Atherosclerosis

Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. It is also called arteriosclerosis or hardening of the arteries. Arteries are the blood vessels that carry oxygen and nutrients from the heart to the rest of your body. As you get older, fat and cholesterol can collect in the arteries and form plaque. The buildup of plaque makes it difficult for blood to flow through the arteries. This buildup may occur in any artery in the body and can result in a shortage of blood and oxygen in various tissues of the body. Pieces of plaque can also break off, causing a blood clot. If left untreated, atherosclerosis can lead to heart attack, stroke, and heart failure.

Atherosclerosis is a fairly common problem associated with aging. According to the University of Maryland Medical Center (UMMC), 80 to 90 percent of individuals over the age of 30 have some degree of atherosclerosis (UMMC, 2010). This condition can be prevented, and many successful treatment options exist.

Atherosclerosis occurs when fat, cholesterol, and calcium harden in the arteries. Atherosclerosis can occur anywhere in the body, including the heart, legs, and kidneys.

Other types of atherosclerosis are:

Coronary Artery Disease

This condition occurs when the coronary arteries of the heart become hard. The coronary arteries are blood vessels that provide the heart’s muscle tissue with oxygen and blood. Plaque prevents blood flow to the heart.

Carotid Artery Disease

The carotid arteries are found in your neck and supply blood to your brain. These arteries may be compromised if plaque builds up in their walls. The lack of circulation may cause a decrease of blood and oxygen to the brain’s tissue and cells.

Peripheral Artery Disease

Your legs, arms, and lower body depend on your arteries to supply blood and oxygen to their tissues. Hardened arteries can cause circulation problems in these areas of the body.

Kidney Disease

The renal arteries supply blood to the kidneys. Kidneys filter waste products and extra water from your blood. When they cannot filter properly, waste products build up inside the renal arteries, making them hard. The hardened vessels may lead to kidney failure.

Plaque build-up and subsequent hardening of the arteries restricts blood flow in the arteries, preventing your organs and tissues from getting the oxygenated blood they need to function.

The following are common causes for hardening of the arteries.

High Cholesterol

Cholesterol is a waxy, yellow substance that is found naturally in your body and also in certain foods you eat. This substance can increase in your blood and clog your arteries. It becomes a hard plaque that restricts or blocks blood circulation to your heart and other organs.

Fat

Eating foods high in fat may also lead to plaque buildup.

Aging

As you age, your heart and blood vessels work harder to pump and receive blood. Your arteries may weaken and become less elastic, making them more susceptible to plaque buildup.

Many factors place you at risk for atherosclerosis. Some risks can be prevented, while others cannot.

Family History

If atherosclerosis runs in your family, you may be at risk for hardening of the arteries. This condition as well as other heart-related problems may be inherited.

Lack of Exercise

Regular exercise is good for the heart — it keeps the heart muscle strong and encourages oxygen and blood flow throughout the body. Living a sedentary lifestyle increases your risk for a host of medical conditions, including heart disease.

Diet

Eating foods high in fats and cholesterol raises your risk for atherosclerosis.

High Blood Pressure

High blood pressure can damage your blood vessels by making them weak in some areas. Cholesterol and other substances in your blood may reduce arterial flexibility over time.

Smoking

Smoking tobacco products can damage your blood vessels and heart.

Diabetes

People with diabetes have a much higher incidence of coronary artery disease.

Most symptoms of atherosclerosis do not show until a blockage occurs. Common symptoms include:

• chest pain (angina)
• pain in the leg, arm, and anywhere else that an artery is blocked
• shortness of breath
• fatigue
• confusion (if the blockage affects circulation to the brain)
• muscle weakness in the legs from lack of circulation

It is also important to know the symptoms of heart attack and stroke. Both of these problems can be caused by atherosclerosis and require immediate medical attention. Symptoms of a heart attack include:

• chest pain or discomfort
• pain in the shoulders, back, neck, arms, and jaw
• abdominal pain
• shortness of breath
• perspiration
• feeling of lightheadedness
• nausea or vomiting
• sense of impending doom

Symptoms of stroke include:

• weakness or numbness in the face or limbs
• trouble speaking
• trouble understanding speech
• vision problems
• loss of balance
• sudden, severe headache

If you experience symptoms of a heart attack or stroke, call 911 and get to a hospital's emergency room as soon as possible. 

If you are experiencing symptoms of atherosclerosis, your doctor will perform a physical exam. He or she will check for a weakened pulse, aneurysm (an abnormal bulging or widening of an artery due to weakness), and slow wound healing, which indicates restricted blood flow. A heart specialist called a cardiologist may listen to your heart to see if you have any abnormal sounds. He or she will be listening for a whooshing noise, which indicates that an artery is blocked. Your doctor will order more tests if he or she suspects atherosclerosis. These tests may include:

• a blood test to check your cholesterol levels
• a Doppler ultrasound, which uses sound waves to create a picture of the artery  that shows if there is a blockage
• ankle-brachial test, which compares the blood pressure in your arms and legs to look for a blockage in your arms or legs
• magnetic resonance arteriography (MRA) or computed tomography (CT) angiography to create pictures of the large arteries in your body
• cardiac angiogram, which requires an injection of radioactive dye that can be seen on X-rays to create a picture of the arteries in your heart
• an electrocardiogram (ECG), which measures the electrical activity in your heart to look for any areas of decreased blood flow
• a stress test (exercise tolerance test), which monitors your heart rate and blood pressure while you exercise on a treadmill or stationary bicycle

Treatment involves changing your current lifestyle to one that limits the amount of fat and cholesterol you consume. You may need to exercise more to improve your cardiovascular (heart and blood vessels) health.

You may also need additional medical treatments, such as:

Medications

Medications can help prevent atherosclerosis from worsening. Medications include:

• cholesterol-lowering medications, including statins and fibric acid derivatives
• antiplatelet drugs and anticoagulants, such as aspirin, to prevent blood from clotting and clogging the arteries
• beta blockers or calcium channel blockers to lower blood pressure
• diuretics (water pills) to help lower blood pressure
• angiotensin converting enzyme (ACE) inhibitors, which help prevent narrowing of the arteries

Surgery

In some cases, surgery may be necessary if symptoms are especially severe, or if muscle or skin tissue are endangered. Possible surgeries for treating atherosclerosis include:

• bypass surgery: a vessel from elsewhere in the body, or a synthetic tube, is used for diverting blood around a blocked or narrowed artery
• thrombolytic therapy: dissolves a blood clot by injecting a drug into the affected artery
• angioplasty: a thin, flexible tube called a catheter and balloon are used to expand an artery
• endarterectomy: surgically removing fatty deposits from an artery
• atherectomy: a nonsurgical procedure that removes plaque from the arteries using a catheter with a sharp blade at one end

With treatment, you may see improvement in your health, but this may take time. Your success will depend on the severity of your condition, how promptly it was treated,  and whether other organs were affected. Hardening of the arteries cannot be reversed, but treating the underlying cause and making healthy lifestyle and dietary changes can help slow down the process, or prevent it from getting worse. 

You should work closely with your doctor to make the appropriate lifestyle changes. You will also need to take the proper medications to control your condition and avoid complications. Complications of atherosclerosis include:

• heart failure
• heart disease
• heart attack
• abnormal heart rhythm
• stroke
• peripheral artery disease (reduced blood flow to arms and legs)
• kidney failure
• death 

Lifestyle changes can help to prevent as well as treat atherosclerosis. Unless your atherosclerosis is severe, your doctor may recommend lifestyle changes as the first line of treatment. Lifestyle changes include:

• eating a healthy diet that is low in saturated fat, and cholesterol
• avoiding fatty foods
• adding fish to your diet twice per week
• exercising for 30 to 60 minutes per day, six days per week
• quitting smoking
• losing weight if you are overweight or obese
• managing stress
• treating conditions associated with atherosclerosis, such as hypertension, high cholesterol, and diabetes