Question

Dr. Reilly has a patient who asks her a question about atherosclerosis, since his brother was diagnosed with this condition. How would she describe what atherosclerosis is?

Answer 1

Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque.

Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body.

As you get older, fats, cholesterol, and calcium can collect in your arteries and form plaque.

The buildup of plaque makes it difficult for blood to flow through your arteries.

This buildup may occur in any artery in your body, including your heart, legs, and kidneys.

It can result in a shortage of blood and oxygen in various tissues of your body.

Pieces of plaque can also break off, causing a blood clot. If left untreated, atherosclerosis can lead to heart attack, stroke, or heart failure.

Atherosclerosis is a fairly common problem associated with aging. This condition can be prevented and many successful treatment options exist.

What causes atherosclerosis?

Plaque buildup and subsequent hardening of the arteries restricts blood flow in the arteries, preventing your organs and tissues from getting the oxygenated blood they need to function.

The following are common causes of hardening of the arteries:

High cholesterol

Cholesterol is a waxy, yellow substance that’s found naturally in the body as well as in certain foods you eat.

If the levels of cholesterol in your blood are too high, it can clog your arteries. It becomes a hard plaque that restricts or blocks blood circulation to your heart and other organs.

Diet

It’s important to eat a healthy diet. The American Heart Association (AHA) recommends that you follow an overall healthy dietary pattern that stresses:

• a wide range of fruits and vegetables
• whole grains
• low-fat dairy products
• poultry and fish, without skin
• nuts and legumes
• non-tropical vegetable oils, such as olive or sunflower oil

Some other diet tips:

• Avoid foods and drinks with added sugar, such as sugar-sweetened beverages, candy, and desserts. The AHA recommends no more than 6 teaspoons or 100 calories of sugar a day for most women, and no more than 9 teaspoons or 150 calories a day for most men.
• Avoid foods high in salt. Aim to have no more than 2,300 milligrams (mg) of sodium per day. Ideally, you’d consume no more than 1,500 mg a day.
• Avoid foods high in unhealthy fats, such as trans fats. Replace them with unsaturated fats, which are better for you. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.

Aging

As you age, your heart and blood vessels work harder to pump and receive blood. Your arteries may weaken and become less elastic, making them more susceptible to plaque buildup.

Who’s at risk for atherosclerosis?

Many factors place you at risk for atherosclerosis. Some risk factors can be modified, while others can’t.

Family history

If atherosclerosis runs in your family, you may be at risk for hardening of the arteries. This condition, as well as other heart-related problems, may be inherited.

Lack of exercise

Regular exercise is good for your heart. It keeps your heart muscle strong and encourages oxygen and blood flow throughout your body.

Living a sedentary lifestyle increases your risk for a host of medical conditions, including heart disease.

High blood pressure

High blood pressure can damage your blood vessels by making them weak in some areas. Cholesterol and other substances in your blood may reduce the flexibility of your arteries over time.

Smoking

Smoking tobacco products can damage your blood vessels and heart.

Diabetes

People with diabetes have a much higher incidence of coronary artery disease (CAD).

What are the symptoms of atherosclerosis?

Most symptoms of atherosclerosis don’t show up until a blockage occurs. Common symptoms include:

• chest pain or angina
• pain in your leg, arm, and anywhere else that has a blocked artery
• shortness of breath
• fatigue
• confusion, which occurs if the blockage affects circulation to your brain
• muscle weakness in your legs from lack of circulation

It’s also important to know the symptoms of heart attack and stroke. Both of these can be caused by atherosclerosis and require immediate medical attention.

The symptoms of a heart attack include:

• chest pain or discomfort
• pain in the shoulders, back, neck, arms, and jaw
• abdominal pain
• shortness of breath
• perspiration
• lightheadedness
• nausea or vomiting
• a sense of impending doom

The symptoms of stroke include:

• weakness or numbness in the face or limbs
• trouble speaking
• trouble understanding speech
• vision problems
• loss of balance
• sudden, severe headache

How is atherosclerosis diagnosed?

Your doctor will perform a physical checkup if you have symptoms of atherosclerosis. They’ll check for:

• a weakened pulse
• an aneurysm, an abnormal bulging or widening of an artery due to weakness of the arterial wall
• slow wound healing, which indicates a restricted blood flow

A cardiologist may listen to your heart to see if you have any abnormal sounds. They’ll be listening for a whooshing noise, which indicates that an artery is blocked. Your doctor will order more tests if they think you may have atherosclerosis.

Tests can include:

• a blood test to check your cholesterol levels
• a Doppler ultrasound, which uses sound waves to create a picture of the artery that shows if there’s a blockage
• an ankle-brachial index (ABI), which looks for a blockage in your arms or legs by comparing the blood pressure in each limb
• a magnetic resonance angiography (MRA) or a computed tomography angiography (CTA) to create pictures of the large arteries in your body
• a cardiac angiogram, which is a type of chest X-ray that’s taken after your heart arteries are injected with radioactive dye
• an electrocardiogram (ECG or EKG), which measures the electrical activity in your heart to look for any areas of decreased blood flow
• a stress test, or exercise tolerance test, which monitors your heart rate and blood pressure while you exercise on a treadmill or stationary bicycle

How is atherosclerosis treated?

Treatment involves changing your current lifestyle to decrease the amount of fat and cholesterol you consume. You may need to exercise more to improve the health of your heart and blood vessels.

Unless your atherosclerosis is severe, your doctor may recommend lifestyle changes as the first line of treatment. You may also need additional medical treatments, such as medications or surgery.

Medications

Medications can help prevent atherosclerosis from worsening.

Medications for treating atherosclerosis include:

• cholesterol-lowering medications, including statins and fibrates
• angiotensin-converting enzyme (ACE) inhibitors, which may help prevent narrowing of your arteries
• beta-blockers or calcium channel blockers to lower your blood pressure
• diuretics, or water pills, to help lower your blood pressure
• anticoagulants and antiplatelet drugs such as aspirin to prevent blood from clotting and clogging your arteries

Aspirin is particularly effective for people with a history of atherosclerotic cardiovascular disease (e.g., heart attack and stroke). An aspirin regimen can reduce your risk of having another health event.

If there's no prior history of atherosclerotic cardiovascular disease, you should only use aspirin as a preventive medication if your risk of bleeding is low and your risk of atherosclerotic cardiovascular disease is high.

Surgery

If symptoms are especially severe or if muscle or skin tissue are endangered, surgery may be necessary.

Possible surgeries for treating atherosclerosis include:

• bypass surgery, which involves using a vessel from somewhere else in your body or a synthetic tube to divert blood around your blocked or narrowed artery
• thrombolytic therapy, which involves dissolving a blood clot by injecting a drug into your affected artery
• angioplasty, which involves using a catheter and a balloon to expand your artery, sometimes inserting a stent to leave the artery open
• endarterectomy, which involves surgically removing fatty deposits from your artery
• atherectomy, which involves removing plaque from your arteries by using a catheter with a sharp blade at one end

What should you expect in the long term?

With treatment, you may see improvement in your health, but this may take time. The success of your treatment will depend on:

• the severity of your condition
• how promptly it was treated
• whether other organs were affected

Hardening of the arteries can’t be reversed. However, treating the underlying cause and making healthy lifestyle and dietary changes can help slow down the process or prevent it from getting worse.

You should work closely with your doctor to make the appropriate lifestyle changes. You’ll also need to take the proper medications to control your condition and avoid complications.

What complications are associated with atherosclerosis?

Atherosclerosis can cause:

• heart failure
• heart attack
• abnormal heart rhythm
• stroke
• death

It’s also associated with the following diseases:

Coronary artery disease (CAD)

The coronary arteries are blood vessels that provide your heart’s muscle tissue with oxygen and blood. Coronary artery disease (CAD) occurs when the coronary arteries become hard.

Carotid artery disease

The carotid arteries are found in your neck and supply blood to your brain.

These arteries may be compromised if plaque builds up in their walls. The lack of circulation may reduce how much blood and oxygen reaches your brain’s tissue and cells. Learn more about carotid artery disease.

Peripheral artery disease

Your legs, arms, and lower body depend on your arteries to supply blood and oxygen to their tissues. Hardened arteries can cause circulation problems in these areas of the body.

Kidney disease

The renal arteries supply blood to your kidneys. Kidneys filter waste products and extra water from your blood.

Atherosclerosis of these arteries may lead to kidney failure.

Which lifestyle changes help treat and prevent atherosclerosis?

Lifestyle changes can help to prevent as well as treat atherosclerosis, especially for people with type 2 diabetes.

Helpful lifestyle changes include:

• eating a healthy diet that’s low in saturated fat and cholesterol
• avoiding fatty foods
• adding fish to your diet twice per week
• getting at least 75 minutes of vigorous exercise or 150 minutes of moderate exercise each week
• quitting smoking if you’re a smoker
• losing weight if you’re overweight or obese
• managing stress
• treating conditions associated with atherosclerosis, such as hypertension, high cholesterol, and diabetes

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