16753 Atherosclerosis Arterial Disease

Overview

Atherosclerosis happens when fatty substances, cholesterol, and other waste build up inside your arteries. Over time, this build-up, called plaque, can harden and narrow your arteries, making it harder for blood to flow. This can lead to serious problems like heart attacks or strokes if not managed.

Yes, atherosclerosis is very common. It is the underlying cause of most heart attacks and strokes. Many people have some degree of arterial build-up as they get older, but it often goes unnoticed until it causes problems.

Atherosclerosis can affect anyone, but it becomes more common with age. Men are often affected at a younger age than women. After menopause, a woman's risk increases. People with high blood pressure, high cholesterol, diabetes, or who smoke are more likely to develop it.

Symptoms

Common symptoms

• Chest pain or discomfort (angina) - may feel like pressure or squeezing
• Shortness of breath
• Pain, cramping, or tiredness in the legs when walking (claudication)
• Fatigue or weakness
• Erectile dysfunction in men

Symptoms in children

• Atherosclerosis is extremely rare in children. It usually takes decades to develop.
• However, children with certain inherited conditions (like familial high cholesterol) or severe obesity may show early signs.

Symptoms in older adults

• In older adults, symptoms may be more noticeable.
• They might feel pain in the legs when walking, become tired easily, or experience memory problems if the brain's blood supply is affected.
• Some older adults may not have typical symptoms, so it is important to attend regular health checks.

Causes

Main causes

• Atherosclerosis begins with damage to the inner layer of the artery. This damage can come from high blood pressure, smoking, high cholesterol, or diabetes.
• The body tries to heal the damage by sending white blood cells and other substances, which combine with cholesterol and form plaque.
• Over time, the plaque hardens and narrows the artery, reducing blood flow.

Risk factors

• High blood pressure
• High cholesterol, especially high LDL ('bad') cholesterol
• Diabetes or prediabetes
• Smoking or exposure to tobacco smoke
• Obesity or excess weight
• Lack of physical activity
• Unhealthy diet, especially one high in saturated fats, trans fats, and salt
• Family history of early heart disease
• Age - risk increases with age
• Chronic kidney disease or autoimmune conditions

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have new chest pain, especially with activity.
• If you have leg pain while walking that does not go away with rest.
• If you have unexplained shortness of breath or severe fatigue.

Book a routine appointment if:

• If you are over 40, ask your doctor about having your blood pressure and cholesterol checked.
• If you have diabetes, high blood pressure, or a family history of heart disease, get regular check-ups.
• Discuss your risk factors and any symptoms you are unsure about.

Diagnosis

Your doctor will first talk to you about your symptoms, medical history, and lifestyle. They will also listen to your heart, check your pulse, and measure your blood pressure. Based on these, they may recommend tests to look for narrowed arteries.

Tests that may be done

• Blood tests to check cholesterol, blood sugar, and other markers
• Electrocardiogram (ECG) to check your heart's electrical activity
• Ankle-brachial index - compares blood pressure in your ankle and arm to check for leg artery disease
• Ultrasound (Doppler) to see blood flow in arteries
• Coronary calcium scan or CT scan to detect plaque in heart arteries
• Angiogram - an X-ray with dye to see blockages, if needed

What to expect at your appointment

Diagnosis usually starts with a simple check-up. You may be asked to fast before some blood tests. If further tests are needed, they are often painless and done in a clinic or hospital. Your doctor will explain results and discuss next steps with you.

Treatment

Treatment for atherosclerosis focuses on slowing the build-up of plaque, preventing blood clots, and reducing your risk of heart attack and stroke. This is usually done through a combination of lifestyle changes, medications, and sometimes procedures to restore blood flow. Your care will be personalised based on which arteries are affected.

Self-care at home

• Quit smoking and avoid secondhand smoke - your doctor or local stop-smoking service can help.
• Move your body regularly - aim for at least 150 minutes of moderate activity per week, but start small and build up.
• Eat a heart-healthy diet rich in vegetables, fruits, whole grains, and lean protein, and low in salt, sugar, and unhealthy fats.
• Manage stress with relaxation techniques, hobbies, or talking to someone you trust.
• Take any prescribed medicines exactly as directed, and do not stop without talking to your doctor.

Medical treatments

Your doctor may prescribe medicines to lower blood pressure, reduce cholesterol, prevent blood clots, or manage diabetes. These are usually long-term medicines. It is very important to take them as prescribed and have regular check-ups. Your doctor will explain why each medicine is needed and how to take it safely. Do not change your dose or stop without speaking to your doctor.

When is surgery considered?

If one or more arteries become severely narrowed, or if you have symptoms that are not controlled by medicines, a specialist may recommend a procedure to restore blood flow. This could include inserting a small mesh tube (stent) to hold the artery open, or bypass surgery to create a new route for blood around the blocked area. These procedures are usually planned with your heart or vascular team.

Living with this condition

Living with atherosclerosis means keeping up with your treatment plan and making heart-healthy choices every day. You may need to take medicines for the rest of your life, and attend regular check-ups. It is important to learn the warning signs of a heart attack or stroke and know when to call your local emergency number.

Lifestyle tips

• Follow a balanced diet and limit foods high in saturated fat, trans fat, salt, and added sugar.
• Stay physically active - even a daily walk makes a difference.
• Keep a healthy weight.
• Limit alcohol - always follow your doctor's advice.
• Get support to quit smoking - it is the single best thing you can do.

Diet and exercise

A Mediterranean-style diet - rich in vegetables, fruits, fish, nuts, and olive oil - can benefit your arteries. Try to include at least five portions of fruit and vegetables a day, choose whole grains, and swap unhealthy fats for healthy ones. For exercise, aim for at least 30 minutes of moderate activity on most days, such as brisk walking, cycling, or swimming. If you are not used to exercise, build up gradually. Always ask your doctor what is safe for you.

Mental health and emotional wellbeing

Getting a diagnosis of atherosclerosis can feel worrying. It is normal to feel anxious, stressed, or low at times. Your mental health matters as much as your physical health. If you are struggling, talk to your doctor or a counsellor. You can also call a mental health helpline for support. Remember, taking care of your emotions is part of taking care of your heart.

Prevention

Atherosclerosis can often be prevented or slowed down by keeping your blood pressure and cholesterol in a healthy range, not smoking, staying active, eating well, and managing diabetes if you have it. Even if you already have atherosclerosis, these steps can stop it from getting worse and reduce your risk of serious problems.

Vaccines

Getting vaccinated against flu and other respiratory infections can help protect you. If you have heart or blood vessel disease, these infections can be more serious. Talk to your doctor or local pharmacist about which vaccines are recommended for you.

Screening programmes

Regular health checks that measure blood pressure and cholesterol can catch problems early. Ask your doctor how often you should be screened, especially if you have risk factors. Some countries also offer national health checks for adults over 40 - find out what is available locally.

Complications

If left untreated

• Heart attack - a blocked artery in the heart can damage heart muscle.
• Stroke or transient ischaemic attack (TIA) - a blocked artery in the brain.
• Peripheral artery disease - poor blood flow in the legs, causing pain and sometimes ulceration.
• Kidney damage - narrowed arteries to the kidneys can affect their function.
• Aneurysm - a bulging, weakened artery wall that can rupture.

Long-term outlook

The outlook for atherosclerosis is better than ever. With early diagnosis, modern treatments, and steady lifestyle changes, many people live long, active lives. Even if you have already had a heart attack or stroke, it is never too late to make changes that protect your health. Your care team will work with you to manage the condition and reduce your risk.

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