Atherosclerosis
Atherosclerosis is a chronic disease in which fatty deposits called plaques build up on the inner walls of arteries throughout the body. These plaques consist of cholesterol, fat, calcium, and other substances found in the blood. Over time, plaque buildup narrows the arteries, reducing blood flow to vital organs and tissues. Atherosclerosis is the underlying cause of most cardiovascular diseases including heart attacks, strokes, and peripheral artery disease. The condition develops gradually over decades and can affect arteries anywhere in the body, though it most commonly impacts the coronary arteries (heart), carotid arteries (neck), and peripheral arteries (legs).
What is it?
Atherosclerosis begins with damage to the endothelium—the thin inner lining of arteries—caused by factors such as high cholesterol, high blood pressure, smoking, or inflammation. Once damaged, LDL cholesterol particles penetrate the arterial wall and become oxidized, triggering an inflammatory response. White blood cells (monocytes) migrate to the site, engulf the oxidized cholesterol, and transform into foam cells. These foam cells, along with additional cholesterol, calcium, and cellular debris, accumulate to form atherosclerotic plaques. Over years, plaques grow larger and may develop a fibrous cap covering a soft, lipid-rich core.
Atherosclerosis can cause problems through several mechanisms: stenosis (narrowing of the artery reducing blood flow), plaque rupture (where the fibrous cap tears, exposing the core contents to blood, triggering blood clot formation that can completely block the artery or travel downstream), calcification (hardening of the artery wall), and aneurysm formation (weakening and bulging of the arterial wall). Risk factors are classified as modifiable and non-modifiable. Non-modifiable risk factors include age, male gender (men develop atherosclerosis earlier than women), family history, and genetic predisposition. Modifiable risk factors include high LDL cholesterol, low HDL cholesterol, high blood pressure, smoking, diabetes or prediabetes, obesity, physical inactivity, unhealthy diet, chronic inflammation, and chronic kidney disease. The disease process typically begins in adolescence or early adulthood and progresses silently for decades before causing symptoms.
Important to Know
Atherosclerosis is often called a “silent disease” because it typically causes no symptoms until an artery becomes severely narrowed or blocked. Symptoms depend on which arteries are affected: coronary artery disease causes chest pain or pressure (angina), shortness of breath, and can lead to heart attack; carotid artery disease causes transient ischemic attacks (TIAs) or stroke with symptoms like sudden weakness, numbness, vision loss, speech difficulty, or confusion; peripheral artery disease causes leg pain with walking (claudication), coldness or numbness in legs or feet, wounds that won’t heal, and in severe cases, tissue death (gangrene); renal artery stenosis causes resistant high blood pressure and declining kidney function; and mesenteric ischemia causes abdominal pain after eating and weight loss. Diagnosis involves multiple approaches depending on the arteries of concern: coronary calcium scoring (CT scan measuring calcium in coronary arteries, predicting future cardiac events), CT angiography (detailed visualization of arteries throughout the body), carotid ultrasound (assessing plaque in neck arteries), ankle-brachial index (comparing blood pressure in arms and legs to detect peripheral disease), stress testing (evaluating heart function under exertion), and invasive angiography (gold standard for detailed assessment, used when intervention is planned). Treatment is multifaceted with lifestyle modifications forming the foundation: heart-healthy diet (Mediterranean diet), regular exercise (at least 150 minutes of moderate activity weekly), smoking cessation (most impactful change for smokers), weight management, and stress reduction. Medications include statins to lower LDL cholesterol, antiplatelet agents (aspirin or clopidogrel) to prevent clot formation, blood pressure medications, and for diabetics, glucose control. Procedures may be necessary for severe narrowing: angioplasty and stenting (opening narrowed arteries with balloons and placing metal scaffolds), bypass surgery (creating new routes around blocked arteries), and endarterectomy (surgical removal of plaque, particularly for carotid artery disease). Prevention is far more effective than treatment—addressing risk factors early can prevent or significantly slow atherosclerosis progression. Once established, atherosclerosis cannot be completely reversed, though aggressive treatment can stabilize plaques and prevent complications. The prognosis varies widely based on disease extent, location, treatment adherence, and risk factor control, with many people living full lives while managing the condition through ongoing medical care and lifestyle modifications.