Arteriosclerosis / atherosclerosis

• Overview
• Symptoms & causes
• Diagnosis & treatment
• Self-management

Overview
By Mayo Clinic Staff

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, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow.
These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable.
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Symptoms and causes
Symptoms
Atherosclerosis develops gradually. 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 adequate 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 symptoms of peripheral artery disease, such as leg pain when walking (claudication).
• 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

• Development of atherosclerosis

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 diseases, such as arthritis, lupus or infections, or inflammation of unknown cause

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 (plaques) 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 a 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 increase the risk of atherosclerosis include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• 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.

Diagnosis
During a physical exam, your doctor may find signs of narrowed, enlarged or hardened arteries, including:

• A weak or absent pulse below the narrowed area of your artery
• Decreased blood pressure in an affected limb
• Whooshing sounds (bruits) over your arteries, heard using a stethoscope

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

• Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test.
  Your doctor should tell you ahead of time if this test will be performed during your visit.
• 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 gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
• Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet.
  Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
• Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity.
  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 not be noticeable otherwise.
  An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.
  In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
• Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked.
  A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
• Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

Self-management Lifestyle and home remedies
Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

• Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications.
• Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently.
  Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes.
  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.
• Eat healthy foods. A heart-healthy diet based on 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; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes.
• Lose extra pounds and maintain a healthy weight. If you're overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis.
  Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes.
• 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.
PreventionThe 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

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.

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