What is atherosclerosis?

Atherosclerosis happens when fatty deposits called plaque buildup in blood vessels and make them narrower. The narrowing decreases the amount of blood flow through the vessels. Plaque also increases the chance that blood clots may form and block a blood vessel, which can cause a heart attack or stroke.

Atherosclerosis affects mainly the medium-sized arteries, such as the heart (coronary) arteries, neck (carotid) arteries, brain (cerebral) arteries, and kidney (renal) arteries. It is also found in the aorta, which is the largest artery in the body, and in the smaller branches of the aorta that go to the arms and legs. Atherosclerosis tends to build up near branching points in the arteries.

Atherosclerosis gets worse over time and is more common as people get older. It is a leading cause of death and disability in the US.

What is the cause?

Risk factors that put you at higher risk for atherosclerosis are:

• Smoking
• High blood pressure
• Diabetes
• Obesity
• Lack of enough exercise
• Abnormal levels of blood fat, such as high LDL (bad) cholesterol, high triglycerides, or low HDL (good) cholesterol
• Close family members with heart disease

Atherosclerosis usually develops slowly. First, the inner lining of an artery is damaged. The damage is usually caused by several factors, such as high blood pressure and high blood cholesterol. Diabetes and viral infection are other possible causes of damage. As the artery tries to repair itself, the walls may thicken. Thickened areas are called plaque. As you get older, especially if you have diabetes, high blood pressure, or abnormal blood fat levels, plaque can grow larger. In time, plaque may block the artery enough to reduce the blood flow through it. When that happens, the part of the body beyond the narrowing starts to suffer from a lack of oxygen.

If plaque breaks open (ruptures), a blood clot forms. The clot may get big enough to block the flow of blood through the artery. This can cause a heart attack or stroke.

What are the symptoms?

Atherosclerosis may not be noticed for many years until it causes symptoms. The symptoms depend on where the narrowing is and may be constant or they may come and go. They may include problems such as:

• Pain or numbness in your arms or legs
• Pain in your chest (angina)
• Dizziness

Call 911 or your local emergency services for help right away if you have symptoms of a heart attack or stroke.

The most common symptoms of a heart attack include:

• Chest pain or pressure, squeezing, or fullness in the center of your chest that lasts more than a few minutes, or goes away and comes back (may feel like indigestion or heartburn)
• Pain or discomfort in one or both arms or shoulders, or in your back, neck, jaw, or stomach
• Trouble breathing
• Breaking out in a cold sweat for no known reason
• If your provider has prescribed nitroglycerin for angina, pain that does not go away after taking your nitroglycerin as directed

Along with these symptoms, you may also feel very tired, faint, or sick to your stomach.

To remember stroke symptoms and what to do, it helps to think of the word FAST (face, arm, speech, and time). Stroke symptoms come on FAST and may include:

• Face/Head
  • Weakness, numbness, drooping, or tingling of face (may just be on one side)
  • Trouble seeing (one or both eyes)
  • Severe headache
  • Trouble thinking
  • Trouble swallowing
  • Feeling dizzy along with one or more of the symptoms listed above
• Arm/Leg
  • Weakness, numbness, or tingling in your arm or leg (may be on just one side of your body)
  • Trouble walking or moving your arm or leg
• Speech
  • Trouble talking or understanding speech
• Time
  • Call 911 for emergency help right away if you have symptoms of a stroke.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• Angiogram, which is a series of X-rays taken after your healthcare provider injects a special dye into your blood vessels to show the walls of the arteries and any blockage
• Ultrasound, which uses sound waves to show pictures of your arteries
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat
• Doppler ultrasound, which uses sound waves to test for blockage and measure the speed of blood flow in your arteries
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the arteries
• CT scan, which uses X-rays and a computer to show detailed pictures of the arteries

How is it treated?

Your treatment depends on many factors, such as your age, heart muscle function, and other health problems. At first, treatment may include diet changes and an exercise program. Your healthcare provider may prescribe medicines to:

• Lower your blood pressure and heart rate so that your heart does not have to work as hard.
• Lower your cholesterol to help keep fatty deposits from building up in your arteries.
• Relax your blood vessels and lower your blood pressure to help your heart to pump more blood out to your body.
• Help your body get rid of the extra fluid that can build up when your heart does not pump well.
• Prevent blood clots that could block your arteries and cause a stroke.

Your provider may recommend a daily low dose of aspirin. Taking an aspirin every day may lower your risk for a heart attack or stroke. Not everyone should take aspirin. Daily use of aspirin can cause problems, such as stomach irritation, bleeding, and hearing loss. Ask your healthcare provider if you should take aspirin and if so, how much to take.

If your coronary arteries are badly blocked, you may need surgery.

• A balloon angioplasty opens blocked blood vessels and improves blood flow. A metal mesh device called a stent is usually left in the blood vessels to help keep them open.
• Bypass surgery uses blood vessels from other parts of the body, or manmade material, to make a new path around a blocked area.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• If you smoke, quit. Talk to your healthcare provider about ways to quit smoking. Avoid exposure to secondhand smoke.
• Try to keep a healthy weight. If you are overweight, talk to your provider about ways to lose weight.
• Exercise according to your healthcare provider’s recommendations.
• Eat a heart-healthy diet. Your provider or a dietician can tell you which foods to avoid.
• Get your cholesterol levels and blood pressure checked by your healthcare provider regularly.
• If you have high blood pressure, high cholesterol, diabetes, or another medical problem, follow your treatment plan.

Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

How can I help prevent atherosclerosis?

Talk to your healthcare provider about your personal and family medical history and your lifestyle habits. This will help you know what you can do to lower your risk for atherosclerosis. Taking good care of your health, including a healthy lifestyle, can help prevent this disease.