.

Diagnosing Atherosclerosis 

Your doctor may screen you for atherosclerosis during a general check-up or order tests if they suspect you might have a problem with your heart or blood vessels. Initial tests usually include:

• A physical exam where they look for signs of heart problems such as a:

  • Abnormal blood flow sounds in your neck, abdomen, or groin

  • Weak pulse

  • Abnormal heart rhythm

  • Poorly healing wounds

• A review of your personal and family medical history

• A review of your symptoms

You might receive blood tests to look for risk factors for atherosclerosis. Blood tests might check your:

• Cholesterol levels

• Triglyceride and lipid levels

• Blood sugar levels

• Inflammation levels

Imaging tests can help doctors see how well blood is moving through your blood vessels. You might receive:

• An ultrasound to measure blood flow

• Angiography, which involves injecting a dye into your blood vessel to help doctors see obstructions with X-rays or computed tomography (CT) scans

• Coronary calcium scan, a type of CT scan that measures calcium build-up in the arteries supplying your heart

Other tests can include:

• Ankle-brachial index (ABI) testing to compare blood pressure in your ankle and arm to help detect peripheral artery disease.

• Electrocardiogram (ECG) to measure the electrical activity of your heart

• Exercise stress tests to assess your heart's function and response to exercise

The primary treatment for atherosclerosis is making lifestyle changes to help prevent the further build-up of plaque in your blood vessels. You may also need to take medications or receive a procedure. 

Atherosclerosis Treatment

Lifestyle changes you can make to help improve atherosclerosis include:

• Eating heart-healthy foods such as plenty of:

  • Fruits

  • Vegetables

  • Lean proteins

  • Unprocessed foods

• Staying physically active, ideally with more than 150 minutes of moderate physical activity per week

• Maintaining or achieving a healthy weight

• Limiting your alcohol consumption, ideally to less than 2 drinks per day for men or 1 drink per day or less for women

• Including more stress-relieving activities in your daily routine

• Quitting or avoiding smoking

• Getting enough sleep, ideally 7 to 9 hours per day

If lifestyle changes alone aren't enough to manage your atherosclerosis, your doctor might recommend medications to treat underlying conditions such as high blood pressure. Some of the medications you might receive include:

• ACE inhibitors, calcium channel blockers, or beta blockers for high blood pressure

• Blood thinners for people at risk for blood clots

• Medications to help lower your blood sugar

• Metformin to help control plaque for people with diabetes

• Nitrates to reduce chest pain from angina

• Ranolazine for coronary microvascular disease

• Statins or other medications to treat high cholesterol levels

• Medications to treat blood clots

If your doctor thinks that you’re at a high risk of developing complications, they may recommend one of several procedures such as:

• Percutaneous coronary intervention (coronary angioplasty with stent placement): A percutaneous coronary intervention involves opening up a narrowed artery in your heart with a thin tube called a catheter that’s inserted into your bloodstream.

• Coronary artery bypass grafting (CABG): A bypass surgery improves blood flow to your heart by taking another blood vessel from somewhere else in your body and using it to create a new passage for blood to circulate around a blockage in your heart.

• Carotid endarterectomy: A carotid endarterectomy is a minimally invasive procedure to remove plaque from within your carotid artery, the main blood vessel that carries blood to your brain. Your doctor will make a small incision into this blood vessel.

Some people are more genetically prone to atherosclerosis than others. You can lower your risk of atherosclerosis by making healthy lifestyle changes.

Atherosclerosis can largely be prevented by making lifestyle changes such as eating a healthy diet and losing weight if you’re overweight.

Atherosclerosis Prevention Tips

You can reduce your chances of developing atherosclerosis by taking steps to support your heart health such as eating a healthy diet and exercising regularly.

The American Heart Association recommends the following for lowering your risk of stroke and heart disease:

• Learning about your risk factors for heart disease

• Eating a healthy overall diet

• Staying physically active

• Maintaining or achieving a healthy weight

• Avoiding tobacco products

• Managing underlying conditions such as high blood pressure or high cholesterol

• Taking your medications as prescribed

• Asking questions of your healthcare team

The National Heart, Lung, and Blood Institute promotes the DASH diet for controlling high blood pressure and maximizing your heart health. The DASH diet involves eating more:

• Fruits, vegetables, and whole grains

• Fat-free or low-fat dairy

• Fish, poultry, beans, nuts, and vegetable oils

And less:

• Foods high in saturated fat, such as fatty meats, full-fat dairy, and tropical oils like coconut oil

• Drinks with added sugar

• Salt

• Sweets and highly processed foods