Understanding atherosclerosis

If the term atherosclerosis sounds unfamiliar, you probably know another name that’s often used for it: hardening of the arteries. Atherosclerosis refers to the buildup of plaque in the arteries. (A more general term, arteriosclerosis, is also used for hardening of the arteries that can develop from a variety of causes, such as diabetes, high blood pressure, and factors related to the aging process.)

Plaques are waxy, fatty deposits made up of cholesterol and other substances like fat, calcium, and fibrin (a protein that helps your blood clot). When plaques build up inside your arteries, they cause them to narrow, which cuts down the flow of oxygen-rich blood to your body’s organs. Plaques may also rupture or split, causing blood clots to form on the inside exposed surface of the artery walls, which may lead to a heart attack or stroke.

Atherosclerosis is often silent until it becomes advanced and you may not even know you have the condition. Diseases related to atherosclerosis are the leading cause of death in the United States, according to the National Institutes of Health.

“Sometimes the first symptom of atherosclerosis is a heart attack or stroke or even sudden coronary death,” says Steven Borzak, MD, a cardiologist affiliated with JFK Medical Center in Atlantis, Florida. Since atherosclerosis often doesn’t have symptoms, how do you know if you have it?

Diagnosing atherosclerosis

Atherosclerosis can be diagnosed with tests like a cardiac catheterization, a cardiac CT or MRI, or exercise stress testing. During a physical exam, your healthcare provider (HCP) may check for atherosclerosis by placing a stethoscope over a large artery, usually in the neck. Because the plaque can disrupt blood flow, your HCP may hear a whooshing sound. This is called a bruit, and it’s an indication that a plaque is causing turbulent blood flow. If your HCP finds a bruit, the next step is usually to have an ultrasound test to find out the cause of it.

Atherosclerosis can contribute to a variety of medical conditions, including:

• Coronary artery disease (CAD), which is atherosclerosis in the arteries that feed the heart
• Carotid artery disease, or atherosclerosis in arteries in the neck that supply blood to the brain
• Vertebral artery disease, which involves blocked arteries that supply blood to the back of the brain
• Peripheral arterial disease (PAD), in which arteries that supply blood to the arms, legs, and pelvis have narrowed
• Renal artery stenosis, atherosclerosis in the arteries that supply blood to the kidneys
• Mesenteric artery ischemia, atherosclerosis in the arteries that that supply blood to the intestines

Risk factors

Borzak says getting to the underlying problems that have caused atherosclerosis is crucial. “I’m less concerned with diagnosing atherosclerosis than I am with treating risk factors and preventing serious complications,” he says.

The good news is that you may have control over many of these risk factors. These include:

High cholesterol: High cholesterol and atherosclerosis often go hand-in-hand. High levels of saturated fat in the diet lead to higher levels of LDL (aka “bad” cholesterol), which can increase the risk of atherosclerosis. Healthy levels of HDL (aka “good” cholesterol) can actually decrease your risk.

Diabetes: Both type 1 and type 2 diabetes cause high blood sugar, which over time can damage artery walls. Diabetes is also associated with chronic inflammation, which can contribute to the development of atherosclerosis.

Smoking: Smoking is the single most damaging and most preventable cause of atherosclerosis and vascular events. Smoking and secondhand smoke damage blood vessels, which directly increases the risk of atherosclerosis. They also lower HDL levels and raise blood pressure.

Obesity: Obesity may promote plaque formation in many ways. It contributes to other risk factors, like high cholesterol, high blood pressure, and diabetes, and causes chronic inflammation that injures blood vessels and contributes to plaque formation.

Alcohol: If you drink, it’s important to keep your intake low. That means no more than one drink per day for women and no more than two per day for men. Moderate drinking of this sort can increase levels of healthy HDL, lower your risk of blood clots, and decrease inflammation.

Heavy drinking, on the other hand—more than 14 drinks per week for men and more than 9 drinks per week for women—can contribute to atherosclerosis and increase your risk for serious health problems and even death.

If you don’t drink, it’s best not to start. Alcohol can add extra calories to your diet, and there are many other ways you can improve your health, such as making a habit of regular physical activity.

Treatment and prevention

Exercise is one of the most important elements for preventing and treating atherosclerosis, says Borzak. “It’s closely linked to diet and weight, but exercise is also important for vascular health. It reduces the burden and impact of atherosclerosis by decreasing the risk for stroke and heart attack, and it can help with managing blood pressure, weight, and blood sugar control.”

Diet is also important, according to Borzak. “The emphasis on diet should really be about aiming to reach and maintain a healthy body weight and following a healthy diet rich in vegetables and fruits and low in saturated fat.”

Atherosclerosis often starts early, says Borzak.

“There’s no question that it takes years to develop, but the rate of progression is rarely linear,” he says. “There can be periods of rapid growth and slow growth. Investing in risk management is a good idea at any age and should begin as early as possible.”