Atherosclerosis

Overview

Atherosclerosis is a condition in which fatty deposits, called plaques, build up inside the arteries. These plaques are made of cholesterol, fat, calcium, and other substances in the blood. Over time, the arteries become narrower and stiffer, which can reduce blood flow to important organs like the heart, brain, and legs.

Yes, atherosclerosis is very common, especially as people get older. It is the underlying cause of many heart attacks, strokes, and circulation problems worldwide.

Atherosclerosis usually affects adults over 40, but the process can start in childhood. Men are generally at higher risk at a younger age, but women's risk rises after menopause. People with a family history of heart disease or stroke, and those with conditions like diabetes or high blood pressure, are also more likely to develop it.

Symptoms

Common symptoms

• Most people have no symptoms in the early stages.
• Chest pain or pressure, especially during physical activity, can be a sign of narrowed heart arteries.
• Leg pain, numbness, or cramping when walking may indicate reduced blood flow to the legs.
• Shortness of breath, tiredness, or dizziness can occur when the heart has to work harder.

Symptoms in children

• Atherosclerosis rarely causes symptoms in children, but invisible changes in the artery walls can begin early in life if risk factors like obesity or an unhealthy diet are present.

Symptoms in older adults

• Symptoms may become more noticeable with age, such as chest pain, calf cramps when walking, or feelings of weakness and fatigue from reduced blood flow.

Causes

Main causes

• Damage or injury to the inner layer of the artery wall, often caused by high blood pressure, smoking, or high blood sugar.
• Inflammation within the artery wall, which attracts cholesterol and other fatty particles.
• A gradual build-up of cholesterol, calcium, and cellular waste that forms a hardened plaque.

Risk factors

• Age (risk increases with age)
• Family history of early heart disease or stroke
• Smoking and exposure to second-hand smoke
• High levels of LDL (bad) cholesterol or high triglycerides
• High blood pressure
• Diabetes or prediabetes
• Being physically inactive
• Eating a diet high in saturated fats, trans fats, and processed foods
• Being overweight or obese
• Chronic stress or depression

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have chest discomfort that occurs with activity and goes away with rest.
• Seek urgent care if you have new leg pain when walking, especially if you also have wounds that are slow to heal.
• If you experience any symptoms of a heart attack or stroke, call your local emergency number immediately.

Book a routine appointment if:

• Make an appointment for a routine check-up if you have risk factors such as high blood pressure, high cholesterol, diabetes, or a family history of heart disease.
• Talk to your doctor about screening if you are over 40 and have not had a cardiovascular risk assessment.
• If lifestyle changes alone have not improved your numbers, discuss medication options with your doctor.

Diagnosis

A doctor will review your medical history, discuss your symptoms and risk factors, and perform a physical exam. They may listen to your heart and check the pulses in your neck, wrists, and feet. Based on your situation, they may recommend tests.

Tests that may be done

• Blood pressure measurement
• Blood tests to check cholesterol, blood sugar, and markers of inflammation
• Electrocardiogram (ECG) to check the heart's electrical activity
• Ankle-brachial index, a test that compares blood pressure in your ankle and arm to detect leg artery narrowing
• Ultrasound of the carotid arteries or other arteries to look for plaque
• CT scan or MRI to visualize plaque and calcium in the vessels
• Coronary angiography, a special X-ray that uses dye to show blockages in heart arteries

What to expect at your appointment

Most tests are painless and can be done in a clinic or hospital. You may need to fast before a blood test. Results help you and your doctor understand your risk and decide on the best next steps.

Treatment

Treatment for atherosclerosis focuses on slowing or stopping plaque build-up, preventing complications, and reducing the risk of heart attack or stroke. A combination of lifestyle changes and medical care works best. Your doctor will tailor the plan to your needs.

Self-care at home

• Eat a heart-healthy diet with lots of vegetables, fruits, whole grains, and lean proteins.
• Be physically active most days of the week, using a plan approved by your doctor.
• Quit smoking and avoid second-hand smoke.
• Maintain a healthy weight.
• Find healthy ways to manage stress, such as breathing exercises, mindfulness, or hobbies.
• Limit alcohol intake.

Medical treatments

Your doctor may prescribe medications to help lower blood pressure, reduce cholesterol levels, prevent blood clots, or manage diabetes. These medicines are chosen based on your individual risk factors. It is important to take them exactly as directed and not stop without talking to your doctor. Do not start any over-the-counter remedies or supplements without first asking your healthcare provider.

When is surgery considered?

If a major artery becomes severely narrowed or a blockage causes persistent symptoms or high risk, a doctor may recommend a procedure. Options include angioplasty (using a tiny balloon to widen the artery), placement of a stent (a small mesh tube), or bypass surgery to create an alternative route for blood flow. These procedures are not for everyone, and your doctor will explain the risks and benefits.

Living with this condition

Living with atherosclerosis means managing your risk factors every day. Keep track of your medications, attend regular check-ups, and monitor your blood pressure and cholesterol as advised. Follow your doctor's recommendations, and let them know about any new or worsening symptoms.

Lifestyle tips

• Take a brisk walk, swim, or do another activity you enjoy for at least 30 minutes most days.
• Create a healthy meal plan that is low in salt and unhealthy fats.
• Join a smoking-cessation program if you smoke.
• Set realistic goals for weight loss or stress reduction.
• Stay consistent with medication routines using pill reminders if needed.

Diet and exercise

A diet rich in fruits, vegetables, whole grains, legumes, nuts, and fish is good for your arteries. Limit red meat, fried foods, and sugary snacks. Exercise helps improve blood flow, lower blood pressure, and control weight. Aim for about 150 minutes of moderate activity per week, such as brisk walking, if your doctor agrees. Start slowly if you have not been active, and seek medical advice before starting a new exercise programme.

Mental health and emotional wellbeing

Living with a condition like atherosclerosis can cause worry, anxiety, or low mood, especially after a heart event. It is normal to feel overwhelmed at times. Talk to your doctor about your feelings, and consider counselling or support groups. Taking care of your mental health is just as important as looking after your physical health.

Prevention

Atherosclerosis can often be prevented or slowed with healthy lifestyle choices. This includes eating well, staying active, not smoking, maintaining a healthy weight, and managing conditions like high blood pressure, diabetes, and high cholesterol. Even if you already have plaque, these steps can help keep it from getting worse.

Vaccines

Your doctor may recommend certain vaccinations, such as the flu vaccine or pneumonia vaccine, because infections can put extra stress on the heart and blood vessels. Ask your healthcare team which vaccines are appropriate for you.

Screening programmes

Regular screening for blood pressure, cholesterol, and blood sugar can detect problems early, before symptoms develop. Talk to your doctor about how often you should be screened based on your age and risk factors.

Complications

If left untreated

• Heart attack
• Stroke or transient ischaemic attack (mini-stroke)
• Peripheral artery disease, causing leg pain, poor wound healing, and even amputation in severe cases
• Kidney disease or kidney failure
• Abdominal aortic aneurysm (a bulge in the main artery of the abdomen)
• Chronic fatigue and reduced mobility

Long-term outlook

The outlook is better than many people think. Atherosclerosis develops slowly, and you can take action to slow it down. With the right treatment, healthy habits, and regular medical care, most people can live active, fulfilling lives. Even if you have already had a heart attack or stroke, modern treatment can greatly reduce the chance of another event. Your healthcare team is there to help you every step of the way.

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