Arteriosclerosis

Overview

Atherosclerosis is the hardening and narrowing of the arteries, the blood vessels that carry blood from the heart to other parts of the body. It is caused by the slow buildup of plaque on the inside of walls of the arteries. As plaque builds up, it narrows the inside of the artery and, in time, may restrict blood flow. It can affect the arteries of the brain, heart, kidneys, and the arms and legs and cause serious complications including coronary artery disease, angina, heart attack, sudden death, and stroke.

Symptoms

Atherosclerosis usually does not cause symptoms until it severely narrows an artery or blocks one altogether. Symptoms will then depend on which arteries are involved.

If the arteries that feed your heart (coronary arteries) are affected, you will have symptoms of coronary artery disease including:

  • chest or arm pain that doesn't go away
  • shortness of breath
  • fainting
  • increased sweating

If the arteries that feed your brain are affected, you may have symptoms of a stroke or a transient ischemic attack (TIA) or "mini-stroke." Tell someone and call 9-1-1 immediately if you experience any of these five main warning signs of a stroke:

  • Sudden weakness, numbness or tingling in the face, arm or leg
  • Sudden temporary loss of speech or trouble understanding speech
  • Sudden loss of vision, particularly in one eye, or double vision
  • Sudden severe and unusual headache
  • Sudden loss of balance, especially with any of the above signs

If the arteries that feed your legs, pelvis, or arms are affected, you may have symptoms of peripheral arterial disease including:

  • leg pain
  • numb or cold legs or feet
  • muscle pain in thighs, calves or feet
  • hair loss on the legs or feet
  • weak pulse in the leg or foot
  • pale or blue skin
  • walking problems

If the arteries that feed your kidneys are affected, you could have symptoms of renovascular hypertension. These include:

  • Severe, difficult-to-control hypertension
  • Episodes of heart failure
  • Rapid progression of kidney failure
  • Acute renal failure which occurs when starting certain medicines
  • Sudden aggravation of hypertension in an elderly patient whose blood pressure was previously well controlled

Causes

Nobody knows exactly how atherosclerosis begins or the exact cause of it. Scientists think that the buildup of plaque starts when the lining of the artery is damaged or injured. Whatever the cause, it is a slow and complex disease which begins in childhood and, in some people, develops faster as they grow older.

Although they don't know the exact cause, scientists do know that certain conditions increase your chance of developing atherosclerosis. You can control some risk factors and others you can't.

Risk factors that you can't do anything about are:

  • Age. As you get older, your risk increases.
    • In men, risk increases after age 45.
    • In women, risk increases after age 55.
  • Family history of early heart disease. Your risk for atherosclerosis is greater if:
    • Your father or brother was diagnosed with heart disease before age 55.
    • Your mother or sister was diagnosed with heart disease before age 65.

Risk factors that you can do something about include:

  • High blood cholesterol
  • High blood pressure
  • Smoking and using tobacco
  • Diabetes
  • Obesity
  • Lack of physical activity

Treatment

The goals of treatment are to reduce the symptoms and prevent the complications of atherosclerosis. Your doctor will recommend which treatments are best for you after reviewing your symptoms, your risk factors, and the results of your physical exam and any lab tests. Treatment can include:

  • Lifestyle changes
  • Medicines
  • Special procedures and surgery

Lifestyle Changes

Most people with atherosclerosis should make certain, long-term lifestyle changes:

  • Eat a healthy diet.
    • A low-saturated fat, low-cholesterol diet
    • A diet lower in salt, total fat, saturated fat, and cholesterol and higher in fruits, vegetables, and low-fat dairy products
  • If you smoke or use tobacco, quit.
  • Physical activity, as directed by your doctor.
  • Lose weight, if you are overweight or obese.
  • Manage stress and seek treatment for depression and increased anxiety.

Medicines

To help slow or reverse atherosclerosis, you may need to take medicines as directed by your doctor to:

  • Lower your cholesterol
  • Lower your blood pressure if you have hypertension
  • Prevent clots from forming in your arteries and blocking blood flow (anticoagulants)
  • Stop platelets from clumping together to form clots (anti-platelet medicines such as aspirin)

Special Procedures and Surgery

Some people may need to have one of the following procedures to treat the complications of atherosclerosis:

  • Angioplasty. This procedure is used to open blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.

  • Coronary artery bypass surgery. This surgery uses arteries or veins from other areas in your body to bypass your diseased coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

  • Carotid artery surgery. This surgery removes plaque buildup from the carotid artery in the neck. This opens the artery and improves blood flow to the brain.

  • Bypass surgery of the leg arteries. This surgery uses a healthy blood vessel to bypass the narrowed or blocked blood vessels. The healthy blood vessel redirects blood around the blocked artery, improving blood flow to the leg.

Prevention

Preventing atherosclerosis starts by knowing which risk factors you have and by taking action to lower your risk.

Know your family history of health problems related to atherosclerosis. If you or someone in your family has atherosclerosis, be sure to tell your doctor. Make sure everyone in your family is getting enough exercise and maintaining a healthy body weight.

By controlling your risk factors with lifestyle changes and medicines, you may prevent or slow the development of atherosclerosis.

If you have any other health conditions, it is important that you follow your doctor's advice. By staying as healthy as possible, you can lower your risk for getting atherosclerosis and prevent serious complications, such as a heart attack.