What is Atherosclerosis?
Atherosclerosis is when fat deposits, cholesterol, calcium and other cellular debris substances build up inside the arteries and limit the oxygen rich blood flow to the heart and rest of the body. Atherosclerosis can be seen on the MRI image below.
Atherosclerosis can affect the arteries in any part of the body including the heart, kidneys, brain, legs, arms and pelvis.
- If the coronary arteries delivering oxygen to the heart have plaque build-up (atherosclerosis), this is called coronary artery disease.
- If plaque builds-up in the carotid artery (arteries on the side of the neck) this is called carotid artery disease.
- If plaque is located in the major arteries of the arms, legs and pelvis this is called peripheral artery disease.
- If plaque is developing in the renal (kidney) arteries, this is called chronic kidney disease.
How does it happen?
The cause of atherosclerosis is unknown. However, research has shown that multiple factors play a role in plaque development including: inflammatory and immunologic factors, endothelial dysfunction and risk factors such as high blood pressure, diabetes, high cholesterol, obesity and smoking.
The stages of atherosclerosis development:
- The lining of blood vessels (endothelium) becomes damaged from smoking, high cholesterol, and/or high blood pressure.
- Inflammation from the damaged cells causes blood cells and cholesterol to build up on the artery walls and forms plaque. This stage signifies early plaque development and called a fatty streak.
- As LDL cholesterol, fibrous tissue, platelets, and cellular debris continue to adhere to the vessel, it narrows the area and reduces elasticity, resulting in a fibrous cap. These fibrous caps will calcify and create advanced lesions in the artery. When fibrous caps grow large enough they can block the vessel, stopping blood flow.
What are possible symptoms?
- Plaque build-up does not usually cause symptoms unless the blood flow to the area is severely or completely blocked. You may not know you have atherosclerosis until a medical emergency occurs.
- If the coronary arteries fill with plaque, it narrows the path for delivery of blood. In this case you may experience chest pain/discomfort, or potentially a heart attack.
- If the carotid artery is filled with plaque it may impede blood flow to your brain, this could lead to neurological changes and/or a stroke.
- In peripheral artery disease, you could experience pain and numbness in your lower extremities.
- Plaque in your kidneys, resulting in chronic kidney disease, may reduce kidney function and impair your body’s ability to excrete waste and extra water.
What are risk factors for developing atherosclerosis?
- High blood pressure
- Elevated cholesterol
- Lack of physical activity
- Older age
- Family history of early heart disease
- Sleep apnea
- Chronic stress
- Heavy alcohol drinking
- Impaired wound healing in extremities
- Heart Attack
- Heart arrhythmias
What are possible treatments?
- Treatment is aimed at reducing risk factors and eliminating underlying causes. For example: blood pressure control, managing diabetes, lowering blood sugar levels, cholesterol management, weight loss, and smoking cessation.
- Healthy lifestyle changes can be a first line therapy
- Healthy diet and exercise are important lifestyle interventions
Where can I get more information?
For additional information, please seek further guidance from your primary care provider or specialist.
American Heart Association. (2017). Atherosclerosis.
National Heart, Lung, and Blood Institute (2017). Atherosclerosis.
Xue-Qiao, Z (2017). Pathogenesis of atherosclerosis. In J.C. Kaski, P. Libbt & G.M. Saperia (Eds.), UptoDate.