Atherosclerosis

What is atherosclerosis?

Atherosclerosis is the gradual buildup of plaque in the walls of your arteries. Arteries are blood vessels that carry oxygen-rich blood to organs and tissues throughout your body. Plaque (atheroma) is a sticky substance made of fat, cholesterol, calcium and other substances.

As plaque builds up, your artery wall grows thicker and harder. This “hardening of the arteries” is usually a silent process in the early stages. You may not notice symptoms for a long time. But eventually, as the plaque grows, the opening (lumen) of your artery narrows, leaving less room for blood to flow. This means less blood can reach your organs and tissues. Plus, the constant force of blood flow can lead to plaque erosion or rupture, causing a blood clot to form.

A narrowed artery is like a highway reduced to one lane. But a blood clot is like a barricade in the middle of the road. It blocks blood flow to certain organs or tissue the artery normally feeds. The effects on your body depend on where the blood clot forms. For example, blockages in a coronary artery deprive your heart of oxygen-rich blood, leading to a heart attack.

But there’s a reason for hope. You can lower your risk for atherosclerosis, or slow its progression, by making lifestyle changes and managing underlying conditions. Research shows some treatments can reduce the size of plaque in your arteries (plaque regression) or change its chemical makeup, so it’s less likely to rupture.

That’s why visiting a healthcare provider for yearly checkups is important. They’ll evaluate your risk for atherosclerosis and explain what you can do to lower it.

What are the complications of atherosclerosis?

Atherosclerosis interferes with the normal workings of your cardiovascular system. It can limit or block blood flow to various parts of your body, including your heart and brain. Possible complications of reduced blood flow include:

• Carotid artery disease.
• Coronary artery disease.
• Heart attack.
• Mesenteric ischemia.
• Peripheral artery disease.
• Renal artery stenosis.
• Stroke.
• Transient ischemic attack (TIA).

Atherosclerosis can also weaken your artery walls, leading to the formation of aneurysms.

Early diagnosis and treatment of atherosclerosis can help you avoid or delay complications.

How common is atherosclerosis?

Atherosclerosis is very common. The complications of plaque buildup (including heart attacks and strokes) are the leading cause of death worldwide.

About half of people age 45 to 84 have atherosclerosis but aren’t aware of it, according to the U.S. National Institutes of Health.

If you have warning signs of atherosclerosis, tell a healthcare provider. Early treatment can lower your risk of life-threatening complications.

What are the symptoms of atherosclerosis?

Atherosclerosis often doesn’t cause symptoms until an artery is very narrow or blocked. Many people don’t know they have plaque buildup until a medical emergency, like a heart attack or stroke, occurs.

You may notice symptoms if your artery is more than 70% blocked. Listed below are common complications and possible associated symptoms:

Coronary artery disease

• Stable angina.
• Shortness of breath (dyspnea) during light physical activity.
• Sometimes, the first symptom is a heart attack.

Heart attack

• Chest pain or discomfort (angina).
• Pain in your back, shoulders, neck, arms or belly.
• Shortness of breath or trouble breathing.
• Feeling dizzy or lightheaded.
• Heart palpitations.
• Fatigue.
• Nausea or vomiting that may feel like indigestion.

Mesenteric ischemia

• Pain or cramping in your belly (abdomen) after eating.
• Bloating, nausea and vomiting.
• Diarrhea.
• Unintentional weight loss due to “food fear” (fear of pain after eating).

Peripheral artery disease (PAD)

• Intermittent claudication. This is leg pain or cramping you feel when you’re active. It goes away when you rest. It’s the first symptom of PAD.
• Burning or aching pain in your feet and toes when you rest, especially when lying flat.
• Changes in skin color (like redness).
• Cool skin on your feet.
• Frequent skin and soft tissue infections, often in your legs or feet.
• Sores on your feet or toes that don’t heal.

Renal artery stenosis

• Markedly elevated blood pressure that’s resistant to multiple medications.
• Changes in how often you pee.
• Swelling (edema).
• Feeling drowsy or tired.
• Skin that feels dry, itchy or numb.
• Headaches.
• Unexplained weight loss.
• Nausea, vomiting or loss of appetite.

Stroke or transient ischemic attack (TIA)

• Dizziness.
• Drooping on one side of your face.
• Loss of feeling, loss of muscle strength or weakness on one side of your body.
• Severe headache.
• Slurred speech or difficulty forming words.
• Vision loss in one eye. You may notice a dark shade coming down over your field of sight.

Carotid artery disease

• Usually, the first symptoms are a TIA or stroke.

Call 911 or your local emergency number right away if you or someone near you has symptoms of a heart attack, stroke or TIA. These are medical emergencies that require immediate care.

What causes atherosclerosis?

Damage to your artery’s inner lining (endothelium) causes atherosclerosis to begin. The damage usually occurs slowly and over time.

Stages of atherosclerosis

The stages of atherosclerosis happen over many years and include:

• Endothelial damage and immune response. Atherosclerosis begins with endothelial damage. Your endothelium is a thin lining of cells that covers the inner layer of your artery wall (intima). Many factors can cause endothelial damage, including high LDL cholesterol levels and toxins from tobacco products. The damage triggers chemical processes that cause white blood cells to travel to the injury site. These cells gather and lead to inflammation within your artery.
• Fatty streak formation. A “fatty streak” is the first visible sign of atherosclerosis. It’s a yellow streak or patch formed out of dead foam cells at the site of endothelial damage. Foam cells are white blood cells that consume invaders to try to get rid of them. In this case, they consume cholesterol and thus appear foamy. Continued foam cell activity causes further damage to your endothelium.
• Plaque growth. Dead foam cells and other debris continue building up. So, the fatty streak turns into a larger piece of plaque. A fibrous cap (made of smooth muscle cells) forms over the plaque. This cap prevents bits of plaque from breaking off into your bloodstream. As the plaque grows, it gradually narrows your artery’s opening (lumen), so there’s less room for blood to flow through.
• Plaque rupture or erosion. In this stage, a blood clot forms in your artery due to plaque rupture or plaque erosion. Plaque rupture happens when the fibrous cap that covers the plaque breaks open. With plaque erosion, the fibrous cap stays intact, but endothelial cells around the plaque get worn away. Both events lead to the formation of a blood clot. The clot blocks blood flow and can lead to a heart attack or stroke.

What are the risk factors for atherosclerosis?

There are many risk factors for atherosclerosis. Non-modifiable risk factors are those you can’t change. You may be able to reduce modifiable risk factors, including some medical conditions and lifestyle factors, in some cases.

It’s important to note that some risk factors vary based on your sex assigned at birth. For example, people assigned male at birth (AMAB) face a higher risk of atherosclerosis at a younger age than people assigned female at birth (AFAB).

Non-modifiable risk factors

• Increasing age.
• People assigned male at birth face a higher risk after age 45.
• People assigned female at birth face a higher risk after age 55.
• Family history of premature cardiovascular disease. This means a close biological family member who’s AMAB was diagnosed with cardiovascular disease before age 45. Or, one who’s AFAB was diagnosed before age 55.

Medical conditions

• Diabetes.
• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia), especially high LDL cholesterol or high levels of a specific lipoprotein called lipoprotein (a).
• Metabolic syndrome.

Lifestyle factors

• Smoking or tobacco use.
• Lack of physical activity.
• A diet high in saturated fat, trans fat, sodium and sugar.

Talk to your provider about your risks and what you can do to lower them.

How is atherosclerosis diagnosed?

To diagnose atherosclerosis or calculate your risk for developing it, a healthcare provider will:

• Perform a thorough physical exam. This includes using a stethoscope to listen to your heart and blood flow through your arteries. For example, your provider will check your carotid arteries (in your neck) for a whooshing sound called a “bruit.” This sound may indicate the presence of plaque.
• Ask about your medical history and family history. These details can help show your risk for atherosclerosis and its complications.
• Ask about your lifestyle. Your provider may ask about lifestyle factors like past or present use of tobacco products.
• Order blood tests. Cardiac blood tests show your cholesterol levels and many details about your heart function.

What tests will be done to diagnose this condition?

Your healthcare provider may order additional tests to diagnose atherosclerosis and plan treatment. These tests include:

• Angiography. This test uses special X-rays to locate and measure blockages. Your healthcare provider will inject a contrast dye into your arteries to help the blockages show up on the X-rays.
• Ankle/brachial index. This test compares the blood pressure in your ankle to the pressure in your arm to measure blood flow in your arms and legs.
• Chest X-ray. A chest X-ray takes pictures inside of your chest.
• CT scan. This scan takes pictures inside of your body and can show any hardening and narrowing of your large arteries.
• Echocardiogram (echo). An echo takes pictures of your heart’s valves and chambers and measures how well your heart is pumping.
• Electrocardiogram (EKG). An EKG measures your heart’s electrical activity, rate and rhythm.
• Exercise stress test. This test measures your heart function while you’re physically active.
• Carotid ultrasound. This test takes ultrasound pictures of the arteries in your neck (carotid arteries). It can detect hardening or narrowing of these arteries as blood flows to your brain.
• Abdominal ultrasound. This ultrasound takes pictures of your abdominal aorta. It checks for ballooning (abdominal aortic aneurysm) or plaque buildup in your aorta.

What specialists might I need to see for atherosclerosis?

If you have atherosclerosis, your healthcare provider may recommend you see a specialist, such as a:

• Cardiologist, who specializes in the heart.
• Nephrologist, who specializes in the kidneys.
• Neurologist, who specializes in the nervous system (brain and spine).
• Vascular surgeon, who specializes in blood vessels.

What is the treatment for atherosclerosis?

Atherosclerosis treatment includes one or more of the following:

• Lifestyle changes.
• Medications.
• Procedures or surgeries.

Your healthcare provider will develop a plan based on your needs. Common treatment goals include:

• Lowering your risk of blood clots.
• Preventing complications like a heart attack or stroke.
• Easing symptoms.
• Helping you develop patterns of eating that support your heart and blood vessels.
• Slowing or stopping plaque buildup in your arteries.
• Improving blood flow by widening your arteries or bypassing (avoiding) blockages.

Lifestyle changes

Lifestyle changes may lower your risk of complications. Your provider will create a plan specific to your needs. General tips include:

• Avoid all tobacco products (including smoking and vaping).
• Follow a heart-healthy eating plan like the Mediterranean Diet.
• Build exercise into your daily routine.

Medications

Medications target risk factors for plaque buildup and may help slow the progression of atherosclerosis. Your provider may prescribe medications to:

• Lower your blood pressure.
• Lower your cholesterol.
• Manage your blood sugar levels.
• Prevent blood clots.

It’s important to take all of your medications as prescribed. Always check with your provider before making any changes to your medication schedule.

Procedures or surgeries

Various minimally invasive procedures and complex surgeries can help people with severe blockages or a high risk of complications. Common treatment options include:

• Angioplasty.
• Atherectomy.
• Carotid endarterectomy.
• Coronary artery bypass grafting (CABG).
• Peripheral artery bypass.
• Stent placement.
• Vascular disease bypass.

How can I prevent atherosclerosis?

You may not be able to prevent atherosclerosis. But you can reduce your risk and lessen the effects of the disease. Here are some steps you can take:

• Eat foods low in saturated fat, trans fat, cholesterol, sodium (salt) and sugar.
• Exercise regularly. Start with short walks and build up to 30 minutes a day most days of the week.
• Keep a weight that’s healthy for you. Ask your provider what that should be.
• Manage any health conditions, especially diabetes, high blood pressure and high cholesterol.
• Don’t use tobacco products.
• Have a yearly checkup with a healthcare provider.

What is the outlook for people with atherosclerosis?

Early diagnosis and treatment can help people with atherosclerosis live healthy, active lives. But the disease can cause medical emergencies and even be fatal. That’s why knowing your risks and working with your healthcare provider to lower them is important.

How do I take care of myself?

It’s essential to work closely with your healthcare provider. They’ll keep a close eye on your condition and tell you how often you should come in for appointments. Go to all of your appointments and follow-ups, and be an active partner in your care. Tell your provider right away about any new or changing symptoms.

Also, take care of your mental health. It’s normal to feel anxious about what the future could bring. You may also feel overwhelmed by the need to make lifestyle changes. But those feelings shouldn’t prevent you from enjoying life. Some tips for managing your thoughts and worries include:

• Share your feelings with a counselor or support group.
• Connect with others who have cardiovascular disease. You can share your experiences and learn from each other.
• Talk to your family and friends about the lifestyle changes you’re making. Explain why these changes are important to you and ask them to help you stay on track.

A note from Cleveland Clinic

Atherosclerosis is a common condition. So, remember that if you have atherosclerosis, you’re not alone. Many other people are in your shoes. Your healthcare provider is ready to help you manage your condition so you can live a long and healthy life.