What is Atherosclerosis (Hardening of the Arteries)?

Arteriosclerosis and atherosclerosis are sometimes used to mean the same thing. However, there is a difference between the two terms.

Arteriosclerosis It occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body thicken and harden. These blood vessels are called arteries. Healthy arteries are flexible and elastic. However, over time, the walls of the arteries can harden, a condition commonly called hardening of the arteries.

Atherosclerosis It is a special type of arteriosclerosis.

Atherosclerosis is the buildup of fat, cholesterol, and other substances in and on the walls of your arteries. This buildup is called plaque. Plaque can narrow your arteries and block blood flow. Plaque can also burst, causing a blood clot.

Although atherosclerosis is generally considered a heart condition, it can affect arteries anywhere in the body. Atherosclerosis is treatable. Healthy lifestyle habits can help prevent atherosclerosis.

Symptoms of Atherosclerosis

Mild atherosclerosis often has no symptoms.

Symptoms of atherosclerosis usually don’t appear until an artery becomes so narrow or blocked that it can’t send enough blood to organs and tissues. Sometimes a blood clot blocks blood flow completely. The clot can break off. If this happens, it can cause a heart attack or stroke.

The symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example, if you have atherosclerosis that:

• In your heart arteries,You may experience chest pain or pressure called angina.
• In the arteries leading to your brain,sudden numbness or weakness in your arms or legs, slurred speech, sudden or temporary loss of vision in one eye, or sagging muscles in your face. These are signs of a transient ischemic attack (TIA). An untreated TIA can lead to a stroke.
• In the arteries in your arms and legs,You may experience leg pain when walking, called claudication. This is a symptom of peripheral arterial disease (PAD). You may also have lower blood pressure in the affected arm or leg.
• In the arteries leading to your kidneys,You may experience high blood pressure or kidney failure.

When should I see a doctor?

If you think you have atherosclerosis, make an appointment for a checkup. Early detection and treatment can stop atherosclerosis from getting worse. Treatment can prevent a heart attack, stroke, or other medical emergency.

Get emergency medical help if you have chest pain or symptoms of a transient ischemic attack or stroke:

• Sudden numbness or weakness in arms or legs.
• I have trouble speaking.
• Speech disorder.
• Sudden or temporary loss of vision in one eye.
• Sagging facial muscles.

Causes of Atherosclerosis

Atherosclerosis is a disease that slowly worsens. It can begin as early as childhood. The exact cause is unknown. It begins with damage or injury to the inner lining of an artery. Arterial damage can result from:

• Hypertension.
• High cholesterol.
• High levels of triglycerides, a type of fat found in the blood.
• Use of cigarettes or other tobacco products.
• Diabetes.
• Insulin resistance.
• Obesity.
• Inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis, or inflammatory bowel disease.

When the inner wall of an artery is damaged, blood cells and other substances can collect at the site of the injury. These substances accumulate in the inner lining of the artery.

Over time, fats, cholesterol, and other substances also build up on and inside the walls of your heart arteries. This buildup is called plaque. Plaque can cause your arteries to narrow. The narrowed arteries can block blood flow. Plaque can also burst, causing a blood clot.

Risk factors

Atherosclerosis risk factors that you cannot control include:

• Aging.
• Having a family history of heart disease or stroke at an early age.
• Changes in genes that increase the likelihood of developing atherosclerosis.
• Having inflammatory conditions such as lupus, inflammatory bowel disease, or psoriasis.

Risk factors for atherosclerosis that you can control include:

• Unhealthy diet.
• Diabetes.
• Hypertension.
• High cholesterol.
• Lack of exercise.
• Obesity.
• Sleep apnea.
• Use of cigarettes and other tobacco products.

Complications

Complications of atherosclerosis depend on which arteries are narrowed or blocked, such as:

Coronary artery disease:Atherosclerosis in the arteries near the heart can lead to coronary artery disease, which can cause chest pain, heart attack, or heart failure.

Carotid artery disease:This is atherosclerosis in the arteries near the brain. Complications include transient ischemic attack (TIA) or stroke.

Peripheral artery disease:This is atherosclerosis in the arteries in the arms or legs. Complications include blockage or alteration of blood flow to the affected areas. Rarely, the lack of blood flow can cause tissue death, called gangrene.

Aneurysms: Sometimes atherosclerosis can cause a bulge in the wall of an artery. This is called an aneurysm. An aneurysm can occur anywhere in the body. Most people with an aneurysm have no symptoms. If an aneurysm ruptures, it can cause life-threatening bleeding inside the body.

Chronic kidney disease:Atherosclerosis can cause the arteries leading to the kidneys to narrow. This prevents the kidneys from getting enough oxygen-rich blood. The kidneys need blood flow to help remove fluids and waste products from the body.

Prevention

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These lifestyle changes can help keep arteries healthy:

• Do not use cigarettes or tobacco products.
• Consume nutritious foods.
• Exercise regularly and have an active lifestyle.
• Maintain a healthy weight.
• Control blood pressure, blood sugar and cholesterol.

Diagnosis

To diagnose atherosclerosis, your health care provider will examine you and listen to your heart. They’ll usually ask about your symptoms and family health history. You may be referred to a doctor who is trained in heart disease, called a cardiologist.

Your healthcare provider may hear a murmur when listening to your heart with a stethoscope.

Tests

Coronary calcium scan

Tests may be done to check the health of your heart and arteries. Tests can help diagnose atherosclerosis and find its cause.

Blood tests:Blood tests can check blood sugar and cholesterol levels. High blood sugar and cholesterol levels increase the risk of atherosclerosis. A C-reactive protein (CRP) test may also be done to check for a protein linked to inflammation of the arteries.

Electrocardiogram (ECG or EKG):This quick, painless test measures the electrical activity of your heart. During an EKG, sticky patches with sensors on them are placed on your chest and sometimes your arms or legs. Wires connect the sensors to a machine that displays or prints the results. An EKG can show if blood flow to your heart is decreasing.

Exercise stress tests:These tests usually involve walking on a treadmill or riding a stationary bike while your heart’s activity is monitored. Because exercise causes your heart to pump harder and faster than it does during most daily activities, an exercise stress test can reveal heart conditions that might otherwise be missed. If you can’t exercise, you may be given a medication that affects your heart in the same way that exercise does.

Echocardiogram:This test uses sound waves to show blood flow through the heart. It also shows the size and shape of the heart’s structures. Sometimes an echocardiogram is done during an exercise stress test.

Doppler ultrasonography:A healthcare provider may use a special ultrasound device to check blood flow in different parts of your body. The test results show the speed of blood flow in your arteries. This can reveal narrowed areas.

Ankle-brachial index (ABI):This test compares the blood pressure in your ankle with the blood pressure in your arm. It is done to check for atherosclerosis in the arteries in your legs and feet. A difference between the ankle and arm measurements may be due to peripheral artery disease.

Cardiac catheterization and angiography:This test can show if your coronary arteries are narrowed or blocked. A doctor inserts a long, thin, flexible tube into a blood vessel, usually in your groin or wrist, and guides it to your heart. Dye flows through the catheter into your heart’s arteries. The dye helps your arteries show up more clearly in images taken during the test.

A coronary calcium scan is also known as a heart scan:This test uses computerized tomography (CT) imaging to look for calcium deposits in your artery walls. A coronary calcium scan can show coronary artery disease before you have symptoms. The results of the test are given as a score. The higher the calcium score, the greater your risk of heart attack.

Other imaging tests:Magnetic resonance angiography (MRA) or positron emission tomography (PET) also may be used to examine the arteries. These tests can show hardening and narrowing of large arteries, as well as aneurysms.

Treatment

Treatment of atherosclerosis may include:

• Lifestyle changes such as eating healthy and exercising more.
• Medicines.
• Heart surgery.
• Heart surgery.

For some people, lifestyle changes may be the only treatment needed for atherosclerosis.

Medicines

Many different medications can slow or even reverse the effects of atherosclerosis. Medications that treat atherosclerosis may include:

Statins and other cholesterol medications:These medications can help lower low-density lipoprotein (LDL) cholesterol, also called “bad” cholesterol. The medications can also reduce plaque formation. Some cholesterol medications can reverse the formation of fatty deposits in your arteries.
Statins are a common type of cholesterol medication. Other types include niacin, fibrates, and bile acid sequestrants. You may need more than one type of cholesterol medication.

Aspirin: Aspirin helps thin the blood and prevent blood clots. Daily low-dose aspirin therapy may be recommended for the primary prevention of heart attack or stroke in certain people. Primary prevention means that you have not had a heart attack or stroke before. You have not had a coronary bypass surgery or coronary angioplasty with stents. You have not had blocked arteries in your neck, legs, or other parts of your body before. However, you take a daily aspirin to prevent these types of heart events. The benefits of aspirin for this use are debated. Do not start taking a daily aspirin without talking to a health care professional.

Blood pressure medication:Medications that lower blood pressure don’t help reverse atherosclerosis. Instead, they prevent or treat complications associated with the disease. For example, some blood pressure medications can help reduce the risk of heart attack.

Other medications:Medications may be used to control other conditions that increase the risk of atherosclerosis. Diabetes is one example. Medications may also be given to treat certain symptoms of atherosclerosis, such as leg pain during exercise.

Fibrinolytic therapy:If a clot in an artery is blocking blood flow, your healthcare provider may use clot-busting medication to break it up. This therapy is usually used in emergency situations.

Surgery or other procedures

If atherosclerosis is causing a serious blockage in your artery, you may need a procedure or surgery to treat it.

Surgery or procedures for atherosclerosis may include:

Angioplasty and stent placement: also called percutaneous coronary intervention. This treatment helps to open a blocked or clogged artery. A doctor guides a thin, flexible tube called a catheter into the narrowed part of the artery. A small balloon is inflated to help widen the blocked artery and improve blood flow. A small wire-mesh tube called a stent may be used to keep the artery open. Some stents slowly release medication to help keep the artery open.

Endarterectomy: This is an operation to remove fatty buildup from the walls of a narrowed artery. When the treatment is done on arteries in the neck, it is called a carotid endarterectomy.

Coronary artery bypass graft (CABG) surgery:The surgeon takes a healthy blood vessel from another part of the body to create a new path for blood through the heart. The blood then goes around the blocked or narrowed coronary artery. CABG is open-heart surgery. It’s usually done only in people who have multiple narrowed heart arteries.

Lifestyle and home remedies

Lifestyle changes can help keep arteries healthy and may also prevent or slow atherosclerosis. The American Heart Association recommends these eight heart-healthy tips:

Do not smoke, e-cigarette or use tobacco products:Also, stay away from cigarette smoke. Smoking damages the arteries. Smoking is a major risk factor for coronary artery disease. Nicotine tightens the blood vessels and forces the heart to work harder. Not smoking is one of the best ways to reduce the risk of complications of atherosclerosis, such as heart attack.

Exercise regularly:Staying active keeps the body healthy. Exercise at least 30 minutes a day, most days of the week. Talk to your healthcare team about the amount and type of exercise that’s best for you.

Maintain a healthy weight:Being overweight increases your risk of coronary artery disease from atherosclerosis. Even small amounts of weight loss can help reduce your risk. Ask your healthcare provider what weight is best for you.

Eat healthy foods:Choose fruits, vegetables and whole grains. Limit salt and saturated fats. Read food labels to check for salt and fat.

Manage stress:Find ways to reduce stress. Some ideas include getting more exercise, practicing mindfulness, and connecting with others in support groups. Or try yoga or deep breathing. These relaxation practices can temporarily lower blood pressure and reduce the risk of developing atherosclerosis.

Control blood pressure, blood sugar and cholesterol:Make lifestyle changes and take medications as directed. Get regular health checkups.

Limit alcohol:If you choose to drink alcohol, do so in moderation. For healthy adults, this means up to one drink per day for women and up to two drinks per day for men.

Sleep well:Poor sleep can increase the risk of heart disease and other health problems. Adults should aim for 7 to 9 hours of sleep per night.

Alternative medicine

Certain foods and herbal supplements may help lower cholesterol and blood pressure. These two conditions are important risk factors for developing atherosclerosis. Possible alternative medicine products for atherosclerosis include:

• Alpha-linolenic acid.
• Arpa.
• Beta-sitosterol is found in supplements and added to some margarines.
• Blond psyllium is found in seed husks and some fiber supplements.
• Cocoa.
• Fish oil.
• Garlic.
• Green tea.
• Oat bran is found in oatmeal and whole oats.
• Sitostanol is available in supplements and added to some margarines.

Talk to your healthcare provider before adding supplements to your atherosclerosis treatment. Some supplements change the way atherosclerosis medications work. This can cause harmful side effects.

Getting ready for your appointment

If you think you may have atherosclerosis or have a family history of heart disease, make an appointment for a checkup. Ask if you need a cholesterol test.

Here’s some information to help you prepare for your appointment:

What can you do?

Please note the following pre-appointment restrictions:When you make an appointment, ask if there’s anything you need to do before your visit. For example, you may be told not to eat or drink anything for a few hours before your cholesterol test.

If there are any symptoms, write down:Include any that don’t appear to be related to atherosclerosis. Always let your healthcare team know if you have symptoms like chest pain or shortness of breath. This type of information helps guide treatment.

Enter your important personal information:Include if you have a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes. Also note any major stress or recent life changes.

Make a list of all medications:Vitamins or supplements you are taking. Include dosages.

Take someone with you:If possible, someone who comes with you may remember something you forgot or missed.

Be prepared to talk:your diet and exercise habits. If you’re not already eating healthy or exercising, your healthcare team can give you tips on how to start.

Write down the questions to ask:consult your healthcare professional.

For atherosclerosis, some basic questions to ask your healthcare provider include:

• What tests will I need?
• What is the best treatment?
• Which foods should I eat and which ones should I not eat?
• What is the appropriate level of exercise?
• How often do I need a cholesterol test?
• What are the alternatives to the primary treatment you recommend?
• Is there a generic option for the medication you prescribe?
• I have other health issues. How can I best manage them together?
• Should I see a specialist?
• Are there any brochures or other printed materials I can take with me? What websites do you recommend?

If you have any further questions, don’t hesitate to ask.

What should you expect from your doctor?

Your healthcare team will likely ask many questions, including:

• Do you have a family history of high cholesterol, high blood pressure, or heart disease?
• How are your nutrition and exercise habits?
• Do you or have you ever used cigarettes or tobacco in any form?
• Do you experience chest pain or discomfort or pain in your legs when walking or at rest?
• Have you had a stroke, unexplained numbness, tingling, weakness on one side of your body, or difficulty speaking?

What can you do in the meantime?

It’s never too early to make healthy lifestyle changes. Eat healthy, be active, exercise more, and don’t smoke or vape. These are simple ways to protect yourself from atherosclerosis and its complications, such as heart attack and stroke.