Arteriosclerosis, the condition often called hardening of the arteries, is a general term for several conditions in which the wall of an artery becomes thicker and less elastic than usual. The most common form of arteriosclerosis is atherosclerosis in which fatty material predominantly cholesterol accumulates on artery walls. Your doctor may refer to arteriosclerosis as vascular disease.
Atherosclerosis affects large and medium-sized arteries and is a slow, progressive disease that may start in childhood. In some people, this disease progresses rapidly in their 30s, while others don't have any problems until they reach their 50s or 60s. Collectively, the effects of atherosclerosis on the brain, heart, kidneys, and other vital organs are the leading cause of death and disease in the United States and most western countries. While it can occur anywhere in the body, atherosclerosis is especially common in the arteries leading to the heart and brain and can lead to heart attack or stroke.
To some extent, arteriosclerosis is a natural part of aging, but a number of lifestyle choices can dramatically affect the onset and severity.
In atherosclerosis, for example, fatty substances cholesterol, cellular waste products, calcium, and fibrin (a clotting material in the blood) deposit on the inner lining of an artery. The innermost layer of the artery becomes thickened by these accumulating cells and surrounding material. The resulting build-up, called plaques or atheromas, over time may partially block the blood's flow through an artery, thus decreasing the oxygen supply reaching your internal organs. Affected arteries lose their elasticity and narrow as the plaque deposits grow. Coronary atherosclerosis is the cause of coronary artery disease. People with coronary artery disease (narrowed coronary arteries) may experience angina pectoris (chest pain) or discomfort caused by insufficient oxygen supply to the heart muscle.
In time, the plaques also collect calcium deposits, causing the plaques to become brittle, and increasing the likelihood of rupturing. When a rupture occurs, blood may flow in and make the plaque larger so that it narrows the artery even more. A ruptured plaque may trigger the formation of a blood clot (thrombus). The clot may further narrow or even block the artery, or it may detach and float freely in the blood until it gets stuck in a small vessel. The end result is usually serious. Blockage of the arteries supplying blood to the heart can cause heart attack. Blockage of the arteries supplying blood to the brain can cause stroke. Blockage of the arteries supplying blood to the extremities can cause gangrene.
Symptoms often don't appear until the atherosclerosis reaches an advanced stage, at which point it becomes harder to treat. The best approach is prevention avoiding the numerous risk factors under your control, including diet, smoking, and exercise.
How Common Is Arteriosclerosis?
Arteriosclerosis is very common in the United States. According to the Centers for Disease Control (CDC), cardiovascular disease, principally heart disease and stroke, accounts for 42% of all deaths nationwide, for both men and women among all racial and ethnic groups. The CDC estimates that one in four Americans has cardiovascular disease.
Goals of Treatment
The immediate goal in treating arteriosclerosis is to halt or at least slow its progress. Your doctor may prescribe medications to help lower cholesterol levels if diet modifications and other lifestyle approaches fail. Drug therapy can also help control high blood pressure and diabetes, two other risk factors.
Lifestyle changes diet, exercise, and smoking cessation are critical. The progress of artery hardening can be delayed with treatment. Over time, the size of plaque may decrease. Certain medications are effective in lowering cholesterol levels and slowing the progress of plaque deposits. When medications don't work, surgery is also an option.
Once you're diagnosed with arteriosclerosis, your doctor will begin monitoring your overall health status, keeping a close watch on your blood pressure and your cholesterol and triglyceride levels. Your doctor can direct you to helpful resources for dietary counseling and smoking cessation if necessary.
The following treatments are general measures that address the risk factors of arteriosclerosis:
- Aerobic exercise, 30 to 45 minutes, at least three times a week
- Weight loss, if needed, to reach and maintain normal body weight
- Low-fat, low-cholesterol, high-fiber diet
- Correction and control of abnormal blood-cholesterol levels
- Smoking cessation
- Maintenance of normal blood pressure and normal blood sugar levels
- Stress reduction
|Drugs most commonly prescribed to treat the causes|
|Fibric acid derivatives|
Blood-pressure lowering agents that may include diuretics, beta-blockers, calcium-channel blockers, ACE inhibitors, vasodilators, and others
When other treatment methods are inadequate, several invasive procedures are available.
- Angioplasty: A catheter with a balloon tip is inserted into a narrowed artery and then inflated, widening the artery by cracking plaques. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque. Angioplasty is most commonly performed on arteries leading to the heart, the kidneys, and vessels in the lower leg.
- Bypass surgery: A section of vein or artery is removed from elsewhere in the body and reconnected to detour blood around the diseased vessel. Coronary bypass surgery is the most common type of bypass, but it's also done in blood vessels in the legs.
- Endarterectomy: The clogged vessel is opened up and the fatty deposits are removed. This procedure is most commonly done on the carotid artery in the neck.
New Treatments in Development
- Gene therapy: In this experimental procedure, genes that direct the growth of new blood vessels are surgically inserted into the blocked artery. This should encourage formation of a natural bypass around the blockage.
- Transmyocardial revascularization: a laser cuts a series of channels in the heart muscle to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle. This is a new procedure and still considered experimental.
Appropriate Healthcare Setting
People with arteriosclerosis do not require hospitalization unless sudden acute complications occur such as severe angina, transient ischemic attacks, heart attack, or stroke. In those cases, inpatient hospitalization is necessary.
Healthcare Professionals Who May Be Involved in Treatment
Many health professionals and cardiac specialists participate in managing this disorder:
- Family physicians
- Critical care physicians
- Thoracic surgeons
- Cardiac surgeons
Activity & Diet Recommendations
Exercise is an important component of treating arteriosclerosis and is especially helpful in preventing development of heart disease. A program of aerobic exercise can improve circulation, reduce cholesterol, and control obesity and diabetes, among other factors contributing to arteriosclerosis.
The connection between diet and vascular disease is well-established and many experts recommend a low-fat, high-fiber diet for patients with arteriosclerosis. Here are some general guidelines:
- Avoid foods high in saturated fats, such as meats, eggs, cheeses, and other dairy products
- Eat plenty of whole grains, breads, and cereals instead of white and refined grains
- Eat lots of fresh fruits and vegetables with meals and as snacks
- Eat legumes such as beans, peas, and lentils in soups and salads
Monitoring the Condition
Keep a close watch on your cholesterol and triglyceride levels. Stick to your exercise and diet programs.
Untreated arteriosclerosis can cause serious complications:
- Angina pectoris and unstable angina
- Coronary artery disease
- Heart attack
- Congestive heart failure
- Stroke or transient ischemic attack (TIA)
Quality of Life
Depending on the severity and stage of arteriosclerosis, available treatments range from lifestyle adjustments to major surgery. Which treatment is right for you depends on your individual situation. Making lifestyle changes, like improving your diet, quitting smoking, gradually increasing exercise, and reducing stress, can improve your overall quality of life and reduce your risk of the serious consequences of arteriosclerosis, such as a heart attack or stroke.
Considerations for Women
Women over age 35 who are on birth control pills and smoke are at an increased risk of developing arteriosclerosis. Estrogen replacement therapy for postmenopausal women with arteriosclerosis may decrease your chances of experiencing angina. Talk to your doctor about whether this option is right for you.
Considerations for Older People
Older people are particularly at risk for coronary artery disease because the effects of risk factors such as high blood pressure build up over time. The arteries also become thicker and lose their elasticity with age. Older people may also be more susceptible to side effects of medication. Talk to your doctor about any drugs you're currently taking.
Considerations for Children and Adolescents
Coronary artery disease doesn't develop overnight. Fatty streaks and deposits can begin forming in children as young as three years old. Establishing healthy habits in childhood such as eating right and exercising can prevent serious health consequences in adulthood.
Last updated 19 November 2011
- Coronary artery disease (CAD)
- Coronary heart disease
- Carotid artery disease
- Peripheral vascular disease
The actual mechanism by which arteriosclerosis begins is unknown, but researchers have proposed two hypotheses to explain what happens: the lipid hypothesis and the chronic endothelial injury hypothesis. The two are not mutually exclusive and are probably related.
The lipid hypothesis postulates that elevated low-density lipoprotein (LDL, or "bad" cholesterol) in the blood causes the LDL to penetrate the artery wall where it not only promotes accumulation and the development of plaques, but also oxidizes and damages the artery wall.
The chronic endothelial injury hypothesis postulates that damage to the arterial wall by various processes causes the clotting agents in blood to attach to the artery wall and initiate the formation of fibrous plaque.
Although the actual mechanism is still the subject of research, the risk factors of arteriosclerosis are well documented.
Some of the key risk factors for arteriosclerosis are associated with lifestyle, while others are hereditary:
- Diet high in fat and cholesterol
- Family history of premature arteriosclerosis or heart attacks
- High blood pressure
- Diabetes mellitus
- Elevated low-density lipoprotein (LDL, or "bad") cholesterol
- Decreased high-density lipoprotein (HDL, or "good") cholesterol
- Elevated levels of fats (triglycerides)
- Sedentary lifestyle
- Increasing age
- Being a man
- Being a postmenopausal woman
- Family history of high cholesterol
- Elevated homocysteine levels in the blood (a genetic condition that may be associated with vascular injury and predispose the vessels to atherosclerosis)
- Chlamydia pneumoniae infection (some experts believe it may contribute to vascular damage and inflammation that could lead to atherosclerosis)
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms & Diagnosis
Arteriosclerosis usually has no symptoms in the early stages and may remain silent in the advanced stages as well. Signs and symptoms that do show up are usually associated with the secondary conditions caused by arteriosclerosis. The most common one is angina pectoris (chest pain), which is caused by a lack of oxygenated blood flow to the heart muscle. You should also be aware of the following:
- Physical exercise, large meals, stress, or exposure to cold can cause angina and its episodes of tightness, heaviness, pressure, and varying intensity of pain in the chest region. Angina can also occur abruptly with no apparent cause ("unstable" angina).
- Some people feel the pain of angina in the face, neck, and other upper-body regions, particularly the left arm.
- Short episodes (less than 24 hours) of dizziness, one-sided weakness, difficulty speaking, or visual changes (collectively called transient ischemic attacks, or TIAs) signal a problem with blood flow to the brain and the risk of stroke.
Cool feet, pain in the back of the thigh, hair loss on your legs, shiny skin on your shins, and red color in your legs and feet when they hang down are all signs that the arteries in your legs may be blocked. If the arteries of your legs are affected, the first symptom is a painful, aching, cramping, or tired feeling in leg muscles when you walk, and the pain is worse when you walk quickly or walk uphill. The pain which you might feel in your calf, foot, thigh, hip, or buttocks goes away when you stop walking. As the condition progresses and the arteries are narrowed even more, the distance you can walk without pain decreases and in severe cases the muscles may ache even when you're resting.
Conditions That May Be Mistaken for Arteriosclerosis/Atherosclerosis
If your arteries are narrowed due to plaque buildup, you have arteriosclerosis. However, chest pain and shortness of breath could be caused by other conditions:
- Gastrointestinal disorders such as peptic ulcer, indigestion, hiatus hernia, gallbladder disease, and spasms or inflammation of the esophagus
- Chronic shortness of breath (dyspnea)
- Blood clot in the lung, pneumonia, or pleurisy
- Aortic aneurysm: injury of the tissue in the wall of aorta (the major artery carrying blood out of the heart)
- Inflammation of the membrane around the heart (pericarditis)
- Inflammation of or damage to the ribs
- Disease of the spinal nerve roots (radiculopathy)
- Psychological disorders due to panic or anxiety
- Cervical or thoracic spine disease
How Is Arteriosclerosis/Atherosclerosis Diagnosed?
Checking your blood-cholesterol level should be part of your routine physical. Men over 45 and women over 55 should have a cholesterol test as frequently as their doctors suggest. If you have symptoms (such as chest pain or heart attack) that your doctor suspects stem from arteriosclerosis, further testing is required to confirm the diagnosis:
- Your medical history and physical exam
- Blood tests
- Electrocardiogram (EKG or ECG)
- Exercise testing
- Various methods of imaging
Laboratory blood tests that detect levels of triglycerides, cholesterol, LDL, and HDL are usually helpful to the diagnosis.
Special tests are performed to confirm arteriosclerosis by evaluating the cardiovascular system.
- Electrocardiogram (EKG) measures electrical activity of the heart, which may be abnormal if there is diminished blood flow to the heart.
- Exercise stress test that measures blood pressure, heartbeat, and breathing rate as well as an EKG, during exercise. This test can show if not enough oxygen is reaching the heart during exercise.
Imaging allows your physician to locate the narrowed artery, which is helpful in determining which therapy is best for your condition.
- Coronary arteriography: A doctor guides a thin plastic tube through an artery in your arm or leg and into the coronary arteries, and then injects a liquid dye visible in x-rays through the catheter. High-speed X-ray movies show the liquid as it flows through the arteries. Doctors can identify blockages in the arteries by tracing the liquid's flow.
- Radionuclide scintigraphy: an imaging technique that involves the use of radioactive elements to demonstrate blood flow in the heart.
- Stress echocardiography: a diagnostic procedure that studies the structure and motion of the heart.
- Stress thallium: imaging test to measure cardiac function and blood flow.
- Carotid ultrasound: evaluates the arteries leading to the brain to look for plaques and narrowing.
Self care & Prevention
The best treatment for atherosclerosis is prevention. Prevention focuses on eliminating controllable risk factors:
- Lower blood cholesterol levels with diet and/or medication
- Lower blood pressure
- Stop smoking
- Lose weight
- Begin an exercise program
- Reduce stress
Once signs of arteriosclerosis appear, most of the same preventive measures are still recommended for slowing the progress of artery hardening.
- If you smoke, quit. Smoking is a major risk factor for atherosclerosis, and quitting quickly reduces your risk.
- Eat an ultra low-fat diet
- Eat more plant foods
- Try drinking tea.
- Eating cold-water fish.
- Drink a little red wine.
- Get more exercise.