Definition

Atherosclerosis is a condition where plaque accumulates inside the walls of arteries, leading them to become hardened and narrowed. Arteries, which transport blood and oxygen from the heart to the rest of the body, should normally have flexible, elastic walls. When plaque forms, it disrupts this natural elasticity.

Plaque is a sticky material composed of:

• Fat
• Cholesterol
• Calcium
• Fibrin (a protein essential for blood clotting)
• Other cellular waste that attaches to the artery walls

As more plaque builds up, the arterial space narrows, restricting blood flow. This not only hardens the artery walls but also increases the risk of plaque rupture, which can result in blood clots.

While often linked to heart conditions, atherosclerosis can develop in any artery in the body. It is frequently confused with arteriosclerosis, which is a broader term for the hardening and thickening of arteries, with atherosclerosis being one specific cause due to plaque accumulation.

This stiffening of blood vessel walls can lead to several more severe complications. The narrowing of arteries limits the delivery of blood, oxygen, and nutrients throughout the body, potentially resulting in tissue death or infection.

Additionally, small pieces of plaque can break loose, traveling to other areas of the body and causing organ damage. Blood clots may also form in narrowed arteries and move through the bloodstream to other regions. Atherosclerosis can begin in childhood and progressively worsen if lifestyle improvements are not made.

Causes

Arteries transport blood from the heart to the entire body. They are lined by a thin layer of cells known as the endothelium, which ensures that the arteries remain smooth and flexible.

Atherosclerosis begins with damage to the endothelial layer of the artery walls, a process that occurs gradually over an extended period and can start in childhood.

When the endothelial lining is damaged, blood cells and other substances collect at the site, forming plaque. As more compounds, such as fat and cholesterol, accumulate, the plaque grows and narrows the blood vessels, hindering blood flow. If the plaque ruptures, it can lead to additional complications. Atherosclerosis increases the risk of various diseases.

Risk Factors

Factors that increase the risk of developing atherosclerosis include:

• Elevated cholesterol or triglyceride levels
• High blood pressure
• Smoking
• Diabetes
• Inflammatory conditions
• Excess weight or obesity
• Lack of physical activity
• A diet high in saturated fats and low in fiber
• Family history of cardiovascular disease
• Men aged 45 and older, and women aged 55 and older

Symptoms

Atherosclerosis typically doesn’t produce noticeable symptoms until later in life, when blood vessels are significantly obstructed (by around 60-70%). Many individuals are unaware they have the condition until they experience a heart attack or stroke.

Early signs that may suggest arterial blockage include:

• Chest pain during physical activity that subsides with rest
• Leg cramps while walking
• Transient Ischemic Attack (TIA), temporary stroke-like symptoms that resolve within hours to days

If a blood vessel becomes suddenly blocked, a heart attack or stroke may occur. Stroke symptoms include weakness in the face and limbs, and patients may have sudden difficulty speaking or understanding others. Other signs are visual disturbances, trouble balancing, and difficulty walking. In certain types of strokes, patients can experience a sudden and severe headache.

Heart attack symptoms include:

• Chest pain, which may spread to both arms or shoulders
• Discomfort in the neck or jaw
• Nausea or vomiting
• Palpitations or a rapid heartbeat
• Anxiety
• Sweating
• Confusion
• Fatigue
• Muscle weakness
• Dizziness
• Shortness of breath
• Fainting

Diagnosis

Atherosclerosis diagnosis involves medical interview, physical examination, and diagnostic tests. Medical interview refers to the interview process between the doctor and patient to identify risk factors, helping to make the diagnosis. The doctor will ask questions about the primary complaint, accompanying symptoms, when the symptoms started, medical history, family history, physical activity, and lifestyle habits.

A thorough physical examination follows, where the doctor will check vital signs like blood pressure, respiration rate, body temperature, and pulse to assess the patient’s stability. The examination will focus on the heart, limbs, and nerve function, depending on the patient's reported complaints.

Supporting tests that may be conducted include:

• Blood tests to measure cholesterol, triglycerides, blood sugar, and proteins
• Angiography, chest X-ray, and CT scan to detect hardening and narrowing of arteries
• Echocardiography (heart ultrasound)
• Electrocardiography (ECG) to assess heart rhythm and blockages
• Ankle/Brachial Index test to compare blood pressure between the heel and arm, assessing blood flow to the limbs

Management

Atherosclerosis treatment combines lifestyle changes, medications, and possibly surgery. Treatment aims to:

• Lower the risk of blood clots
• Encourage a heart-healthy diet, including whole grains, nuts, fruits, vegetables, lean meats like fish and chicken, and healthy oils like olive and sunflower oil
• Prevent complications such as heart attacks or strokes
• Reduce symptom severity
• Slow plaque buildup in the arteries
• Improve blood flow by widening arteries

Doctors may prescribe medication to control blood pressure, lower cholesterol, thin the blood, manage blood sugar, and prevent clots. In more severe cases, procedures such as angioplasty (to open blocked arteries) or bypass surgery (to reroute blood around blockages) may be necessary.

Complications

Atherosclerosis can lead to several complications, such as:

• Aneurysm or blood vessel rupture
• Angina (chest pain that worsens with physical activity)
• Chronic kidney disease
• Coronary heart disease
• Heart attack
• Peripheral artery disease
• Stroke or other nerve damage
• Irregular heart rhythms

Prevention

Anyone can develop atherosclerosis, but you can reduce your risk by:

• Eating a nutritious diet low in saturated fat, salt, and sugar
• Exercising regularly, at least 30 minutes, 3-4 times a week
• Maintaining a healthy body mass index to prevent obesity
• Avoiding smoking
• Getting annual medical check-ups if needed

When to See a Doctor?

Seek medical attention immediately if you experience any of the above symptoms and have risk factors for atherosclerosis. You can visit a general practitioner to evaluate your risk of developing this condition.

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