Atherosclerosis is an inflammation process in the blood vessels due to a build up of plaque. The build up is made of fatty deposits, cholesterol, and calcium. Over time, the plaque and inflammation can narrow and harden the arteries.
Plaque buildup can slow and even stop blood flow. This can lead to pain or problems with tissue that depend on the blood flow. Depending on the location of the blockage, atherosclerosis can lead to:
- Coronary heart disease (CAD)—loss of blood flow to areas of the heart
- Stroke —loss of blood flow to areas of the brain
- Peripheral artery disease (PAD)—loss of blood flow to the extremities
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Plaque can weaken the inner walls of the arteries. If the wall tears, a blood clot can form. The blood clot can further slow or even stop the flow of blood through the blood vessel. Long-term atherosclerosis can also cause arteries to weaken and bulge. This bulge is called an aneurysm. If untreated, it can rupture and bleed.
Atherosclerosis is caused by plaque. Plaque is created by high levels of cholesterol and fat in the blood. Scar tissue and calcium from previous injury can also add to the plaque buildup.
Men, especially those over 45 years of age, are more likely to have this condition. Atherosclerosis is more common in women over 55 years of age. Other factors that may increase the chances of atherosclerosis:
- Family history of the disease
- High cholesterol —Especially low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol
- High blood pressure
- Poor diet
- Cigarette smoking
- Diabetes type 1 and type 2
- Excess weight and obesity
- Lack of physical activity
- Metabolic syndrome
—A combination of 3 out of the following 5 findings:
- Low HDL-cholesterol—Also called good cholesterol
- High triglycerides
- Elevated blood sugar
- Elevated blood pressure
- Increased waist circumference—greater than 40 inches in men and 35 inches in women
Early atherosclerosis does not have any symptoms. Symptoms may begin to appear as the arteries become harder and narrow. A blockage from a clot can cause sudden symptoms.
Symptoms depend on which arteries are affected. For example:
- Coronary arteries of the heart—May cause symptoms of heart disease, such as chest pain
- Arteries to the brain—May cause symptoms of a stroke such as weakness, vision problems, speech problems, or headache
- Arteries in the lower extremities—May cause pain in the legs or feet and trouble walking
Most people are diagnosed after they develop symptoms. However, people can be screened and treated for risk factors.
You will be asked questions to help determine what arteries might be affected. You will also be asked about your symptoms and medical history. A physical exam will be done. Tests will depend on which arteries may be involved. Many of these tests detect problems with the tissue that is not getting enough blood.
Tests that evaluate the atherosclerotic arteries are:
An important part of treatment is reducing risk factors. To do so, see the steps in the prevention section below. Treatment depends on the area of the body most affected.
Treatment may include:
- Make it difficult for blood clots to form
- Control blood pressure if elevated—high blood pressure can damage blood vessel walls
- Lower cholesterol if elevated
- Improve the flow of blood through narrowed arteries
A thin tube called a catheter is inserted into an artery and passed to the diseased area. Tools are passed through this catheter to repair blood vessels. It allows the doctor to access blood vessels throughout the body without having to use large incisions. Procedures that can be done through a catheter include:
- Balloon angioplasty —A balloon-tipped catheter is used to press plaque against the wall of the artery. This increases the amount of space for the blood to flow.
- Stenting—Usually done after angioplasty. A wire mesh tube is placed in a damaged artery. It will support the wall of the artery and keep it open.
- Atherectomy —Instruments are inserted via catheter. They are used to cut away and remove plaque so that blood can flow more easily. This procedure is not used as often.
Surgical options include:
- Endarterectomy —Removal of the lining of an artery obstructed with large plaques. This is often done in carotid arteries of the neck. These arteries bring blood to the brain.
- Arterioplasty— Repair of an aneurysm. It is usually done with synthetic tissue.
- Bypass —Creates a new path for blood to flow around a blocked area, often uses vein from leg.
To help prevent and reverse atherosclerosis:
- Eat a healthful diet. It should be low in saturated fat and cholesterol. Aim for a diet rich in whole grains, fruits, and vegetables.
- Exercise regularly.
- Maintain a healthy weight. If you are overweight, talk to a registered dietitian who can help you lose weight safely.
- Don't smoke. If you smoke, talk to your doctor about ways to quit.
- Control any chronic conditions you may have such as diabetes.
- If your doctor recommends it, take medication to reduce your risk factors. This may include medication for high blood pressure or high cholesterol.
- Talk to your doctor about screening tests for CAD if you have risk factors.
American Heart Association
National Heart, Lung, and Blood Institute
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
Atherosclerosis. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Atherosclerosis_UCM_305564_Article.jsp#.Wpg9d2rwZQI. Updated November 16, 2017. Accessed March 1, 2018.
Atherosclerosis. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/atherosclerosis. Accessed March 1, 2018.
Coronary artery disease. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116156/Coronary-artery-disease-CAD. Updated February 28, 2018. Accessed March 1, 2018.
Heart and stroke statistics. American Heart Association website. Available at: http://www.heart.org/HEARTORG/General/Heart-and-Stroke-Association-Statistics_UCM_319064_SubHomePage.jsp. Accessed March 1, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 2/2/2018