Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a condition in which fatty deposits called plaque slowly build up inside the walls of the arteries. Arteries are the blood vessels that carry oxygen-rich blood from the heart to the rest of the body. Plaque is made of cholesterol (a waxy, fat-like substance), calcium, cellular debris, and other material. Over many years, plaque can make the artery walls thick and stiff and narrow the channel through which blood flows.

The word comes from the Greek terms for “gruel” and “hardening,” which describes how the soft, fatty material eventually hardens the vessel. Atherosclerosis is the most common form of a broader group of conditions known as arteriosclerosis, a general term for any stiffening of the arteries.

Atherosclerosis can affect arteries anywhere in the body. When it involves the arteries supplying the heart, it is called coronary artery disease. In the arteries leading to the brain, it is a major cause of stroke. In the arms and legs, it is known as peripheral artery disease. It can also affect the arteries that supply the kidneys and intestines.

The process often begins early in life and progresses silently for decades. It is very common among older adults, and in many people it causes no problems at all. In others, it leads to serious cardiovascular events. Men tend to develop clinically significant disease at a younger age than women, although risk in women rises after menopause. People with diabetes, high blood pressure, high cholesterol, or a history of smoking are affected more often and at an earlier age.

Atherosclerosis symptoms

Mild to moderate atherosclerosis usually causes no symptoms. Many people learn they have it only after a test done for another reason, or when an artery has become narrowed enough to limit blood flow. Atherosclerosis symptoms depend mainly on which arteries are affected and how severely they are blocked.

Common symptoms include:

• Chest pain, pressure, or tightness, especially during exertion (angina)
• Shortness of breath with activity
• Pain, cramping, or heaviness in the legs when walking that eases with rest (claudication)
• Numbness, weakness, or coldness in a leg or arm
• Sudden weakness or numbness on one side of the body, trouble speaking, or drooping of the face (possible stroke or transient ischemic attack)
• Unusual fatigue
• Erectile dysfunction in men
• Wounds on the feet or legs that heal slowly
• Sudden severe pain in the abdomen after eating, or unexplained high blood pressure when kidney arteries are involved

Symptoms by location:

Heart arteries. Narrowing in the coronary arteries often causes angina, a discomfort in the chest that may spread to the arm, neck, jaw, or back. It usually appears with physical or emotional stress and fades with rest. If a plaque ruptures and a blood clot suddenly blocks the artery, a heart attack can occur. Heart attack symptoms may include prolonged chest pain, sweating, nausea, and shortness of breath. Some people, particularly women, older adults, and people with diabetes, may have less typical symptoms.

Brain arteries. Plaque in the carotid arteries of the neck or the arteries within the brain can lead to a transient ischemic attack (a brief, stroke-like episode that resolves) or a stroke. Symptoms come on suddenly and may include weakness, confusion, vision loss, or difficulty speaking.

Leg and arm arteries. Peripheral artery disease typically causes pain in the calf, thigh, or buttock during walking. In advanced stages there may be pain at rest, skin color changes, hair loss on the legs, or ulcers that do not heal.

Stages. In early stages there are usually no symptoms. As narrowing progresses, symptoms may appear only during effort. In advanced disease they may occur at rest. Complications such as heart attack or stroke can happen at any stage if a plaque becomes unstable, which is why atherosclerosis is sometimes described as a “silent” disease.

Causes and risk factors

The exact sequence that starts atherosclerosis is not fully understood, but it is widely accepted that it begins with damage to the endothelium, the thin inner lining of the artery. Once the lining is injured, cholesterol and other substances in the blood can collect at the site. The body responds with inflammation, sending white blood cells that absorb the fat and become trapped. Over time this mixture forms plaque, which may harden with calcium or remain soft and prone to rupture.

Atherosclerosis causes are therefore closely tied to factors that injure the artery lining or increase the amount of fat circulating in the blood. Recognized risk factors include:

• High cholesterol, particularly high levels of low-density lipoprotein (LDL), often called “bad” cholesterol
• High blood pressure, which places constant stress on artery walls
• Smoking and other tobacco use, which damages the lining and promotes clotting
• Diabetes and insulin resistance, which raise blood sugar and injure vessels
• Obesity, especially excess weight around the abdomen
• Physical inactivity
• An unhealthy diet high in saturated and trans fats, salt, and added sugar
• Family history of early heart disease or stroke
• Older age, since plaque accumulates over a lifetime
• Chronic inflammatory conditions such as rheumatoid arthritis, lupus, or psoriasis
• Chronic kidney disease
• Sleep apnea and long-term stress

Some risk factors, such as age and genetics, cannot be changed. Many others can be influenced through lifestyle and medical care, which is the basis of prevention and treatment.

Atherosclerosis diagnosis

Atherosclerosis diagnosis starts with a medical history and physical examination. Your doctor will ask about symptoms, lifestyle, and family history, and may check your blood pressure, listen for abnormal sounds over arteries (called bruits), and feel for weak or absent pulses in the legs or feet.

Because plaque cannot be seen or felt directly in most cases, doctors rely on a combination of blood tests and imaging:

• Blood tests measure cholesterol, triglycerides, blood sugar, and sometimes markers of inflammation or kidney function.
• Electrocardiogram (ECG or EKG) records the electrical activity of the heart and can show signs of reduced blood flow or previous heart attack.
• Stress testing monitors the heart during exercise or after a medication that mimics exercise, sometimes combined with imaging, to reveal narrowing that only causes problems under effort.
• Echocardiogram uses ultrasound to show how well the heart pumps and whether parts of the heart muscle are weakened.
• Ankle-brachial index compares blood pressure in the ankle with that in the arm to screen for peripheral artery disease.
• Doppler ultrasound shows blood flow in arteries such as the carotids in the neck or the arteries of the legs.
• Coronary calcium scan, a specialized CT scan, measures calcified plaque in the heart arteries and helps estimate risk.
• CT angiography or MR angiography uses contrast dye with a CT or MRI scanner to produce detailed pictures of the arteries.
• Catheter angiography involves threading a thin tube into an artery and injecting dye so blockages can be seen on X-ray. It is the most direct way to confirm narrowing and is often performed when a procedure to open the artery is being considered.

Not every person needs every test. The choice depends on your symptoms, your overall risk, and which arteries are suspected to be involved. Doctors also use risk calculators that combine age, cholesterol, blood pressure, smoking status, and diabetes to estimate the likelihood of a heart attack or stroke over the coming years. This estimate helps guide decisions about medication even when no symptoms are present.

Atherosclerosis treatment options

There is currently no way to completely remove plaque from the arteries, but atherosclerosis treatment can slow or stabilize its growth, relieve symptoms, and lower the risk of heart attack, stroke, and limb loss. The plan depends on how advanced the disease is and which arteries are affected. In most hospitals, including Acibadem, this care is coordinated through the Cardiology Department, often together with vascular surgery and other specialties.

Lifestyle changes. These are the foundation of every treatment plan. They typically include stopping smoking, eating a diet rich in vegetables, fruits, whole grains, legumes, and healthy fats, limiting saturated fat and salt, being physically active most days, maintaining a healthy weight, managing stress, and getting enough sleep. In people with early disease and no symptoms, lifestyle measures combined with regular monitoring may be the main approach.

Medications. Your doctor may prescribe one or more of the following, depending on your risk and other conditions:

• Statins and other cholesterol-lowering drugs reduce LDL cholesterol and are thought to help stabilize plaque.
• Antiplatelet medicines such as aspirin or clopidogrel make the blood less likely to form clots on a damaged plaque. They are not appropriate for everyone, so this decision is made individually.
• Blood pressure medicines, including ACE inhibitors, angiotensin receptor blockers, beta blockers, and calcium channel blockers, reduce strain on the arteries and heart.
• Diabetes medicines to control blood sugar; some newer classes may also offer heart and kidney protection.
• Nitrates and other anti-anginal drugs relieve chest pain by widening blood vessels.
• Medicines for leg symptoms may be considered in peripheral artery disease to improve walking distance.

Procedures. When an artery is severely narrowed and causing symptoms, or when blood flow must be restored urgently, a minimally invasive procedure may be recommended:

• Angioplasty and stenting. A thin catheter with a small balloon is guided to the blockage and inflated to widen the artery. A stent, a small mesh tube, is usually left in place to keep the vessel open.
• Atherectomy. A device on a catheter cuts or shaves plaque away, used in selected cases, most often in leg arteries.
• Thrombolysis. Clot-dissolving medicine is given, usually during a heart attack or stroke, when a clot has suddenly blocked an artery.

Surgery. For extensive or complex disease, surgical options include:

• Coronary artery bypass grafting (CABG). A blood vessel taken from another part of the body is used to route blood around blocked heart arteries.
• Carotid endarterectomy. Plaque is surgically removed from the carotid artery in the neck to reduce stroke risk.
• Peripheral bypass surgery. A graft redirects blood around a blocked artery in the leg.

Rehabilitation. After a heart attack, stent, or bypass surgery, cardiac rehabilitation offers supervised exercise, education, and support to help people recover safely and lower the chance of future events. Supervised walking programs are also a recognized treatment for peripheral artery disease and may improve walking distance in many people.

Treatment is usually lifelong. Procedures address the most dangerous blockage at a given moment, but they do not cure the underlying disease, so medication and lifestyle changes remain essential afterward.

Living with atherosclerosis and outlook

Atherosclerosis is a chronic condition, meaning it is managed rather than cured. The outlook varies widely from person to person. Many people who control their risk factors and follow their treatment plan live for many years without a major cardiovascular event. Others, particularly those with extensive disease, diabetes, kidney disease, or continued smoking, face a higher chance of complications. No treatment can guarantee that a heart attack or stroke will not occur, but consistent management is widely accepted to lower the risk substantially.

Practical steps for daily life often include taking medications exactly as prescribed, attending follow-up visits and blood tests, monitoring blood pressure and blood sugar at home if advised, staying physically active within limits set by your care team, and knowing the warning signs of heart attack and stroke. It is also common to feel anxious or low after a diagnosis; talking with your doctor about these feelings is part of good care, since untreated depression and stress can affect heart health.

Family members may benefit from understanding that risk factors often run in families and that screening for cholesterol, blood pressure, and diabetes may be appropriate for them as well.

Frequently asked questions

What are the first signs of atherosclerosis?

In most cases there are no early signs. Atherosclerosis usually develops silently for years. The first noticeable symptoms often appear only when an artery is significantly narrowed, and they depend on the location: chest discomfort with exertion for heart arteries, leg pain when walking for leg arteries, or a brief stroke-like episode for brain arteries. Because symptoms come late, doctors often recommend checking blood pressure, cholesterol, and blood sugar even in people who feel well.

Can atherosclerosis be reversed?

Plaque cannot be fully removed by medicine or lifestyle, but studies have shown that intensive cholesterol lowering and healthy habits may slightly shrink plaque in some people and, more importantly, make it more stable and less likely to rupture. Most doctors describe the goal as slowing or halting progression rather than reversing the disease. Any improvement takes years and requires ongoing treatment.

What is the main cause of atherosclerosis?

There is no single cause. Atherosclerosis causes involve a combination of damage to the artery lining and excess cholesterol in the blood, with inflammation playing a central role. High LDL cholesterol, high blood pressure, smoking, and diabetes are the most strongly established contributors, and having several together multiplies the risk. Age and family history also matter but cannot be changed.

How is atherosclerosis diagnosed if I have no symptoms?

Atherosclerosis diagnosis in people without symptoms usually begins with risk assessment: blood tests for cholesterol and sugar, blood pressure measurement, and a calculation of overall cardiovascular risk. If the risk is uncertain, your doctor may suggest a coronary calcium scan or an ultrasound of the neck arteries to look for plaque. More invasive tests are generally reserved for people with symptoms or abnormal initial results.

What is the best treatment for atherosclerosis?

There is no single best treatment. Atherosclerosis treatment is tailored to the individual and typically combines lifestyle changes with medications such as statins and blood pressure drugs. Procedures like stenting or bypass surgery are added when a blockage is severe or causing symptoms that medication does not control. Your doctor weighs the benefits and risks of each option based on your specific situation.

Does atherosclerosis always lead to a heart attack or stroke?

No. Many people with atherosclerosis never have a heart attack or stroke, especially when risk factors are well controlled. These events happen when a plaque ruptures and a clot blocks the artery, or when narrowing becomes critical. Treatment aims to make plaque more stable and reduce clotting, which lowers but does not eliminate the risk.

Is atherosclerosis the same as arteriosclerosis?

Not exactly. Arteriosclerosis is a general term for stiffening or thickening of artery walls from any cause. Atherosclerosis is the most common specific type, in which the stiffening is caused by fatty plaque buildup. The two terms are often used interchangeably in everyday conversation, but doctors usually mean plaque-related disease when they say atherosclerosis.

When to see a doctor

If you have risk factors such as high cholesterol, high blood pressure, diabetes, a history of smoking, or a close relative with early heart disease, it is reasonable to discuss screening with your doctor even if you feel well. Symptoms such as leg pain when walking, chest discomfort with exertion, or unexplained shortness of breath also warrant a medical evaluation.

Seek emergency medical care immediately if you or someone near you experiences any of the following, as they may signal a heart attack, stroke, or acute loss of blood flow to a limb:

• Chest pain, pressure, or tightness lasting more than a few minutes or that comes and goes, especially with sweating, nausea, or shortness of breath
• Pain spreading to the arm, jaw, neck, or back
• Sudden weakness or numbness of the face, arm, or leg, particularly on one side of the body
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Sudden loss of vision in one or both eyes
• Sudden severe headache with no known cause, or loss of balance and coordination
• A leg or arm that suddenly becomes cold, pale, painful, numb, or weak
• Fainting or near-fainting

These symptoms need urgent assessment because early treatment can limit permanent damage to the heart, brain, or limbs. Do not wait to see whether they pass on their own.