Arteriosclerosis / atherosclerosis

Date Updated: 03/16/2021

Overview

Arteriosclerosis and atherosclerosis are sometimes used to mean the same thing, but there's a difference between the two terms.

Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff — sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries.

Atherosclerosis is a specific type of arteriosclerosis.

Atherosclerosis is the buildup of fats, cholesterol and other substances in and on your artery walls. This buildup is called plaque. The plaque can cause your arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.

Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis can be treated. Healthy lifestyle habits can help prevent atherosclerosis.

Symptoms

Mild atherosclerosis usually doesn't have any symptoms.

You usually won't have atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply enough blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example:

If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina).
If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
If you have atherosclerosis in the arteries in your arms and legs, you may have signs or symptoms of peripheral artery disease, such as leg pain when walking (claudication) or decreased blood pressure in an affected limb.
If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure.

When to see a doctor

If you think you have atherosclerosis, talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness.

Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency.

Causes

Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by:

High blood pressure
High cholesterol
High triglycerides, a type of fat (lipid) in your blood
Smoking and other sources of tobacco
Insulin resistance, obesity or diabetes
Inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis or inflammatory bowel disease

Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery.

Over time, fatty deposits (plaque) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then don't receive enough blood to function properly.

Eventually, pieces of the fatty deposits may break off and enter your bloodstream.

In addition, the smooth lining of the plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ.

Risk factors

Hardening of the arteries occurs over time. Besides aging, factors that may increase your risk of atherosclerosis include:

High blood pressure
High cholesterol
High levels of C-reactive protein (CRP), a marker of inflammation
Diabetes
Obesity
Sleep apnea
Smoking and other tobacco use
A family history of early heart disease
Lack of exercise
An unhealthy diet

Complications

The complications of atherosclerosis depend on which arteries are blocked. For example:

Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene).
Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery.

Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency.

If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point.
Chronic kidney disease. Atherosclerosis can cause the arteries leading to your kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect your kidney function, keeping waste from exiting your body.

Prevention

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These include:

Quitting smoking
Eating healthy foods
Exercising regularly
Maintaining a healthy weight
Checking and maintaining a healthy blood pressure
Checking and maintaining healthy cholesterol and blood sugar levels

Just remember to make changes one step at a time, and keep in mind what lifestyle changes are manageable for you in the long run.

Diagnosis

Your doctor will perform a physical exam and ask questions about your personal and family health history. You may be referred to a doctor that specializes in heart diseases (cardiologist).

Your doctor may hear a whooshing sound (bruit) when listening to your arteries with a stethoscope.

Depending on the results of the physical exam, your doctor may suggest one or more tests, including:

Blood tests. Your doctor will order blood tests to check your blood sugar and cholesterol levels. High levels of blood sugar and cholesterol raise your risk of atherosclerosis. A C-reactive protein (CRP) test also may be done to check for a protein linked to inflammation of the arteries.
Electrocardiogram (ECG or EKG). This simple and painless test records the electrical signals in your heart.
Exercise stress test. If your signs and symptoms occur most often during exercise, your doctor may recommend this test. You'll walk on a treadmill or ride a stationary bike while you're connected to an ECG. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might otherwise be missed.

If you're unable to exercise, you may be given a medication that mimics the effect of exercise on your heart.
Echocardiogram. This test uses sound waves to show how well blood moves when the heart beats and through your arteries. Sometimes it is combined with exercise stress testing.
Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor determine the degree of any blockages, as well as the speed of blood flow in your arteries.
Ankle-brachial index (ABI). This test can tell if you have atherosclerosis in the arteries in your legs and feet.

During an ABI test, your doctor compares the blood pressure in your ankle with the blood pressure in your arm. An abnormal difference may be a sign of peripheral vascular disease, which is usually caused by atherosclerosis.
Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked.

During this procedure, a doctor inserts a thin, flexible tube (catheter) into a blood vessel and to your heart. Dye flows through the catheter. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
Coronary calcium scan. Also called a heart scan, this common test uses computerized tomography (CT) imaging to create detailed pictures of your heart. It can show calcium deposits in the artery walls. Results of the test are given as a score. When calcium is present, the higher the score, the higher your risk of heart disease.
Other imaging tests. Your doctor may also use magnetic resonance angiography (MRA) or positron emission tomography (PET) to study your arteries. These tests can show hardening and narrowing of large arteries, as well as aneurysms.

Treatment

Lifestyle changes, such as eating a healthy diet and exercising, are the first treatment for atherosclerosis — and may be all that you need to treat your atherosclerosis. But sometimes, medication or surgical procedures may be needed.

Medications

Many different drugs are available to slow — or even reverse — the effects of atherosclerosis. Here are some medications used to treat atherosclerosis:

Statins and other cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol — the bad cholesterol — can slow, stop or even reverse the buildup of fatty deposits in your arteries.

Statins are commonly prescribed to lower cholesterol, improve artery health and prevent atherosclerosis. There are many other types of cholesterol-lowering medications. Another common type is a cholesterol absorption inhibitor called ezetimibe (Zetia). You may need more than one type of cholesterol medication.
Blood thinners. Your doctor may prescribe blood-thinning medications, such as aspirin, to reduce your risk that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
Blood pressure medications. Drugs to lower blood pressure don't help reverse atherosclerosis but instead prevent or treat complications related to the disease. For example, certain blood pressure medications can help reduce your risk of a heart attack.
Other medications. Your doctor may prescribe other medications to control health conditions that raise your risk of atherosclerosis, such as diabetes. And, specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, may be prescribed.

Surgery or other procedures

Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage, your doctor may recommend one of the following surgical procedures:

Angioplasty and stent placement. This procedure — also called percutaneous coronary intervention (PCI) — helps open a clogged or blocked artery. Your doctor inserts a catheter into the diseased artery. A second catheter with a deflated balloon on its tip is passed through the first catheter to the blockage. Your doctor inflates the balloon, widening the artery. A mesh tube (stent) is usually left in the artery to help it open.
Endarterectomy. Sometimes, plaque buildup must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's called a carotid endarterectomy.
Fibrinolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may use a clot-dissolving drug to break it apart.
Coronary artery bypass surgery. During this type of open-heart surgery, your doctor takes a healthy blood vessel from another part of the body to create a bypass around the blocked artery, redirecting blood flow. Sometimes the bypass is a graft made of synthetic material.

Lifestyle and home remedies

Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

Stop smoking. Smoking damages your arteries. Quitting smoking is the best thing you can do to keep your arteries healthy and prevent atherosclerosis complications.
Exercise most days of the week. Regular exercise improves blood flow, lowers blood pressure, and reduces your risk of conditions that increase the risk of atherosclerosis and heart disease.

Aim to exercise at least 30 minutes most days of the week. If you can't fit it all into one session, try breaking it up into 10-minute intervals.

You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television.
Lose extra pounds and maintain a healthy weight. If you're overweight, losing even just a few pounds can reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Ask your doctor what your target weight should be.
Eat healthy foods. A heart-healthy diet full of fruits, vegetables and whole grains — and low in refined carbohydrates, sugars, saturated fat and sodium — can help you control your weight, blood pressure, cholesterol and blood sugar.

Try substituting whole-grain bread in place of white bread. Grab an apple, a banana or carrot sticks as a snack. Read nutrition labels as a guide to control the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes.
Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.

Alternative medicine

It's thought that some foods and herbal supplements can help reduce your high cholesterol level and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor's OK, you might consider these supplements and products:

Alpha-linolenic acid
Barley
Beta-sitosterol (found in supplements and some margarines, such as Promise Activ)
Blond psyllium (found in seed husk and products such as Metamucil)
Calcium
Cocoa
Fish oil
Garlic
Green tea
Oat bran (found in oatmeal and whole oats)
Sitostanol (found in supplements and some margarines, such as Benecol)

Talk to your doctor before adding any of these or other supplements to your atherosclerosis treatment. Some supplements can interact with medications, causing harmful side effects.

You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure, reducing your risk of developing atherosclerosis.

Preparing for an appointment

If you think you may have atherosclerosis or are worried about having atherosclerosis because of a strong family history of heart disease, make an appointment with your doctor to have your cholesterol level checked.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. When you make the appointment, ask whether there's anything you need to do in advance, such as restrict your diet. Many blood tests, including cholesterol and triglycerides, require that you avoid eating and drinking for a certain amount of hours before the tests.
Write down any symptoms you're experiencing. Atherosclerosis is a risk factor for heart disease. Always tell your doctor if you have symptoms such as chest pains or shortness of breath. Such information helps your doctor decide how to best treat your atherosclerosis.
Write down key personal information, including a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements you're taking.
Take a family member or friend along, if possible. Someone who goes with you may remember something that you missed or forgot.
Be prepared to talk about your diet and exercise habits. If you don't already eat a healthy diet or exercise, your doctor can give you tips on how to get started.
Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For atherosclerosis, some basic questions to ask your doctor include:

What tests will I need?
What's the best treatment?
What foods should I eat or avoid?
What's an appropriate level of exercise?
How often do I need a cholesterol test?
What are the alternatives to the primary treatment you're suggesting?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing?
Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

Do you have a family history of high cholesterol, high blood pressure or heart disease?
What are your diet and exercise habits like?
Do you or did you smoke or use tobacco in any form?
Do you have discomfort in your chest or pain in your legs with walking or at rest?
Have you had a stroke or unexplained numbness, tingling or weakness of one side of your body or difficulty speaking?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. These are simple ways to protect yourself against atherosclerosis and its complications, including heart attack and stroke.