Atherosclerosis

Atherosclerosis is a slow disease where arteries become clogged and hardened. It can lead to heart attack, stroke, and vascular dementia.

Atherosclerosis is found in 80 to 90% of Americans over the age of 30. Fat, cholesterol, calcium, and other substances form plaque, which builds up in arteries. Hard plaque narrows the passage that blood flows through. That causes arteries to become stiff and inflexible (atherosclerosis is also known as hardening of the arteries). It contributes to the development of cardiovascular disease, which is the leading cause of death in people over 45. Soft plaque is more likely to break free from the artery wall and cause a blood clot, which can block blood flow to vital organs.

The effects of atherosclerosis differ depending upon which arteries in the body narrow and become clogged with plaque. If the arteries that bring oxygen-rich blood to your heart are affected, you may have coronary artery disease, chest pain, or a heart attack. If the arteries to your brain are affected, you may have a transient ischemic attack (TIA) or a stroke. If the arteries in your arms or legs are affected, you may develop peripheral artery disease. You may also develop a bulge in the artery wall (aneurysm).

Lowering blood pressure and LDL (“bad”) cholesterol levels, eating a healthy diet with lots of fruits and vegetables, quitting smoking, losing weight, and getting more exercise can prevent atherosclerosis.

Many times, people with atherosclerosis do not have any symptoms until an artery is 40% clogged with plaque. Symptoms vary depending upon which arteries are affected.

Symptoms of coronary artery disease (where the heart arteries narrow) are usually brought on by physical exercise, sexual activity, exposure to cold weather, anger, or stress. Common symptoms include:

  • Chest pain (generally a heavy, squeezing, or crushing sensation with possible burning or stabbing pains)
  • Abdominal, neck, back, jaw, or shoulder/arm pain
  • Weakness
  • Perspiration
  • Shortness of breath

Cerebrovascular disease (where the arteries that supply the brain with blood are narrowed) can cause transient ischemic attack (a sudden loss of brain function with complete recovery within 24 hours) and stroke. Symptoms may include:

  • Weakness or paralysis on one side of the body
  • Trouble speaking or understanding speech
  • Loss of vision in one eye
  • Muscle weakness
  • Sudden trouble walking
  • Dizziness
  • Loss of balance or coordination
  • Sudden severe headache

Peripheral artery disease affects the arteries that supply the arms and legs with oxygen-rich blood. Symptoms may include:

  • Pain, aching, cramps, numbness, or sense of fatigue in the leg muscles (intermittent claudication)
  • “Bruits” (blowing sounds your doctor can hear with a stethoscope that indicate turbulence in blood flow)
  • Hair loss
  • Thickened nails
  • Smooth, shiny skin surface
  • Skin that is cold to the touch
  • Gangrene

What Causes It?

No one knows the exact cause of atherosclerosis, although they do know what causes it to get worse. Many researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. Researchers believe the following factors contribute to the damage:

  • High blood pressure
  • Elevated LDL (“bad”) cholesterol
  • An accumulation of homocysteine. An amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia.
  • Smoking
  • Diabetes
  • Inflammation
  • Overweight or obesity
  • Unhealthy diet
  • Lack of exercise
  • Family history of heart disease

Once the artery is damaged, blood cells called platelets build up there to try and heal the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The blood flow through the artery is decreased, and the oxygen supply to organs also decreases. Blood clots may form, blocking the artery and cutting off blood supply to other organs.

Some people do not have the classic risk factors of atherosclerosis (such as cigarette smoking and high blood pressure). It is possible that there may be other causes, such as an infection. Research is ongoing.

Risk Factors

Risk factors for atherosclerosis may include:

  • Being male
  • If female, being past menopause.
  • High blood pressure
  • High LDL (“bad”) cholesterol or triglycerides (fats in the blood)
  • Low HDL (“good”) cholesterol
  • Diabetes
  • Being overweight
  • Smoking
  • A family history of heart disease, stroke, or arterial disease
  • Elevated homocysteine levels
  • Sedentary lifestyle
  • Diets high in saturated fat and trans fatty acids (trans fats)
  • Depression
  • Obstructive sleep apnea

What to Expect at Your Doctor’s Office

Your doctor can determine your risk for heart disease by conducting certain tests. Blood tests can show high levels of cholesterol, homocysteine, and blood clotting factors.

A stress test (also known as an exercise tolerance test) monitors your heart rate and blood pressure while you walk on a treadmill or ride a stationary bicycle. An electrocardiogram (ECG) is used during a stress test to detect abnormal heart rhythms, scar tissue in the heart muscle from a prior heart attack, and areas of decreased blood flow to the heart.

Imaging techniques used during a stress test (such as an ultrasound) can pinpoint areas where blood flow to the heart may be reduced. An angiogram (or angiography), where your doctor injects a dye into your arteries and then performs a chest x-ray, can reveal areas of damage and plaque buildup.

Preventive Care

Leading a healthy lifestyle can help prevent atherosclerosis.

  • Stop smoking.
  • Exercise at least 30 minutes a day, 6 days a week.
  • Eat healthy foods, such as fruits, vegetables, and whole grains that are low in saturated fat and high in fiber.
  • Maintain a normal weight (or lose weight if you need to).
  • Reduce stress.
  • If you have high blood pressure, high cholesterol, diabetes, or another chronic condition, work with your doctor to keep it in check.
  • Talk to your doctor about adding supplements to your diet.

Treatment Options

Healthy lifestyle choices are important in preventing and treating atherosclerosis. Your doctor may prescribe drugs to lower your cholesterol or blood pressure and to prevent complications. Nutrition and dietary supplements may help reduce your risk when used along with certain medications.

Prognosis and Complications

Some complications of atherosclerosis may include:

  • Heart disease
  • Heart failure
  • Abnormal heart rhythms
  • Stroke
  • Heart attack
  • Poor blood supply to certain parts of the body (such as the legs or intestines)
  • Kidney failure
  • Death

The outlook for atherosclerosis varies from person to person. People with atherosclerosis should work closely with their doctors to make appropriate lifestyle changes and, if needed, take the proper medications to control their condition and avoid complications.