Arteriosclerosis Coronary Artery

When fatty substances slowly build up inside the arteries that supply blood to your heart, they can create a serious health threat that may show no warning signs until a life-threatening emergency occurs.

Table of contents

• What Is Arteriosclerosis Coronary Artery?
• Symptoms and Warning Signs
• Causes and Risk Factors
• How Is It Diagnosed?
• Treatment Options
• Prevention and Lifestyle Changes
• Living With the Condition
• Possible Complications

What Is Arteriosclerosis Coronary Artery?

Arteriosclerosis coronary artery, also known as coronary artery disease, is a common type of heart disease that affects the main blood vessels supplying blood to the heart^[1][6]. The condition develops when a sticky substance called plaque builds up inside the walls of your coronary arteries. This plaque consists of fat, cholesterol, calcium, and other substances found in the blood^[2][3].

The buildup happens gradually over time, often beginning in childhood. As plaque accumulates, the artery walls become thicker and harder—a process commonly called hardening of the arteries^[1]. This hardening makes the arteries less flexible and elastic. Eventually, the plaque causes the arteries to narrow, reducing the amount of oxygen-rich blood that can reach your heart muscle^[6].

Atherosclerosis is very common. In America, about half of people between ages 45 and 84 have atherosclerosis but are not aware of it^[2]. The complications of plaque buildup, including heart attacks and strokes, are the leading cause of death worldwide^[2].

Symptoms and Warning Signs

One of the most concerning aspects of coronary artery disease is that it often develops silently. Mild atherosclerosis usually does not cause symptoms^[1]. Many people don’t know they have plaque buildup until they experience a medical emergency like a heart attack or stroke^[2]. In fact, half of the time, the first symptom a person has of coronary artery disease is actually a heart attack, and half of these heart attacks are fatal^[12].

Symptoms usually don’t appear until an artery is so narrowed or clogged that it can’t send enough blood to organs and tissues^[1]. You may notice symptoms if your artery is more than 70% blocked^[2]. When symptoms do occur in the heart arteries, they may include:

• Chest pain or pressure, called angina, which may feel like indigestion or pain in the shoulders, arms, back, neck, or jaw^[1][2]
• Shortness of breath during light physical activity^[2][6]
• Feeling dizzy or lightheaded^[2]
• Heart palpitations (racing or pounding heart)^[2]
• Fatigue^[2]
• Nausea or vomiting that may feel like indigestion^[2]

It’s important to note that women’s symptoms can be quite different from men’s. Women may experience nausea, abdominal pain, and lightheadedness instead of typical chest pain^[10].

Causes and Risk Factors

Atherosclerosis develops slowly as cholesterol, fat, blood cells, and other substances in your blood form plaque in the walls of arteries^[3]. The exact cause is unknown, but researchers believe that plaque buildup happens when there is damage to the arteries^[7].

Several factors put you at greater risk for developing coronary artery disease:

• Smoking: Cigarettes damage the artery walls, making it easier for plaque to build up. Smoking is even more risky when you have other risk factors such as high blood pressure or diabetes^[1][20].
• High blood pressure: When blood pressure is high, it causes tears in artery walls that cholesterol can settle into more easily^[16].
• High cholesterol: High levels of LDL (“bad”) cholesterol play a role in plaque formation. Cholesterol is always involved in the initiation of the narrowing of the arteries to the heart^[12][16].
• Diabetes: This condition increases your risk of developing coronary artery disease^[7].
• Family history: Having a family history of high cholesterol or heart disease increases your risk^[7][20].
• Physical inactivity: An inactive lifestyle raises your risk^[7][20].
• Being overweight or obese: Carrying extra weight raises LDL cholesterol levels and lowers HDL (“good”) cholesterol levels^[7][16].
• Age: The risk increases after age 45 in men and age 55 in women^[7].
• Inflammatory diseases: Conditions such as rheumatoid arthritis and psoriasis can increase risk^[7].

Having more than one risk factor can increase your risk even more^[20].

How Is It Diagnosed?

To diagnose coronary artery disease, your healthcare professional examines you and listens to your heart^[19]. You will usually be asked questions about your symptoms and your family health history. Your healthcare professional may hear a whooshing sound when listening to your heart with a stethoscope^[19].

Several tests may be done to check the health of your heart and arteries:

• Blood tests: These can check blood sugar and cholesterol levels. High levels of blood sugar and cholesterol raise the risk of atherosclerosis. A C-reactive protein test also may be done to check for a protein linked to inflammation of the arteries^[19].
• Electrocardiogram (ECG or EKG): This quick and painless test measures the electrical activity of the heart. It can show if there’s reduced blood flow to the heart^[19].
• Exercise stress tests: These often involve walking on a treadmill while wearing sticky electrode patches connected to an electrocardiogram machine. If a patient’s health prevents walking, doctors use a chemical test with medication to get the heart rate up^[10].
• Imaging tests: If the heart’s activity is irregular, doctors may perform follow-up testing such as myocardial perfusion imaging (MPI), which allows them to watch the blood flow in the area near the heart, or a CT scan with dye to reveal spots where there is blockage^[10].
• Coronary angiography: If tests suggest coronary atherosclerosis, doctors might have the patient undergo an angiography, an imaging technique that reveals plaque buildups causing obstruction^[10].
• Coronary calcium scan: This test uses computerized tomography (CT) imaging to take pictures of the heart’s arteries. It can detect calcium deposits in the coronary arteries^[19].

Treatment Options

The treatment goals for coronary artery disease are to relieve symptoms and prevent future cardiac events, such as unstable angina, heart attack, and death^[13]. Treatment can help manage symptoms and reduce the risk of further problems. With the right treatment, the symptoms can be reduced and the functioning of the heart improved^[14].

Medications

Many different medicines are used to treat coronary artery disease. Usually they either aim to reduce blood pressure, widen your arteries, or prevent blood clots^[14]. Common medications include:

• Blood-thinning medicines: Such as low-dose aspirin, clopidogrel, rivaroxaban, ticagrelor, and prasugrel can help reduce the risk of a heart attack by thinning your blood and preventing it from clotting^[14].
• Statins: Cholesterol-lowering medicines like atorvastatin, simvastatin, and rosuvastatin work by slowing down the production of LDL cholesterol in your liver^[14].
• Beta blockers: Including atenolol, bisoprolol, and metoprolol are often used to treat angina and high blood pressure. They slow down your heartbeat and some improve blood flow^[14].
• Nitrates: Available as tablets, sprays, and skin patches, these widen your blood vessels by relaxing them, which lowers blood pressure and relieves heart pain^[14].
• ACE inhibitors: Such as ramipril and lisinopril are commonly used to treat high blood pressure. They improve the flow of blood around the body^[14].
• Calcium channel blockers: Including amlodipine, verapamil, and diltiazem work to decrease blood pressure by relaxing the muscles that make up the walls of your arteries^[14].

Procedures and Surgery

If the stress test shows blockage in the arteries but the patient is not at high risk for complications, doctors prescribe medication as a first step^[10]. However, procedures and surgery may help people who have dangerous levels of plaque buildup^[9].

• Angioplasty: A procedure to widen narrowed arteries^[10].
• Coronary artery bypass surgery: A surgical procedure to restore blood flow to the heart^[10].

Sometimes atherosclerosis can be reversed over time by following a heart-healthy lifestyle and taking medicines^[9]. Studies have shown that even if your cholesterol is well controlled with medicines, if you do not eat a healthy diet, your heart attack, stroke, and death rate is not significantly reduced^[12].

Prevention and Lifestyle Changes

Heart-healthy living is very important for preventing and treating atherosclerotic plaque buildup throughout your lifetime^[9]. The prevention and treatment of atherosclerosis requires control of the known modifiable risk factors^[13]. You can control most risk factors, and taking steps to prevent atherosclerosis can help you avoid heart disease^[20].

Stop Smoking

If you smoke, get help to quit. Studies have shown smoking damages the artery walls, which can lead to atherosclerosis^[9][20]. Stopping smoking after a heart attack quickly reduces your risk of having a heart attack in the future to near that of a non-smoker^[14]. You should also stay away from places where there is cigarette smoke, as research suggests that inhaling smoke from others can increase your risk^[20].

Choose Heart-Healthy Foods

A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), and added sugars^[9]. A diet high in saturated fat and cholesterol can raise your cholesterol levels. When you have high cholesterol, there may be more plaque to line artery walls and narrow your arteries^[20].

Limit foods high in saturated fat and check food labels to find the amount of saturated fat in a product. Also limit how much salt and sugar you eat. Be careful with baked goods, sugar-sweetened foods and beverages, fried foods, and processed foods such as frozen dinners^[20]. Choose lots of fresh or frozen fruits and vegetables, lean meats and fish, as well as whole grains. Choose fat-free or low-fat milk, cheese, and yogurt. Choose unsaturated vegetable oils like canola oil instead of saturated fats like butter^[20].

Limiting saturated and trans fats from your diet by eating less red meat, fried food, and dairy products made with whole milk will help lower your cholesterol. Swap them for healthy oils, fruits, vegetables, whole grains, poultry, fish, and nuts. Eating high-fiber foods can lower cholesterol by as much as 10 percent^[16].

Be Physically Active

Regular physical activity can help manage risk factors, such as unhealthy cholesterol levels, high blood pressure, and being overweight or obese^[9]. Adults should engage in a total of 150 minutes or more per week of moderate physical activity or 75 minutes per week of vigorous physical activity^[9]. Being sedentary lowers your HDL cholesterol levels, so there’s less of it to clear your arteries. Take brisk walks, cycle, or do other exercises for 40 minutes three or four times a week to help lower cholesterol and blood pressure^[16].

Maintain a Healthy Weight

Carrying around extra weight raises LDL cholesterol levels and lowers HDL cholesterol levels. But dropping 10 percent of your weight improves your numbers^[16]. Maintaining a healthy weight can play a big role in preventing further health problems related to coronary artery disease^[18].

Monitor Your Numbers

Keep an eye on your cholesterol and blood pressure. High cholesterol is a contributing factor to coronary artery disease. Try to reduce your cholesterol levels with exercise and a heart-healthy diet. If necessary, your doctor can prescribe medication to help you manage cholesterol levels that are too high^[18]. Since your heart beats one hundred thousand times a day, even mild elevations of blood pressure above 130 over 80 can cause significant health problems, including heart attacks^[12].

Research shows that women who have a healthy lifestyle could expect to live 14 years longer than those who do not, while men could have 12 more years of life^[15].

Living With the Condition

Living with coronary artery disease is possible with proper management^[16]. Heart-healthy living, along with ongoing medical care, can help prevent complications of atherosclerosis and help you have a long, healthy life^[15]. Having a higher quality of life and a longer life expectancy is achievable with determination and the right attitude^[18].

One of the first and best steps you can take to improve your health is to eat the right foods for your body. Try not to view dieting as restrictive. Instead, focus on making heart-healthy choices^[18]. To help keep yourself on track, plan ahead by creating different menu plans. Meal prepping can also make eating heart-healthy food convenient. Remember not to punish yourself for the occasional overindulgence. Enjoying a treat sometimes is just fine as long as you are maintaining a consistently healthy diet long-term^[18].

A central part of living a heart-healthy lifestyle is to be active. Some exercises like walking, swimming, and bicycling can help strengthen your heart along with your muscles. How much exercise you can do safely will depend on your age, risk factors, and overall health condition. It’s important to start slowly and always talk with your doctor before starting an exercise program. They can help you create a personalized exercise plan for your condition^[18].

One of the most important tips for living with coronary artery disease is to take steps to limit future damage. The same risk factors that caused your coronary artery disease can continue to make it worse^[18].

Surgical treatment does not permanently solve a patient’s cardiac problems, even if the surgery is completely successful. Many doctors refer patients for cardiac rehabilitation. This gets you in with a supervised exercise program. At rehab, they go over diet and weight loss techniques. It’s motivating for people, and just as important, you’re with other people who have a similar problem so you’re not isolated^[10].

Possible Complications

Complications of atherosclerosis can occur suddenly with no warning signs. Some conditions, such as heart attack, stroke, or cardiac arrest, may lead to disability or death^[15].

As plaque builds up, your artery wall grows thicker and harder. Eventually, as the plaque grows, the opening of your artery narrows, leaving less room for blood to flow. This means less blood can reach your organs and tissues. Plus, the constant force of blood flow can lead to plaque erosion or rupture, causing a blood clot to form^[2].

A decrease in blood flow can lead to symptoms like angina. If a plaque bursts, blood clots may form and block the artery or travel to other parts of the body. Full or partial blockages can cause heart attack, stroke, vascular dementia, erectile dysfunction, heart failure, or limb loss^[3].

A narrowed artery is like a highway reduced to one lane. But a blood clot is like a barricade in the middle of the road. It blocks blood flow to certain organs or tissues the artery normally feeds. The effects on your body depend on where the blood clot forms. For example, blockages in a coronary artery deprive your heart of oxygen-rich blood, leading to a heart attack^[2].

Coronary heart disease can also cause aortic aneurysm, arrhythmia (irregular heartbeat), and cardiac arrest^[15]. Plaque buildup can take away years of life, especially for people who have complications. For example, a heart attack takes away more than 16 years of life on average. People with heart failure lose an average of nearly 10 years^[15].

If you think that you or someone else has symptoms of heart attack or stroke, call emergency services immediately. Every minute matters^[15].