Atherosclerosis: Plaque in the Arteries

Atherosclerosis is a buildup of plaque inside the arteries. Plaque is a sticky substance made of cholesterol, fat, blood cells, calcium and other material found in the blood. Over time it hardens and narrows the arteries, which limits the flow of oxygen-rich blood to the body.

It is often confused with arteriosclerosis, which is a broader term: hardening of the arteries, in which they thicken and become less flexible. Arteriosclerosis has several possible causes, and atherosclerosis, the kind that comes from plaque, is a common type of it.

One process, many diseases

Atherosclerosis can affect most arteries in the body, and it takes a different name depending on where the plaque is:

Causes and risk

Plaque often begins to form in childhood and gets worse with age. Its exact cause is unknown, but researchers think the buildup follows damage to the arteries, which may come from unhealthy habits, medical conditions and genes.

The risk is higher for people who:

• have high blood pressure, high blood cholesterol, diabetes, metabolic syndrome, or an inflammatory disease such as rheumatoid arthritis or psoriasis;
• have a family history of high blood cholesterol;
• eat a lot of food high in saturated fat;
• smoke or chew tobacco; or
• are older: risk rises after age 45 in men and age 55 in women.

Symptoms

Early on there are often no symptoms. They may first appear when the body needs more oxygen, such as during physical or emotional stress, and they depend on which arteries are affected and how badly blood flow is blocked:

• Heart: angina (a type of chest pain), palpitations, and shortness of breath.
• Neck: a bruit, a whooshing sound a provider hears through a stethoscope, or a transient ischemic attack, sometimes called a mini-stroke.
• Legs: pain, aching, heaviness or cramping when walking or climbing stairs.
• Back of the brain: trouble with thinking and memory, weakness or numbness on one side of the body or face, problems with vision, or a transient ischemic attack.
• Intestines: severe pain after meals, weight loss and diarrhea.

In men, erectile dysfunction can be an early warning sign of higher risk for atherosclerosis and its complications, and is worth raising with a provider.

Complications

If a plaque bursts, a blood clot can form. The clot may block the artery completely or travel elsewhere in the body. Depending on the arteries involved, blockages can lead to heart attack, stroke, vascular dementia or loss of a limb.

Diagnosis and treatment

A provider will ask about medical and family history, lifestyle and risk factors, examine the patient — including listening to the heart and the blood flow in the arteries — and will likely order tests such as blood tests and heart tests.

Treatment is planned around which arteries are affected, how much flow is blocked and what other conditions the person has. It can include heart-healthy lifestyle changes; medicines to manage risk factors, treat the disease or its complications, or treat conditions that make plaque worse; procedures or surgery, depending on the arteries involved; and cardiac rehabilitation after certain complications.

Prevention

• Eat heart-healthy food such as fruit, vegetables and whole grains, and limit saturated fat, salt and added sugar.
• Be physically active regularly, after asking a provider what level of activity suits you.
• Aim for a healthy weight.
• Limit alcohol: less is better than more. Men should have 2 drinks or fewer a day, and women 1 or fewer.
• Manage stress and get enough good-quality sleep.
• Quit smoking if you smoke, and avoid secondhand smoke.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Atherosclerosis" (summary from the National Heart, Lung, and Blood Institute): https://medlineplus.gov/atherosclerosis.html