Atherosclerosis (ath-er-o-skler-O-sis) is a disease in which plaque (plak) builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.
The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:
Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected.
- Coronary Heart Disease
- Carotid Artery Disease
- Peripheral Arterial Disease
- Chronic Kidney Disease
“Atherosclerosis starts when high blood pressure, smoking, or high cholesterol damage the endothelium,” says Richard Stein, MD, national spokesperson for the American Heart Association. “At that point, cholesterol plaque formation begins.”
Who Gets Atherosclerosis?
It might be easier to ask, who doesn’t get atherosclerosis?
Atherosclerosis starts early. In autopsies of young American soldiers killed in action in the Korean and Vietnam wars, half to three-quarters had early forms of atherosclerosis.
Even today, a large number of asymptomatic young people have evidence of atherosclerosis. A 2001 study of 262 apparently healthy people’s hearts may surprise you:
- 52% had some atherosclerosis
- Atherosclerosis was present in 85% of those older than 50
- 17% of teenagers had atherosclerosis
- No one had symptoms, and very few had severe narrowings in any arteries.
Signs and Symptoms :
Atherosclerosis usually doesn’t cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don’t know they have the disease until they have a medical emergency, such as a heart attack or stroke.
Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected.
The coronary arteries supply oxygen-rich blood to your heart. If plaque narrows or blocks these arteries (a disease called coronary heart disease, or CHD), a common symptom is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn’t get enough oxygen-rich blood.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
The carotid arteries supply oxygen-rich blood to your brain. If plaque narrows or blocks these arteries (a disease called carotid artery disease), you may have symptoms of a stroke. These symptoms may include:
- Sudden weakness
- Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body
- Trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Problems breathing
- Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
- Loss of consciousness
- Sudden and severe headache
Doctor will diagnose atherosclerosis based on your medical and family histories, a physical exam, and test results.
- Physical Exam
- Diagnostic Tests
- Blood Tests
- Chest X Ray
- Ankle/Brachial Index
- Computed Tomography Scan
- Stress Testing
Treatments for atherosclerosis may include lifestyle changes, medicines, and medical procedures or surgery.
The goals of treatment include:
- Relieving symptoms
- Reducing risk factors in an effort to slow or stop the buildup of plaque
- Lowering the risk of blood clots forming
- Widening or bypassing plaque-clogged arteries
- Preventing atherosclerosis-related diseases
- Lifestyle Changes
- Follow a Healthy Diet
- Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high blood cholesterol. TLC is a three-part program that includes a healthy diet, physical activity, and weight management.
- Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and salt.
- Be Physically Active
- Maintain a Healthy Weight
- Quit Smoking
- Manage Stress
- Medical Procedures and Surgery
- Coronary artery bypass grafting (CABG)
- Carotid endarterectomy
- Bypass surgery
Atherosclerosis is progressive, but it’s also preventable. For example, nine risk factors are to blame for upwards of 90% of all heart attacks:
- High cholesterol
- High blood pressure
- Abdominal obesity (“spare tire”)
- Not eating fruits and vegetables
- Excess alcohol intake (more than one drink for women, one or two drinks for men, per day)
- Not exercising regularly
- You may notice all of these have something in common: You can do something about them! Experts agree that reducing your risk factors leads to a lower risk of cardiovascular disease.
For people at moderate or higher risk — those who’ve had a heart attack or stroke, or who suffer angina — taking a baby aspirin a day can be important. Aspirin helps prevent clots from forming. Ask your doctor before starting daily aspirin, as it can have side effects.
Of the various atherosclerotic risk factors, which one is an absolute prerequisite for development of atherosclerosis?
The answer is hypercholesterolemia. What level of total cholesterol and specifically LDL cholesterol is required for atherosclerotic plaques to develop? Symptomatic and fatal atherosclerosis is extremely uncommon in societies where serum total cholesterol levels are <150 mg/dL and serum LDL cholesterol levels are <100 mg/dL (8). If the LDL cholesterol level is <100— and possibly it needs to be <80 mg/dL—the other previously mentioned risk factors in and of themselves are not associated with atherosclerosis. In other words, if the serum total cholesterol is 90 to 140 mg/dL, there is no evidence that cigarette smoking, systemic hypertension, diabetes mellitus, inactivity, or obesity produces atherosclerotic plaques. Hypercholesterolemia is the only direct atherosclerotic risk factor; the others are indirect. If, however, the total cholesterol level is >150 mg/dL and the LDL cholesterol is >100 mg/dL, the other risk factors clearly accelerate atherosclerosis.