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Atherosclerosis

Definition

Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), 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 - arteries

Causes, incidence, and risk factors

Atherosclerosis is a common disorder that specifically affects the medium and large arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Eventually, the plaques can make the artery narrow and less flexible, making 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 off and move through the affected artery to smaller blood vessels, blocking them and causing tissue damage or death (embolization). This is a common cause of heart attack and stroke. Blood clots can also form around a tear (fissure) in the plaque leading to blocked blood flow. If the clot moves into an artery in the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism. In some cases, the atherosclerotic plaque is associated with a weakening of the wall of an artery leading to an aneurysm.

Risk factors for atherosclerosis include:

• Diabetes
• Heavy alcohol use
• High blood pressure
• High blood cholesterol levels
• High-fat diet
• Increasing age
• 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 restricted 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
• Hypertension
• Stroke (cerebrovascular disease)
• Thoracic aortic aneurysm

Signs and tests

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.

Tests that may be used to diagnose atherosclerosis or its complications include:

• Ankle/brachial index (ABI)
• Aortic arteriography (aortic angiography)
• Arteriography
• Cardiac stress testing
• Carotid duplex
• Coronary artery angiography)
• CT scan
• Doppler study
• Extremity arteriography
• Intravascular ultrasound (IVUS)
• Magnetic resonance arteriography (MRA)
• Mesenteric arteriography
• Pulmonary angiography
• Renal arteriography

Treatment

To help prevent atherosclerosis or its complications (such as heart disease and stroke), make the following lifestyle changes:

• Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Do not drink more than one or two alcoholic drinks a day.
• Exercise regularly for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight.

Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family. Have your blood pressure checked more often if you have high blood pressure, heart disease, or you have had a stroke. Talk to your doctor about how often you should have yours checked. Specific recommendations depend on your age and blood pressure readings.

• Everyone should keep their blood pressure below 140/90 mmHg
• If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure should probably be less than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.

Have your cholesterol checked and treated if it is high.

See: High cholesterol and triglycerides

• Adults should have their cholesterol checked every 5 years. If you are being treated for high cholesterol or a family history of cholesterol problems, you will need to have it checked more often.
• All adults should keep their LDL ("bad") cholesterol levels below 130-160 mg/dL.
• If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your LDL cholesterol should be lower than 100 mg/dL.
• Few medications have been found to clear up plaque. Statins and other cholesterol-lowering drugs can help prevent more plaque from forming.

Your doctor may suggest taking aspirin or another drug called clopidogrel (Plavix) to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your doctor.

Talk to your doctor about the safety of hormone replacement therapy for menopause.

Guidelines no longer recommend vitamins E or C, antioxidants, or folic acid to prevent heart disease.

A number of surgeries are performed to help prevent the complications of atherosclerosis. Some of these are:

• Angioplasty and stent - heart - discharge
• Angioplasty and stent placement - peripheral arteries
• Abdominal aortic aneurysm repair - open
• Coronary artery bypass surgery
• Carotid artery surgery
• Minimally invasive heart surgery

Support Groups

Expectations (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.

Complications

• Coronary heart 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)

Calling your health care provider

Call for an appointment with your health care provider if you are at risk for atherosclerosis, especially if you have symptoms.

Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with coronary heart disease or you have ever had a heart attack.

References

Fuster V. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 69.