Atherosclerosis: Symptoms, Risks and Treatment

Introduction

Atherosclerosis develops when plaque collects within artery walls. Plaque contains fat, cholesterol, calcium, and other blood substances ^[2]. Over time, this buildup can narrow arteries and reduce blood flow ^[2].

Plaque can also make blood clots more likely ^[2]. A clot may block oxygen from reaching the heart, brain, or other organs ^[2]. This can cause a heart attack or stroke ^[2,9].

The disease can affect arteries throughout the body ^[6]. It may lead to coronary artery disease or peripheral artery disease ^[2,9]. Yet early care can lower the risk of severe problems ^[8].

This guide covers atherosclerosis symptoms, risk factors, treatment and prevention. It also explains which warning signs need emergency care.

Overview: What Atherosclerosis Is and How It Develops

Atherosclerosis is one type of arteriosclerosis ^[6]. Arteriosclerosis means that arteries become thick and stiff ^[6]. With atherosclerosis, plaque also builds up within artery walls ^[2,6].

Arteries carry blood from the heart to the body ^[2]. Most arteries deliver blood that is rich in oxygen ^[2]. Plaque makes the open space inside an artery smaller ^[8].

This process is often slow and silent ^[4,8]. It may begin during childhood and continue throughout life ^[4].

How plaque forms inside artery walls

Plaque growth often starts with damage to an artery ^[3]. Smoking and high blood pressure can play a role in this damage ^[3]. Unhealthy cholesterol, health problems, and genes can also play a role ^[3].

Inflammatory cells move to the damaged part of the artery ^[3]. Inflammation is the body’s response to damage. These cells release signals that draw cholesterol and cell waste to the site ^[3].

The stored material forms plaque over time ^[3]. Plaque may become thick and hard as it grows ^[8]. It can contain fat, cholesterol, calcium, and other blood substances ^[2].

A plaque may also contain LDL cholesterol and firm tissue ^[9]. LDL is often called “bad” cholesterol. Unhealthy cholesterol levels are a key risk for plaque growth ^[3].

Plaque growth can take place over many years ^[3,8]. A person may feel well while this process occurs ^[5,8]. Early heart-healthy habits can help delay plaque and its effects ^[4].

How narrowed arteries reduce blood flow

Growing plaque leaves less room for blood to pass ^[8]. The tissues beyond the narrow area may receive less oxygen-rich blood ^[5,8].

The body needs more oxygen during activity or stress ^[5]. Symptoms may first occur at those times ^[5]. For example, heart-related chest pain may appear during physical effort ^[5,9].

Plaque does not always stay stable. Its surface may wear away or break open ^[6,8]. This event is called plaque erosion or rupture.

A blood clot can then form over the damaged plaque ^[2,8]. The clot may partly or fully block the artery ^[2]. Blood and oxygen can no longer reach tissue beyond a full blockage ^[2].

A clot in a coronary artery can cause a heart attack ^[6,9]. Coronary arteries supply blood to the heart muscle ^[9]. A full blockage can harm part of that muscle ^[9].

A clot that blocks blood flow to the brain can cause an ischemic stroke ^[2,9]. An ischemic stroke occurs when part of the brain loses its blood supply ^[9].

Health problems caused by atherosclerosis

The location of plaque helps determine which body part is at risk. Atherosclerosis may cause several related conditions:

• Coronary artery disease: Plaque narrows arteries that supply the heart muscle ^[9].
• Angina: Reduced heart blood flow may cause this type of chest pain ^[9].
• Peripheral artery disease: Narrow arteries reduce blood flow outside the heart ^[2,7].
• Heart attack: A coronary artery becomes fully blocked ^[6,9].
• Ischemic stroke: A clot blocks blood flow to part of the brain ^[2,9].
• Poor blood flow elsewhere: Plaque may affect the kidneys, arms, legs, brain, or pelvis ^[2,6].

Symptoms and Atherosclerosis Warning Signs

Why early atherosclerosis may be silent

Early or mild atherosclerosis often causes no symptoms ^[5,6]. Symptoms may not start until an artery becomes very narrow or blocked ^[6,8].

Some people first notice a problem during exercise or stress ^[5]. The body needs more oxygen at these times ^[5]. A narrow artery may not carry enough blood to meet that need ^[5,8].

Other people have no warning before a major event ^[5,8]. A heart attack or stroke may be the first clear sign ^[5,8]. Routine medical visits can help find risks before such problems occur ^[5].

Atherosclerosis warning signs depend on the arteries involved ^[5]. New or unexplained symptoms should be discussed with a healthcare professional.

Symptoms based on the arteries affected

Plaque in the coronary arteries can reduce blood flow to the heart ^[9]. Possible symptoms include:

• Chest pain or pressure during activity or stress ^[5,9].
• Shortness of breath when the body needs more oxygen ^[5].
• Symptoms that become worse during physical effort ^[5].

Chest pain from low blood flow to the heart is called angina ^[9]. Angina may be a sign of coronary artery disease ^[9]. It should not be ignored.

Plaque may also affect the arteries in the legs ^[2,7]. Reduced leg blood flow may cause pain during walking ^[5]. The discomfort may occur because active muscles need more oxygen-rich blood ^[5].

Brain-related warning signs may appear without notice ^[5]. These can include sudden weakness, numbness, or speech changes ^[5]. Such signs may mean that blood flow to the brain is blocked ^[2,5].

Symptoms cannot show the amount of plaque in an artery. A healthcare professional may need to check the heart and blood flow ^[7]. The evaluation may also include health history and risk factors ^[7].

Causes and Atherosclerosis Risk Factors

Plaque growth can begin after an artery is damaged ^[3]. Habits, health conditions, and genes may all cause this damage ^[3]. Having several risks raises the chance of atherosclerosis ^[10].

Risk factors you can change

Smoking, high blood pressure, and unhealthy cholesterol are major changeable risks ^[3]. A changeable risk is one you may prevent or manage.

Other risks include diabetes and lack of physical activity ^[3,10]. Excess weight and an unhealthy diet can also raise risk ^[3,10].

Important changeable risks include:

• Smoking: Tobacco use can trigger artery damage and plaque growth ^[3].
• High blood pressure: High pressure can harm artery walls ^[3].
• Unhealthy cholesterol: Cholesterol can collect in damaged parts of an artery ^[3].
• Diabetes: High blood sugar raises the risk of atherosclerosis ^[7].
• Physical inactivity: Lack of activity is a controllable heart and artery risk ^[10].
• Unhealthy food choices: Poor eating habits can add to preventable risk ^[3,10].
• Excess weight: Weight-related health issues may add to atherosclerosis risk ^[3].

Smoking, high blood pressure, and unhealthy cholesterol often occur together ^[3]. Treating more than one risk can form part of a complete care plan ^[1].

A treatment plan should fit a person’s needs ^[1]. It may consider home life, local resources, and culture ^[1].

Risk factors you cannot change

Some risks cannot be changed. These include older age, genes, and family history ^[3,10].

A family history of heart disease may point to inherited risk ^[3,10]. A healthcare professional may ask about family health during an exam ^[7].

Age and genes cannot be controlled. However, knowing about these risks can guide talks about prevention and care ^[1].

How multiple risk factors affect overall risk

The chance of atherosclerosis rises as risk factors add up ^[10]. One person may have high blood pressure, smoke, and have unhealthy cholesterol. This set of risks calls for close attention.

Ask a healthcare professional to review your:

• Blood pressure.
• Cholesterol.
• Blood sugar.
• Tobacco use or exposure.
• Level of physical activity.
• Eating habits.
• Personal health history.
• Family health history.
• Ten-year and lifetime heart risk.

A ten-year or lifetime risk check can help start a care discussion ^[1]. It may guide choices about habits, medicine, and follow-up ^[1].

Treatment: How Atherosclerosis Is Diagnosed and Managed

Treatment depends on the person’s risks and the arteries involved ^[1,7]. Care aims to manage risk factors and limit further plaque growth ^[1,10]. It also aims to prevent dangerous loss of blood flow ^[1].

Medical evaluation and diagnostic tests

A healthcare professional will ask about symptoms and family health history ^[7]. The professional will also perform a physical exam ^[7]. This may include listening to the heart ^[7].

Blood tests can measure cholesterol and blood sugar ^[7]. High levels can raise atherosclerosis risk ^[7]. A blood test may also check C-reactive protein, or CRP ^[7].

CRP is linked to inflammation in the arteries ^[7]. A healthcare professional decides whether this test is useful ^[7].

Other tests may check the heart, arteries, and blood flow ^[7]. The choice depends on the person’s symptoms and exam ^[7].

Possible tests include:

• Ankle-brachial index: This compares blood pressure in the ankle and arm ^[7].
• Stress test: This checks the heart while a person exercises ^[7].
• Artery imaging: Images may help find narrowed areas in arteries ^[7].
• Other circulation tests: The selected test depends on the arteries involved ^[7].

A stress test often uses a treadmill or exercise bike ^[7]. The heart is watched while it works harder than usual ^[7].

The ankle-brachial index can check for narrow arteries in the legs and feet ^[7]. A healthcare professional compares ankle pressure with arm pressure ^[7].

Not every person needs every test. The healthcare professional chooses tests based on the full medical review ^[7].

Lifestyle changes and medicines

A heart-healthy lifestyle is a key part of treatment ^[1]. It also helps prevent plaque buildup throughout life ^[1].

Important changes include healthy food and regular activity ^[1,10]. Stopping tobacco use is also a main part of care ^[1,10].

Medicine may be needed when lifestyle changes are not enough ^[4]. Treatment may include medicine for cholesterol or blood pressure ^[1]. It may also address diabetes or the risk of blood clots ^[1].

Take all prescribed medicines as directed ^[4]. Do not stop or change them without speaking with the prescriber.

A heart-healthy lifestyle and the right medicines can slow plaque growth ^[1]. In some people, this plan may cause some plaque regression over time ^[1]. Regression means that the amount of plaque becomes smaller.

The response to treatment can differ from person to person. Regular visits help the healthcare team review the care plan ^[1].

Procedures and surgery for severe disease

Lifestyle changes and medicine may not be enough for severe narrowing ^[1]. A procedure or surgery may then help restore blood flow ^[1].

Possible options include:

• Angioplasty: This procedure opens a narrow artery.
• Stenting: A small support helps hold the artery open.
• Endarterectomy: Surgery removes plaque from an artery.
• Bypass surgery: Surgery creates another path around a blockage.

Procedures may help when plaque reaches dangerous levels ^[1]. They may be used for arteries in the heart or other body areas ^[1]. The care team chooses an option based on the person’s condition.

These treatments may restore flow when severe plaque causes dangerous narrowing ^[1]. They may also be considered after a serious problem develops ^[1].

Atherosclerosis Prevention and Long-Term Care

Daily habits that protect arteries

A heart-healthy lifestyle can help prevent or delay atherosclerosis ^[1,4]. These habits should begin early in life ^[4]. Plaque growth can start during childhood and continue through adulthood ^[4].

A heart-healthy eating plan includes:

• Fruits ^[1].
• Vegetables ^[1].
• Whole grains ^[1].
• Other heart-healthy foods ^[1].

The plan should limit saturated fat and sodium ^[1]. It should also limit highly processed foods ^[1]. The DASH eating plan is one heart-healthy option ^[1].

Regular physical activity can form part of heart-healthy living ^[1,10]. Avoiding tobacco is also important ^[1,10]. Maintaining a healthy weight may help manage preventable risks ^[1,10].

Stress control and enough sleep can support a wider heart-healthy routine ^[1]. Choose changes that are safe and realistic for your needs.

Managing medical risk factors

Healthy habits may not fully control every risk ^[4]. A healthcare professional may then recommend medicine ^[4]. Take each prescribed medicine as directed ^[4].

Long-term care may include checks of blood pressure and cholesterol ^[3,7]. Blood sugar may also need to be checked ^[7]. High cholesterol and high blood sugar increase atherosclerosis risk ^[7].

Do not wait for symptoms before asking about prevention. Early atherosclerosis is often silent ^[5]. Regular healthcare visits may find risks sooner ^[5].

Follow-up questions for a healthcare professional

Consider asking these questions:

• What is my ten-year heart risk?
• What is my lifetime heart risk?
• Is my blood pressure in a healthy range?
• Are my cholesterol and blood sugar controlled?
• Do I need tests for narrow arteries?
• Which eating plan is best for me?
• What type of activity is safe for me?
• Do I need medicine?
• How often should I have follow-up visits?
• Which symptoms should lead me to call 911?

A risk check can guide talks about treatment and prevention ^[1]. A care plan should fit the person’s needs and daily life ^[1].

When to See a Doctor or Call 911

Arrange a medical visit for chest discomfort during activity ^[5,9]. Also seek care for unexplained shortness of breath or leg pain while walking ^[5]. These symptoms may be atherosclerosis warning signs ^[5,9].

Call 911 at once for possible heart attack or stroke symptoms ^[5]. Do not drive yourself to the hospital. Emergency services can arrange fast transport and emergency care.

Possible emergency warning signs include:

• Sudden chest pain or pressure ^[5,9].
• Sudden weakness ^[5].
• Sudden numbness ^[5].
• Sudden trouble speaking ^[5].
• Other sudden signs of a heart attack or stroke ^[5].

Every minute matters during a possible heart attack or stroke ^[5]. Do not wait to see if symptoms improve. Call 911 immediately ^[5].

Conclusion

Understanding atherosclerosis symptoms, risk factors, treatment and prevention can support early action. Early disease may cause no symptoms ^[5,8]. Yet plaque can slowly narrow arteries and reduce blood flow ^[2,8].

Regular checkups may help find risks before severe problems occur ^[5]. Managing blood pressure, cholesterol, blood sugar, and tobacco use can protect artery health ^[3,7].

A heart-healthy lifestyle can prevent or slow plaque growth ^[1,4]. Prescribed medicine may also help control major risks ^[1,4]. Together, these steps may lead to some plaque regression in certain people ^[1].

Procedures or surgery may restore blood flow when narrowing becomes dangerous ^[1]. Possible heart attack or stroke symptoms require an immediate call to 911 ^[5]. Every minute matters ^[5].