You may not have heard of the term atherosclerosis, but you probably know it by another name: hardening of the arteries. Atherosclerosis is a buildup of plaque—a waxy, fatty substance—in the arteries. This plaque can rupture or fissure, causing blood clots to form on the exposed surface and may lead to heart attack or stroke. Plus, you may not even know you have atherosclerosis.
“Sometimes the first symptom of atherosclerosis is a heart attack or stroke or even sudden coronary death,” says Steven Borzak, MD, a cardiologist with JFK Medical Center in Atlantis, Florida. Cholesterol in the blood combines with other substances, such as fat and calcium, and forms plaque. But since atherosclerosis usually doesn’t have symptoms, how do you know if you have it?
Atherosclerosis can be diagnosed in a number of ways, including blood tests, electrocardiograms, CT scans and stress tests. During a physical exam, a doctor may actually hear the presence of plaque (which disrupts blood flow) by placing a stethoscope on a large artery.
Forms of atherosclerosis include coronary artery disease, which is atherosclerosis in arteries that feed the heart; carotid artery disease, or atherosclerosis in arteries that supply blood to the brain; and peripheral arterial disease, where arteries that supply blood to the arms, legs and pelvis are blocked.
Borzak says diagnosing atherosclerosis is less important than getting to the underlying problems that caused the disease. “I’m less concerned with diagnosing atherosclerosis than I am with treating risk factors and preventing events,” he says.
The good news is that many of these risk factors are reversible or preventable.
High cholesterol and atherosclerosis often go hand-in-hand. High levels of saturated fat in the diet lead to higher LDL cholesterol levels (“bad” cholesterol), which can increase the risk of atherosclerosis. But healthy levels of HDL cholesterol (the “good” kind) can decrease risk.
Both type 1 and type 2 diabetes are characterized by an excess of blood sugar. Too much sugar—aka glucose—in the bloodstream produces some chemicals that damage artery wall cells and reduces other chemicals that promote increased blood flow.
Smoking and secondhand smoke damage blood vessels, which directly increases the risk of atherosclerosis. They also lower HDL cholesterol levels and raise blood pressure. Smoking is the single most potent and most preventable cause of atherosclerosis and vascular events.
Obesity is thought to promote plaque formation in many ways. It contributes to other risk factors, like high cholesterol, HTN and diabetes, and causes chronic inflammation that injures blood vessels and leads to plaque formation.
Treatment and prevention
Exercise is an important element of treatment and prevention, says Borzak. “It’s closely linked to diet and weight, but exercise is also important for vascular health,” says Borzak. “It reduces the burden and impact of atherosclerosis by reducing stroke and heart attack risk, and it can help with blood pressure and weight and glucose control.”
Diet is important in relation to obesity, according to Borzak. “The emphasis on diet should really be more about reducing caloric intake and maintaining a good body weight and less about food selection.”
Atherosclerosis starts early, says Borzak. “There’s no question that it takes years to develop, but the rate of progression is rarely linear; there can be periods of rapid growth and slow growth. Investing in risk management is a good idea at any age and should begin as early as possible.”