Atherosclerosis is a slow disease in which your arteries become clogged and hardened. 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 hard and inflexible (atherosclerosis is also known as hardening of the arteries). It leads to 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.
Signs and Symptoms:
Many times, people with atherosclerosis have any symptoms until an artery is 40% clogged with plaque. Symptoms vary depending upon which arteries are affected.
Coronary Artery Disease
Symptoms of coronary artery disease (where the heart arteries are narrowed) are usually brought on by physical exercise, sexual activity, exposure to cold weather, anger, or stress. The most 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
- Shortness of breath
Cerebrovascular diseases (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
- Loss of balance or coordination
- Sudden severe headache
Peripheral Artery Disease
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
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. These factors are thought to 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)
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 or entering your bloodstream and cut off blood supply to other organs.
Because 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 for atherosclerosis include:
- eing male
- If female, being past menopause
- High blood pressure
- High LDL ("bad) cholesterol or triglycerides (fats in the blood)
- Being overweight
- A family history of heart disease
- Elevated homocysteine levels
- Sedentary lifestyle
- Diets high in saturated fat and trans fatty acids (trans fats)
What to Expect at Your Provider's Office:
Your doctor can determine your risk for heart disease by conducting some 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 decreased. 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.
You can prevent atherosclerosis by living a healthy lifestyle.
- 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.
To help prevent atherosclerosis or its complications (such as heart disease and stroke), make the following lifestyle changes:
- Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
- Do not drink more than one or two alcoholic drinks a day.
- Exercise regularly for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight.
Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family. Have your blood pressure checked more often if you have high blood pressure, heart disease, or you have had a stroke. Talk to your doctor about how often you should have yours checked. Specific recommendations depend on your age and blood pressure readings.
- Everyone should keep their blood pressure below 140/90 mmHg
- If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure should probably be less than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.
Have your cholesterol checked and treated if it is high.
- Adults should have their cholesterol checked every 5 years. If you are being treated for high cholesterol or a family history of cholesterol problems, you will need to have it checked more often.
- All adults should keep their LDL ("bad") cholesterol levels below 130-160 mg/dL.
- If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your LDL cholesterol should be lower than 100 mg/dL.
- Few medications have been found to clear up plaque. Statins and other cholesterol-lowering drugs can help prevent more plaque from forming.
Your doctor may suggest taking aspirin or another drug called clopidogrel (Plavix) to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your doctor.
Talk to your doctor about the safety of hormone replacement therapy for menopause.
Guidelines no longer recommend vitamins E or C, antioxidants, or folic acid to prevent heart disease.
A number of surgeries are performed to help prevent the complications of atherosclerosis. Some of these are:
- Angioplasty and stent - heart - discharge
- Angioplasty and stent placement - peripheral arteries
- Abdominal aortic aneurysm repair - open
- Coronary artery bypass surgery
- Carotid artery surgery
- Minimally invasive heart surgery