Atherosclerosis

What Is Atherosclerosis?

Atherosclerosis occurs when plaque builds up and hardens inside your arteries. Plaque consists of cholesterol, calcium and other fatty substances which can partially or completely block blood flow to your heart.

Atherosclerosis develops slowly over time and can start to impact your cardiac health as early as your thirties. With this condition, there is a risk of blood clots forming or plaque splintering, which can completely block the arteries, cut off oxygen supply, and cause a heart attack or stroke. Diseases associated with atherosclerosis cause about half of all deaths worldwide.

What are the Symptoms of Atherosclerosis?

Most people with mild atherosclerosis do not have any symptoms until an artery is severely narrowed or becomes blocked.

Symptoms of atherosclerosis depend on which artery is affected. For example:

• Chest pain during activity that goes away when you rest is a sign of coronary disease and a warning sign of a heart attack.
• Deep, aching pain in the abdomen or back is an early sign of an abdominal aortic aneurysm.
• Painful muscle cramps in your hips or legs when walking that stops when you rest may indicate you have peripheral artery disease.
• Transient ischemic attack (TIA), also called a “mini stroke”, is a warning sign that you may experience a full stroke. Symptoms appear then go away after a few minutes. Symptoms include severe sudden headache, difficulty moving or thinking and numbness or weakness on one side.

Heart attack, stroke or a ruptured abdominal aortic aneurysm can occur quickly and are medical emergencies. Watch for symptoms and call 911 immediately.

Symptoms of a stroke:

• Confusion or difficulty talking or understanding others
• Dizziness, loss of balance or lack of coordination
• Severe headache
• Weakness or numbness in the face, arm or leg, usually on one side of the body
• Vision problems in one or both eyes

Heart attack symptoms:

• Chest discomfort (pain, pressure or tightness) that can be mild or severe
• Cold sweat
• Discomfort in the arm, shoulder or jaw
• Lightheadedness
• Nausea or vomiting
• Shortness of breath

Symptoms of a ruptured abdominal aortic aneurysm:

• Dizziness, lightheadedness or fainting
• Rapid heartrate
• Shortness of breath
• Sudden severe pain in your stomach, back or legs

What is the Difference Between Atherosclerosis and Arteriosclerosis?

Arteriosclerosis and atherosclerosis are similar, related conditions that affect the heart and blood vessels. Atherosclerosis is a subtype of arteriosclerosis, a vascular disease where the arteries become damaged from factors such as high cholesterol, high blood pressure, diabetes or certain genetic influences. Many people use the terms interchangeably, however, there are differences between the two conditions:

• Arteriosclerosis vs atherosclerosis: Arteriosclerosis includes any condition that causes hardening and thickening of the arteries. Atherosclerosis is the most common type of arteriosclerosis that occurs due to plaque buildup.
• Atherosclerotic cardiovascular disease: This is an umbrella term that describes any disease of the heart and blood vessels caused by atherosclerosis.

Types of Atherosclerosis-Related Diseases

Plaque can accumulate in any artery in your body.

Atherosclerosis of the Aorta

The aorta is the largest artery in your body. Shaped like a candy cane, it leaves the heart traveling toward your head, arches down and runs the length of your torso.

Atherosclerosis usually occurs in the abdominal section of the aorta and is a common cause of abdominal aortic aneurysms. An aneurysm is a bulging or ballooning of the blood vessel that can be deadly if it ruptures.

Cerebral Atherosclerosis

This is atherosclerosis of the arteries in and leading to your brain. Carotid artery disease is a narrowing of the carotid arteries in your neck that carry blood to your head.

Other Types of Atherosclerotic-Related Disease

Atherosclerosis can also affect the arteries that bring blood to your internal organs and extremities. Common diseases associated with atherosclerosis in these arteries include:

• Coronary artery disease (CAD) - atherosclerosis in the arteries that deliver blood to your heart muscle.
• Peripheral artery disease (PAD) - narrowing of the arteries in the legs, arms or pelvis.
• Renal artery disease - narrowing of the arteries that lead to the kidneys.

Atherosclerosis Causes and Risk Factors

Atherosclerosis is an inflammatory process that develops over time. It starts when the inner layer of your arteries becomes damaged due to such factors as:

• Age
• Diabetes
• High blood pressure
• High levels of cholesterol and triglycerides
• Smoking

Other risk factors for atherosclerosis include:

• Diet high in saturated fats and trans-fatty acids
• Family history of atherosclerosis in a male relative under age 55 or female relative under 65
• Hypercholesterolemia, an inherited disorder that causes high cholesterol
• Obesity
• Physical inactivity

Complications of Atherosclerosis

Damage to the arteries causes an immune response and formation of plaque at the site of injury. Over time, more plaque accumulates and the inside of your artery narrows. This buildup can restrict blood flow or stop it completely. If this process occurs in an artery that supplies blood to your heart, it can cause a heart attack.

Plaque usually has a fibrous cap over the top that keeps it in place. If the cap ruptures, the plaque can break off and enter your bloodstream. This blood clot (thrombus) travels through your arteries until it gets stuck and blocks blood flow. If a clot lodges in an artery in your brain, it can cause an ischemic stroke.

Atherosclerosis can also weaken the artery walls and cause an aneurysm. Abdominal aortic aneurysms are often silent and deadly. Doctors recommend a one-time screening for people at high risk for abdominal aortic aneurysms. Talk to your doctor about screening if you:

• Are a man between the ages of 65 and 75
• Ever smoked cigarettes
• Have a family member who had an abdominal aortic aneurysm

Diagnosis of Atherosclerosis

Your doctor will evaluate your risk of atherosclerosis during regular physical exams. This evaluation includes a review of your personal and family history and your lifestyle habits. Routine blood tests also help your doctor determine if you are at risk of atherosclerosis. These tests include:

• Blood sugar
• Cholesterol and triglycerides
• Proteins that are signs of inflammation, such as C-reactive protein

If you have symptoms or risk factors for developing atherosclerosis, your doctor may order other tests, such as:

• Ankle-brachial index: This test compares the blood pressure between your ankle and arm using a blood pressure cuff and ultrasound
• Cardiac imaging tests: These tests include X-ray, CT, MRI, PET and doppler ultrasound scans that assess the health of your heart and blood vessels
• Cerebral angiography: This minimally invasive test allows your doctor to see how blood circulates through your blood vessels
• Coronary calcium scan: This is a CT test that shows calcium deposits in the coronary arteries and scores your risk of heart disease
• Heart function tests: These tests include electrocardiogram and echocardiogram
• Stress tests: These tests include stress electrocardiogram and echocardiogram to evaluate how your heart functions when it is working hard

Preventing Atherosclerosis

Arteriosclerosis and atherosclerosis are not always preventable, however, through healthy lifestyle changes you can greatly reduce your risk. Some steps you can take towards a heart-healthy lifestyle include:

• Eat a heart-healthy diet low in saturated fats, trans fats, cholesterol, sodium and sugar
• Exercise regularly for 30 minutes or more
• Avoid smoking
• Maintain a healthy weight
• Stay on top of any health conditions, particularly, diabetes, high blood pressure and high cholesterol
• Don’t skip your annual checkup with your primary care provider or any other specialists you see

Treatment Atherosclerosis at Penn Medicine

Atherosclerosis treatments range from lifestyle changes to open surgical procedures.

Doctors in the Penn Heart and Vascular Center have deep expertise in treating all types of atherosclerosis-related diseases. They work with you to develop an individualized treatment plan. Your plan may include strategies to:

• Control your blood pressure, cholesterol and blood glucose levels
• Improve your lifestyle by eating healthier, exercising and quitting smoking
• Increase blood flow through your arteries
• Lower your risk of blood clots
• Prevent a heart attack, stroke or aneurysm rupture
• Reduce symptoms caused by atherosclerosis-related diseases
• Slow the buildup of plaque

Surgical procedures your doctor may recommend for atherosclerosis-related conditions include:

• Carotid endarterectomy: This surgery opens a blocked carotid artery and restores blood flow to the brain. Carotid endarterectomy can reduce your risk of stroke.
• Coronary artery bypass grafting (CABG): This is an open surgery that uses a blood vessel from another part of your body to reroute blood around a blocked coronary artery. Doctors perform coronary artery bypass grafting to improve blood flow to your heart and improve heart function. Learn more about our Coronary Artery Disease Program.
• Endarterectomy: This type of open surgery restores blood flow to narrowed or blocked arteries.
• Endovascular treatment: This includes a wide range of minimally invasive catheter-based procedures. A catheter is a thin tube your doctor inserts into a blood vessel in your groin or wrist and threads through your arteries to the affected area. Your doctor uses state-of-the-art techniques to remove blockages, reinforce weak areas and redirect blood flow. Read more about Penn Vascular Surgery and Endovascular Therapy Program.
• Limb preservation: This involves advanced steps to avoid amputation of a foot or leg in people with peripheral artery disease. Find out more about the Penn Advanced Limb Preservation Program.

Penn Programs & Services for Atherosclerosis