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Hardening of arterial walls: Hardening of the arteries Information | Mount Sinai

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Atherosclerosis | Cedars-Sinai

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CAUSES
DIAGNOSIS

TREATMENT

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What is atherosclerosis?

Atherosclerosis is thickening of
the walls of the arteries. It is also known as hardening of the arteries. It is caused
by a buildup of plaque in the inner lining of an artery.

Plaque is made up of deposits of
fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it
builds up in the arteries, the artery walls become thickened and stiff.

Atherosclerosis is a slow,
progressive disease. It may start as early as childhood. But in some people, it can
progress quickly.

What causes atherosclerosis?

It’s not clear exactly how it
starts or what causes it. A gradual buildup of plaque or thickening due to inflammation
occurs on the inside of the walls of the artery. This reduces blood flow and oxygen
to
body organs and tissues.

Who is at risk for atherosclerosis?

Risk factors include:

  • High cholesterol and triglyceride
    levels
  • High blood pressure
  • Smoking
  • Type 1 and 2 diabetes
  • Obesity
  • Physical inactivity
  • High saturated fat diet
  • Family history

What are the symptoms of atherosclerosis?

Signs and symptoms may develop
slowly over time. Symptoms may also vary depending on the affected artery. Or you
may
have few symptoms. But when a major artery is blocked, you may have a heart attack,
stroke, or blood clot.

The symptoms of atherosclerosis may
be like other health conditions. See your healthcare provider for a diagnosis.

How is atherosclerosis diagnosed?

First, your healthcare provider
will do a complete health history and physical exam. You may also have 1 or more of
these tests:

  • Cardiac catheterization.A long thin tube (catheter) is passed into the coronary arteries. A dye is
    injected into an artery. Then X-rays are taken. The dye helps to show the narrowing,
    blockages, and other problems of certain arteries.
  • Doppler sonography.A probe is used to send sound waves into a blood vessel to look at blood flow.
    An audio receiver amplifies the sound of the blood moving though the vessel. Faint
    sound or no sound may mean there is a blockage. This is used to find narrowed blood
    vessels in the abdomen, neck, or legs.
  • Blood pressure comparison.Blood pressure measurements in the ankles and in the arms are compared. This
    helps find any differences in blood pressure. Big differences may mean blood vessels
    are narrowed.
  • MUGA/radionuclide
    angiography.
    This is a type of nuclear scan. It is done to see how the heart wall moves and
    how much blood is pumped with each heartbeat while you are at rest.
  • Thallium/myocardial perfusion scan.This is a type of nuclear scan. It is done while you are at rest, or after
    exercise. It may show areas of the heart muscle that are not getting enough
    blood.
  • Cardiac CT.This is a type of X-ray test. It can show if there is coronary calcification or
    even heart artery blockages. These calcifications or blockages may lead to a future
    heart problem.

How is atherosclerosis treated?

Treatment may include lifestyle
changes, medicine, and surgery.

Lifestyle changes

Lifestyle changes can include:

  • Stopping smoking
  • Controlling cholesterol levels
  • Controlling blood sugar (glucose) levels
  • Treating high blood pressure
  • Getting exercise
  • Eating a healthy diet

Medicines

Medicines that may be used are
listed below.

Antiplatelet medicines

These are used to decrease the ability of platelets in the
blood to stick together and form a clot.

Anticoagulants

These are also called blood thinners. They work differently from antiplatelet
medicines to decrease the ability of the blood to clot. Bivalirudin, enoxaparin,
and heparin are examples of IV (intravenous) and injectable anticoagulants. There
are many other anticoagulants used for treating blood clots that occur with
irregular heart rhythms. But these are not used often for atherosclerosis.

Cholesterol-lowering medicines

These are medicines used to lower fats (lipids) in the blood.
They focus on changing levels of low-density lipid (LDL) cholesterol. Statins are
a type of this medicine. They include simvastatin, atorvastatin, rosuvastatin, and
pravastatin. Other types of medicine may be used to reduce cholesterol levels.
These include bile acid sequestrants such as colesevelam, cholestyramine, and
colestipol. Another medicine is nicotinic acid. Your healthcare provider may also
prescribe fibrates. These help improve your cholesterol and triglyceride levels.
People with inherited high levels of cholesterol (familial hypercholesterolemia)
may need to use a medicine called a PCSK9 inhibitor to control their cholesterol.
Two kinds of this medicine are alirocumab and evolocumab and are given by
injection.

Blood pressure medicines

Several different types of medicines act in different ways to lower blood pressure.

Coronary angioplasty

With this procedure, a long thin
tube (catheter) is put into a blood vessel and moved up into the heart. There,
a balloon is inflated to create a bigger opening in the vessel. This increases blood
flow. Angioplasty is done in other blood vessels elsewhere in the body.
Percutaneous coronary intervention (PCI) refers to angioplasty in the coronary
arteries to let more blood flow into the heart. There are several types of PCI,
including:

  • Balloon angioplasty.A small balloon is inflated inside the blocked artery to open the blocked
    area.
  • Atherectomy.The blocked area inside the artery is shaved away by a tiny device on the end
    of a catheter.
  • Laser angioplasty.A laser is used to vaporize the blockage in the artery.
  • Coronary artery stent.A tiny mesh coil is expanded inside the blocked artery to open the blocked
    area and is left in place to keep the artery open.

Coronary artery bypass

This is most often called bypass
surgery. It is often done in people who have angina (chest pain) or have had a heart
attack and have significant atherosclerosis in multiple heart arteries. During the
surgery, a bypass is created around a blocked area of an artery. A healthy vein is
taken from elsewhere in the body. This is called a graft. The graft is usually taken
from the leg or from the chest wall. The graft is attached above and below the
blocked area of a coronary artery. This lets blood flow around the blocked area.
An
artery from another blood vessel in the chest can also be used to supply the heart
artery blood beyond a blockage as well. Sometimes more than 1 artery needs to be
bypassed during the same surgery.

What are possible complications of atherosclerosis?

Plaque buildup inside the arteries
reduces the blood flow. A heart attack may occur if the blood supply is reduced to
the
heart. A damaged heart muscle may not pump as well. This can lead to heart failure.
A
stroke may occur if the blood supply is cut off to the brain. If the blood supply
is
reduced in the arms or legs, it may cause severe pain and destroy tissue.

Can atherosclerosis be prevented?

You can prevent or delay
atherosclerosis by reducing your risk factors. This includes:

  • Eating a healthy diet
  • Losing weight
  • Being physically active
  • Not smoking

A healthy diet includes:

  • Fruits and vegetables
  • Whole grains
  • Lean meats, skinless chicken, and fish
  • Fat-free or low-fat dairy foods and drinks
  • Low sodium
  • Low amounts of refined sugars and grains
  • Low amounts of solid fats

If you are at risk for
atherosclerosis because of family history or high cholesterol, take medicines as
directed by your healthcare provider.

When should I call my healthcare provider?

Call your healthcare provider if:

  • Your symptoms get worse
  • You have new symptoms

Key points of atherosclerosis

  • Atherosclerosis is thickening of the
    walls of the arteries. It is also known as hardening of the arteries. It is caused
    by
    a buildup of plaque in the inner lining of an artery.
  • Risk factors may include high
    cholesterol levels, high blood pressure, smoking, diabetes, obesity, and saturated
    fats.
  • Atherosclerosis can cause a heart
    attack, stroke, aneurysm, or blood clot.
  • You may need medicine, treatments, or
    surgery to reduce the complications of atherosclerosis.

Next steps

Tips to help you get the most from
a visit to your healthcare provider:

  • Know the reason for your visit and
    what you want to happen.
  • Before your visit, write down
    questions you want answered.
  • Bring someone with you to help you ask
    questions and remember what your provider tells you.
  • At the visit, write down the name of a
    new diagnosis and any new medicines, treatments, or tests. Also write down any new
    instructions your provider gives you.
  • Know why a new medicine or treatment
    is prescribed and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated
    in other ways.
  • Know why a test or procedure is
    recommended and what the results could mean.
  • Know what to expect if you do not take
    the medicine or have the test or procedure.
  • If you have a follow-up appointment,
    write down the date, time, and purpose for that visit.
  • Know how you can contact your provider
    if you have questions.

Medical Reviewer: Steven Kang MD

Medical Reviewer: Callie Tayrien RN MSN

Medical Reviewer: Stacey Wojcik MBA BSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

  • What Is Atherosclerosis?
  • What Causes Atherosclerosis?
  • What Are the Symptoms of Atherosclerosis?
  • What Are the Risk Factors for Atherosclerosis?
  • How Do You Diagnose Atherosclerosis?
  • How Does Plaque Affect Atherosclerosis?
  • What Are the Complications of Atherosclerosis?
  • How Do You Treat Atherosclerosis?
  • More

Atherosclerosis is a hardening and narrowing of your arteries caused by cholesterol plaques lining the artery over time. It can put blood flow at risk as your arteries become blocked.

You might hear it called arteriosclerosis or atherosclerotic cardiovascular disease. It’s the usual cause of heart attacks, strokes, and peripheral vascular disease — what together are called cardiovascular disease.

You can prevent and treat this process.

Arteries are blood vessels that carry blood from your heart throughout your body. They’re lined by a thin layer of cells called the endothelium. It keeps the inside of your arteries in shape and smooth, which keeps blood flowing.

Atherosclerosis begins with damage to the endothelium. Common causes include:

  • High cholesterol
  • High blood pressure
  • Inflammation, like from arthritis or lupus
  • Obesity or diabetes
  • Smoking

That damage causes plaque to build up along the walls of your arteries.

When bad cholesterol, or LDL, crosses a damaged endothelium, it enters the wall of your artery. Your white blood cells stream in to digest the LDL. Over the years, cholesterol and cells become plaque in the wall of your artery.

Plaque creates a bump on your artery wall. As atherosclerosis gets worse, that bump gets bigger. When it gets big enough, it can create a blockage.

That process goes on throughout your entire body. It’s not only your heart at risk. You’re also at risk for stroke and other health problems.

Atherosclerosis usually doesn’t cause symptoms until you’re middle-age or older. As the narrowing becomes severe, it can choke off blood flow and cause pain. Blockages can also rupture suddenly. That causes blood to clot inside an artery at the site of the rupture.

You might not have symptoms until your artery is nearly closed or until you have a heart attack or stroke. Symptoms can also depend on which artery is narrowed or blocked.

Symptoms related to your coronary arteries include:

  • Arrhythmia, an unusual heartbeat
  • Pain or pressure in your upper body, including your chest, arms, neck, or jaw. This is known as angina.
  • Shortness of breath

Symptoms related to the arteries that deliver blood to your brain include:

  • Numbness or weakness in your arms or legs
  • A hard time speaking or understanding someone who’s talking
  • Drooping facial muscles
  • Paralysis
  • Severe headache
  • Trouble seeing in one or both eyes

Symptoms related to the arteries of your arms, legs, and pelvis include:

  • Leg pain when walking
  • Numbness

Atherosclerosis starts when you’re young. Research has found that even teenagers can have signs.

If you’re 40 and generally healthy, you have about a 50% chance of getting serious atherosclerosis in your lifetime. The risk goes up as you get older. Most adults older than 60 have some atherosclerosis, but most don’t have noticeable symptoms.

These risk factors are behind more than 90% of all heart attacks:

  • Abdominal obesity (“spare tire”)
  • Diabetes
  • High alcohol intake (more than one drink for women, one or two drinks for men, per day)
  • High blood pressure
  • High cholesterol
  • Not eating fruits and vegetables
  • Not exercising regularly
  • Smoking
  • Stress

Rates of death from atherosclerosis have fallen 25% in the past 3 decades. This is because of better lifestyles and improved treatments.

Your doctor will start with a physical exam. They’ll listen to your arteries and check for weak or absent pulses.

You might need tests, including:

  • Angiogram, in which your doctor puts dye into your arteries so they’ll be visible on an X-ray
  • Ankle-brachial index, a test to compare blood pressures in your lower leg and arm
  • Blood tests to look for things that raise your risk of having atherosclerosis, like high cholesterol or blood sugar
  • CT scan or magnetic resonance angiography (MRA) to look for hardened or narrowed arteries
  • EKG, a record of your heart’s electrical activity
  • Stress test, in which you exercise while health care professionals watch your heart rate, blood pressure, and breathing

You might also need to see doctors who specialize in certain parts of your body, like cardiologists or vascular specialists, depending on your condition.

Plaques from atherosclerosis can behave in different ways.

They can stay in your artery wall. There, the plaque grows to a certain size and then stops. Since this plaque doesn’t block blood flow, it may never cause symptoms.

Plaque can grow in a slow, controlled way into the path of blood flow. Over time, it causes significant blockages. Pain in your chest or legs when you exert yourself is the usual symptom.

The worst happens when plaques suddenly rupture, allowing blood to clot inside an artery. In your brain, this causes a stroke; in your heart, a heart attack.

The plaques of atherosclerosis cause the three main kinds of cardiovascular disease:

  • Coronary artery disease: Stable plaques in your heart’s arteries cause angina (chest pain). Sudden plaque rupture and clotting cause heart muscle to die. This is a heart attack.
  • Cerebrovascular disease: Ruptured plaques in your brain’s arteries cause strokes with the potential for permanent brain damage. Temporary blockages in your artery can also cause something called transient ischemic attacks (TIAs), which are warning signs of a stroke. They don’t cause any brain injury.
  • Peripheral artery disease: When the arteries in your legs narrow, it can lead to poor circulation. This makes it painful for you to walk. Wounds also won’t heal as well. If you have a severe form of the disease, you might need to have a limb removed (amputation).

Complications of atherosclerosis include:

  • Aneurysms
  • Angina
  • Chronic kidney disease
  • Coronary or carotid heart disease
  • Heart attack
  • Heart failure
  • Peripheral artery disease
  • Stroke
  • Unusual heart rhythms

Once you have a blockage, it’s generally there to stay. But with medication and lifestyle changes, you can slow or stop plaques. They may even shrink slightly with aggressive treatment.

Lifestyle changes: You can slow or stop atherosclerosis by taking care of the risk factors. That means a healthy diet, exercise, and no smoking. These changes won’t remove blockages, but they’re proven to lower the risk of heart attacks and strokes.

Medication: Drugs for high cholesterol and high blood pressure will slow and may even halt atherosclerosis. They lower your risk of heart attack and stroke.

Your doctor can use more invasive techniques to open blockages from atherosclerosis or go around them:

  • Angiography and stenting: Your doctor puts a thin tube into an artery in your leg or arm to get to diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (using a catheter with a balloon tip) and stenting can often open a blocked artery. Stenting helps ease symptoms, but it does not prevent heart attacks.
  • Bypass surgery: Your doctor takes a healthy blood vessel, often from your leg or chest, and uses it to go around a blocked segment.
  • Endarterectomy: Your doctor goes into the arteries in your neck to remove plaque and restore blood flow. They also may place a stent higher risk patients.
  • Fibrinolytic therapy: A drug dissolves a blood clot that’s blocking your artery.

Your doctor will discuss the complications of these procedures with you. 

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Atherosclerosis

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In our clinics you can:

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For more details and any questions, please contact the number listed on the website

What is atherosclerosis

Atherosclerosis of the coronary vessels is a chronic heart disease that occurs against the background of a violation of metabolic processes, in particular lipid (fat) metabolism. As a result, cholesterol plaques are deposited on the inner walls of the myocardial arteries, in which defective connective tissue (sclerosis) gradually grows. Sealing of the walls of blood vessels leads to irreversible deformations, narrowing of the lumen, up to complete blockage.

Atherosclerosis of the heart vessels is the first symptom of IHD. Without timely and proper treatment, the development of coronary disease is inevitable.

As a rule, before the first clinical signs appear, the disease has been asymptomatic for a long time. According to medical statistics, atherosclerosis begins at a fairly young age and is clearly manifested by the age of 45-50. This is due to the cumulative feature of cholesterol. For many years, it can gradually envelop the walls of blood vessels until it reaches a critical level. The accumulation of trans fats interferes with full blood flow, up to a complete blockage of circulation. There comes asphyxia and atrophy of the heart muscle.

Causes

Atherosclerosis of the arteries of the heart develops under the influence of both social and physiological factors. In cardiology, there are more than 200 causes that provoke the progress of pathology. The most common are:

  • Lipid metabolism disorders, as a result of which excess cholesterol accumulates in the body, settling on the walls of blood vessels;
  • Smoking has an extremely negative effect on the cardiac system. Nicotine, heavy resins damage cell membranes in blood vessels. Permeability is disturbed, blood circulation worsens;
  • Hypertension. High blood pressure increases the load on the heart muscle;
  • Static lifestyle. Office work, the lack of normal activity leads to a slowdown in metabolic processes, stagnant processes begin to develop;
  • Unbalanced diet. Eating a large amount of fried, fatty foods leads to pathologies of the circulatory system;
  • Genetic predisposition. If at least one close blood relative was diagnosed with atherosclerosis of the heart vessels, then the risk of developing the disease increases several times;
  • Pos. In young and middle-aged women, the development of atherosclerosis is prevented by natural processes in the body – the synthesis of estrogens. After the onset of menopause, the risk of pathology increases;
  • Old age. Gradual accumulation of harmful fats occurs over decades. Therefore, the older a person becomes, the greater the likelihood of a dangerous diagnosis;
  • Narcological diseases. The presence of alcohol or drug addiction aggravates the general state of human health, one of the complications of addiction can be atherosclerosis of the coronary arteries of the heart;

Diabetes. The clinical picture of the disease includes multiple lesions of blood vessels, against the background of impaired metabolism. Atherosclerosis can become a complication.

Symptoms

The danger of atherosclerosis of the coronary vessels of the heart lies in the absence of symptoms in the first stages of development. The disease can “silently” destroy arteries for many years. As a rule, the first signs appear in middle age, after 45 years. During this time, negative processes in the vessels reach a critical level and are manifested by the following symptoms:

  • Pain in the region of the heart, left shoulder and under the shoulder blade;
  • Discomfort, burning sensation under ribs;
  • Dyspnea while walking and in a fully horizontal position;
  • General weakness, dizziness;
  • Persistent slight nausea.

Nonspecific symptoms of atherosclerosis of the heart are often mistaken by patients for the manifestation of other diseases that have similar symptoms. This makes it difficult to make a diagnosis in the early stages, when the treatment prognosis is favorable in the vast majority of cases.

Progressive atherosclerosis of the heart vessels is manifested by more serious symptoms:

  • Angina pectoris. Short-term attacks of pain in the region of the heart, radiating to the shoulder blade, arm, abdominal cavity and lower jaw. Occur after physical activity, eating spicy food or emotional stress. Last no more than 15-20 minutes, the symptoms disappear after rest or taking sedatives, such as validol.
  • Cardiosclerosis. The process of development of atherosclerosis is in the active stage – there is scarring and replacement of muscle tissue with inferior compounds. Manifested by constant weak to moderate pain, swelling of the extremities, shortness of breath, fatigue, decreased physical activity.
  • Arrhythmia. The frequency and sequence of heartbeats is disturbed. The patient has paroxysmal pain, a feeling of cardiac arrest, dizziness, fainting, abnormal tremors in the chest region.

Heart failure. The rupture of a cholesterol plaque is accompanied by the formation of a blood clot that clogs the artery. The blood stops carrying oxygen and nutrients. The heart stops beating normally. There are strong, burning pains in the chest, nausea, the patient feels a lack of air, limbs swell, clouding of consciousness appears.

Important! In acute failure, the risk of myocardial infarction increases to 90%. If the attack is accompanied by a rupture of the aneurysm, death occurs.

Depending on how quickly the patient seeks medical help, the prognosis of atherosclerosis will be positive or unfavorable. If the pathology is launched to such an extent that foci of necrosis began to form in the myocardium, then there is a significant threat to life.

Treatment

The treatment of atherosclerosis of the coronary vessels of the heart requires a heterogeneous, complex approach and a long period of time. After an accurate assessment of the clinical picture of the disease, medications and therapeutic measures are prescribed, which include:

  • Antihypertensive preparations for removing excess lipids and fluid from body tissues from blood vessel cells;
  • Beta-blockers, inhibitors to decrease the oxygen demand of the heart. At the time of treatment, this reduces myocardial activity and the severity of symptoms.
  • Anticoagulants to exclude the possibility of blood clots.
  • Prescribing a special diet;
  • Prohibition of smoking, alcoholic beverages;
  • Moderate therapeutic exercise to prevent stagnant processes;
  • Weight loss to normalize metabolic processes and remove toxic substances from the body.

Surgical intervention

Treatment of atherosclerosis involves surgical methods when the development of the disease is in the last stages and the patient’s life is in danger. The way to solve the problem is determined by the cardiologist if conservative therapy has not brought results. Modern medicine offers the following types of surgical intervention:

  • Coronary bypass surgery. Prostheses are inserted into the vessels, which allow you to restore blood circulation in the proper volume.
  • Angioplasty. Mechanical expansion of the coronary vessels by introducing special catheters with a balloon. When the balloon is inflated, the cholesterol plaque is “flattened” and, accordingly, the throughput of the vessel is restored.
  • Stenting. A rigid frame is inserted into the vessel cavity, which expands and fixes the lumen of the artery.

Preventive examination and early diagnosis will help to avoid dangerous surgery. The initial stages of the disease respond well to treatment and the prevention of dangerous complications.

Possible complications

Atherosclerosis of the aorta of the heart has two types of complications – chronic and acute. Chronic forms include vascular insufficiency, irreversible deformation of the myocardial muscles, growth of defective connective tissue, oxygen starvation of the heart. Most often, the following pathologies appear:
Myocardial infarction – necrotic scarring of muscle tissue associated with a lack of oxygen.

  • Stroke is a myocardial disorder resulting in the death of nerve cells in the brain due to mild or extensive hemorrhage;
  • Hypertension – persistent increase in blood pressure due to impaired blood circulation in the coronary vessels of the heart;
  • Ischemic heart disease is a pathology with absolute or partial damage to the myocardium.

Acute complications are directly life-threatening and are associated with the formation of blood clots and spasms in the blood vessels. These include:

  • Aortic hematoma – accumulation of blood between the walls of blood vessels. Manifested by fainting, severe chest pain. Requires immediate surgery.

Aneurysm is an expansion of the vascular cavity due to abnormal growth of connective tissue. A distinctive feature is a sudden rupture with large blood loss, which occurs asymptomatically. In most cases, it ends in death.

Important! Already at the first consultation with a cardiologist, you can find out about the presence of atherosclerosis of the coronary vessels. Visual inspection and listening are simple and, most importantly, timely diagnostic methods that will help preserve health and life.

Who is at risk

Everyone, regardless of gender and age, can get atherosclerosis of the coronary arteries. Many factors contribute to this, ranging from social causes to poor ecology.
Guidelines for assessing risk factors for developing cardiovascular diseases, developed on the basis of many years of research in the field of cardiology, highlight the following indicators:

  • Men aged 50-55;
  • Difficult working conditions due to professional activities;
  • Hereditary pathologies of the heart;
  • Obesity;
  • Smoking, including passive smoking;
  • Psychological disorders – stress, depression, depression;
  • Diseases of the thyroid gland;
  • Poor nutrition, the definition includes fried, fatty, sweet and starchy foods, fast food.

A systemic risk assessment for the next 10 years can be done independently according to the well-known SCORE (Systemic COronary Risk Evaluation) scale proposed by American cardiologists.
The modern pace and rules of life put every second person at risk. Therefore, it is difficult to find a better prevention of atherosclerosis of the heart vessels than regular preventive examinations. At the slightest suspicion, it is better to contact a cardiologist and adjust your lifestyle than undergo a long treatment, not always with a positive outcome.

Appointment for a preventive examination

You can make an appointment with a cardiologist using the contacts listed on the website or by contacting the nearest IMMA medical center. You will receive comprehensive information not only about the internal routine of the clinic, but also about modern research standards, methods of diagnosis and treatment. Therapeutic and diagnostic assistance provided to patients in the cardiology department is carried out according to the recommendations of the WHO RF by cardiologists of the highest category and candidates of medical sciences.

Author of the material: therapist at the clinic on Nikulinskaya Nichman E. G.

Treatment of vascular atherosclerosis in Petrozavodsk