Atherosclerosis
Definition
Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens, and may eventually block the arteries.
Atherosclerosis is a type of arteriosclerosis. The two terms are often used to mean the same thing.
Alternative Names
Arteriosclerosis; Hardening of the arteries; Plaque buildup - arteriesCauses
Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.
Eventually, the plaque deposits can make the artery narrow and less flexible. This makes it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms.
Pieces of plaque can break apart and move through the bloodstream (embolization). This is a common cause of heart attack and stroke. Blood clots can also form around the plaque deposits. Clots block blood flow. If the clot moves into the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism.
Risk factors for atherosclerosis include:
- Diabetes
- High blood pressure
- High cholesterol
- High-fat diet
- Obesity
- Personal or family history of heart disease
- Smoking
Atherosclerosis can affect many different organ systems, including the heart, lungs, brain, intestines, kidneys, and limbs (extremities).
Symptoms
Symptoms usually do not occur until blood flow becomes slowed or blocked.
See the specific condition for more details on symptoms:
- Abdominal aortic aneurysm
- Coronary artery disease
- Kidney disease
- Mesenteric artery ischemia
- Peripheral artery disease
- Renal artery stenosis
- Renovascular hypertension
- Stroke (cerebrovascular disease)
- Thoracic aortic aneurysm
Exams and Tests
A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Early atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.
Tests that may be used to diagnose atherosclerosis or complications include:
- Ankle/brachial index (ABI)
- Aortic arteriography
- Arteriography
- Cardiac stress testing
- Carotid duplex
- CT scan
- Doppler study
- Extremity arteriography
- Intravascular ultrasound (IVUS)
- Magnetic resonance arteriography (MRA)
- Mesenteric arteriography
- Pulmonary angiography
- Renal arteriography
Treatment
Your doctor will probably suggest a low-fat diet, weight loss if you are overweight, and exercise.
Few medications have actually been found to clear up plaque. Most medications are used to treat the complications of atherosclerosis. Blood thinners may be given to prevent clots from forming.
Medications are often prescribed to treat the risk factors for CAD:
- Medications to lower lipids
- Medications to keep blood sugar under control
- Medications to lower high blood pressure
Atherosclerosis can lead to coronary heart disease (CHD). If you have CHD that does not cause symptoms, you can be treated with either medicine or angioplasty with stenting. These procedures are designed to enlarge the narrowing in the arteries, but do not remove plaque.
Recent studies show that medicine and angioplasty with stenting have similar benefits. Angioplasty with stenting does not help you live longer, but it can reduce angina or other symptoms of coronary artery disease.
Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.
Other procedures (bypass surgery) place a piece of an artery or vein from the aorta to the diseased artery to bypass the blocked area.
Some people may need a procedure called an endarterectomy to remove plaque build up.
See also:
Outlook (Prognosis)
Everyone starts to develop some amount of atherosclerosis as they grow older. In some people, the condition can cause complications such as a heart attack or stroke.
Possible Complications
- Coronary artery disease
- Damage to organs (such as the kidneys, brain, liver, and intestines)
- Heart attack
- Stroke
- Too little blood to the legs and feet
- Transient ischemic attack (TIA)
When to Contact a Medical Professional
Call for an appointment with your health care provider if you are at risk for atherosclerosis, especially if symptoms occur.
Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with coronary artery disease or if you have ever had a heart attack.
Prevention
The following lifestyle changes can help prevent atherosclerosis:
- Eat a low-fat, low-cholesterol, and low-salt diet.
- Eat fish. Adding fish to the diet at least twice a week has been shown to be helpful. Do not fry the fish, as this destroys the benefit.
- If you don't like to eat fish, try a fish oil supplement.
- Exercise 30 minutes every day. If you are overweight, you should get 60 - 90 minutes of exercise a day.
- Lose weight if you are overweight.
- Stop smoking.
- Mild to moderate consumption of alcohol or wine (1-2 drinks per day) may also reduce the risk of cardiovascular events. Too much alcohol, however, does more harm than good.
- If you have one or more risk factors for heart attack or stroke, ask your doctor if you should take aspirin every day. Aspirin can help some people reduce the risk of heart disease and stroke.
Work with your doctor to bring your blood pressure into the normal range. This may require medication. Follow your doctor's recommendations for treating and controlling diabetes and other diseases.
Do not take hormonal replacement therapy, folic acid supplements, vitamin C or E, or antioxidants to decrease the risk of heart disease or stroke. These methods have not been proven to prevent these conditions.
References
Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].
Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.
Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo: WB Saunders; 2005:921-935.
Reviewed By: Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
