Arteriosclerosis

Arteriosclerosis is a condition where your arteries become hard and stiff, often developing silently over many years before causing serious health problems like heart attacks or strokes.

Table of contents

• What is arteriosclerosis?
• Types of arteriosclerosis
• Symptoms
• Causes and risk factors
• Health problems and complications
• How is it diagnosed?
• Treatment
• Prevention and living with arteriosclerosis

What is arteriosclerosis?

Arteriosclerosis means “hardening of the arteries.” It’s a general medical term that refers to your normally flexible artery walls becoming hard or stiff^[1]. Your arteries are blood vessels that deliver oxygen-rich blood from your heart to all the organs and tissues in your body. When arteries harden, they can interfere with blood flow and disrupt the normal workings of your circulatory system^[2].

This condition develops slowly over many years and can be dangerous because it progresses silently. You may have no symptoms for a long time until the hardening of your arteries leads to complications^[2]. Arteriosclerosis raises your risk for a wide range of cardiovascular diseases (conditions affecting your heart and blood vessels).

People often use the terms “arteriosclerosis” and “atherosclerosis” to mean the same thing, but there’s a difference between the two. Arteriosclerosis is hardening of the arteries from any cause, while atherosclerosis is hardening that happens specifically due to plaque buildup^[1]. Atherosclerosis is one specific type of arteriosclerosis, and probably the one you’ve heard the most about.

Types of arteriosclerosis

There are three main types of arteriosclerosis^[2]:

Atherosclerosis is the gradual buildup of plaque in the walls of your medium and large arteries. This includes arteries like your aorta, coronary arteries, carotid arteries, femoral arteries, and iliac arteries. Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium, and other substances found in the blood^[3]. Over time, plaque builds up in the innermost layer of your artery wall. As plaque grows, it gradually narrows the opening of your artery, creating less room for blood to flow. Plaque buildup also raises your risk for blood clots, which can form on the plaque and block blood flow entirely^[5]. Clots can trigger medical emergencies like a heart attack or stroke.

Arteriolosclerosis affects small arteries called arterioles, which are the connectors between your larger arteries and your capillaries. They play an important role in controlling your blood pressure, or how forcefully blood moves through your body. Arteriolosclerosis is the thickening of the walls of your arterioles. This can affect arterioles throughout your body, including those in your kidneys or brain. When your arterioles’ walls are too thick, they can’t do their job properly, and blood may not be able to reach your organs, leading to complications^[2].

Mönckeberg medial calcific sclerosis, also called medial arterial calcification, means there’s calcium buildup in the middle layer of your artery wall. This calcification causes your artery wall to harden. This often happens in people older than 50, but it may happen sooner if you have certain medical conditions like chronic kidney disease. This condition can cause blood flow problems and raise your risk for cardiovascular complications^[2].

• Arteries
• Heart
• Brain
• Kidneys
• Legs
• Arms
• Pelvis
• Intestines

Symptoms

Arteriosclerosis usually doesn’t cause symptoms until it leads to complications^[2]. Mild arteriosclerosis often develops without any noticeable signs. Many people don’t know they have plaque buildup until they have a medical emergency like a heart attack or stroke^[5]. In the early stages, the disease often has no symptoms for a long time.

Symptoms usually don’t happen until an artery is so narrowed or clogged that it can’t send enough blood to organs and tissues^[1]. Sometimes a blood clot completely blocks blood flow, which can break apart and cause a heart attack or stroke. You may first notice some symptoms at times when your body needs more oxygen, such as during physical or emotional stress^[4].

Symptoms of moderate to severe arteriosclerosis depend on which arteries are affected. Your symptoms will vary widely depending on the problem and where the blockage occurs^[2]:

In the heart: If you have arteriosclerosis in your heart arteries, you may have chest pain or pressure called angina. Other symptoms include shortness of breath during light physical activity, pain in your back, shoulders, neck, arms or belly, feeling dizzy or lightheaded, heart palpitations (racing or pounding heart), fatigue, and nausea or vomiting that may feel like indigestion^[5].

In the brain: If arteriosclerosis affects the arteries leading to your brain, you may have sudden weakness, facial or lower limb numbness, confusion, difficulty understanding speech, and problems seeing^[6]. You could also have a transient ischemic attack (TIA), sometimes called a mini-stroke^[4].

In the legs and feet: When arteriosclerosis affects arteries in your limbs, you may experience muscle pain, burning or aching pain in your feet and toes when you rest (especially when lying flat), changes in skin color like redness, cool skin on your feet, frequent skin and soft tissue infections (often in your legs or feet), and sores on your feet or toes that don’t heal^[5].

In the kidneys: With narrowing of the arteries that take blood to your kidneys, you may experience markedly elevated blood pressure that doesn’t respond to multiple medications, changes in how often you urinate, swelling, feeling drowsy or tired, and skin that feels dry, itchy or numb^[5].

In the digestive system: When you don’t have enough blood flow in parts of your digestive system, you may experience pain or cramping in your belly after eating, bloating, nausea and vomiting, diarrhea, and unintentional weight loss due to “food fear” (fear of pain after eating)^[5].

For men, erectile dysfunction is an early warning sign that you may be at higher risk for arteriosclerosis and its complications^[4]. If you have erectile dysfunction, talk with your healthcare provider about your risk of plaque buildup.

Causes and risk factors

Arteriosclerosis develops slowly as cholesterol, fat, blood cells, and other substances in your blood form plaque in the walls of arteries^[3]. Plaque often starts to build up during childhood and gets worse with age. The exact cause is unknown, but researchers believe that this buildup happens when there is damage to the arteries^[4]. This damage may be caused by unhealthy lifestyle habits, medical conditions, and your genes.

You may be more likely to develop arteriosclerosis if you^[4]:

• Have certain medical conditions, including high blood pressure, high blood cholesterol, diabetes, metabolic syndrome, and inflammatory diseases such as rheumatoid arthritis and psoriasis
• Have a family history of high blood cholesterol or heart disease
• Eat a lot of foods high in saturated fats
• Smoke or chew tobacco
• Are older – the risk increases after age 45 in men and age 55 in women
• Live a sedentary lifestyle or are overweight or obese

Having more than one risk factor can increase your risk even more^[4]. Risk factors also include family history, smoking, and obesity^[6]. Family history is considered the most significant independent risk factor for coronary artery disease^[7].

Studies have shown smoking damages the artery walls, which can lead to arteriosclerosis and makes it easier for plaque to build up^[17]. Research also suggests that inhaling smoke from others can increase your risk for arteriosclerosis.

When blood pressure is high, it causes tears in artery walls that cholesterol can settle into more easily^[15]. LDL (bad) cholesterol plays a role in plaque formation, while HDL (good) cholesterol helps clear LDL cholesterol from arteries.

Health problems and complications

Arteriosclerosis can affect almost any artery in the body^[3]. Diseases linked to arteriosclerosis are the leading cause of death in the United States and the world^[3]. Atherosclerosis, the most common type of arteriosclerosis, is very common. The complications of plaque buildup, including heart attacks and strokes, are the leading cause of death worldwide^[5].

Complications of arteriosclerosis can occur suddenly with no warning signs. Some conditions, such as heart attack, stroke, or cardiac arrest, may lead to disability or death^[14]. Arteriosclerosis can cause other health problems or complications^[4]:

Arteriosclerosis has a different name depending on the arteries that are affected^[3]:

• Coronary artery disease (CAD) is plaque buildup in the arteries of your heart. It can lead to a heart attack
• Peripheral artery disease (PAD) most often is plaque buildup in the arteries of the legs, but it can also build up in your arms or pelvis
• Carotid artery disease is plaque buildup in the neck arteries. It reduces blood flow to the brain
• Renal artery stenosis is plaque buildup in the arteries that supply blood to your kidneys
• Vertebral artery disease is arteriosclerosis in the arteries that supply blood to the back of the brain. This area of the brain controls body functions that are needed to keep you alive
• Mesenteric artery ischemia is plaque buildup in the arteries that supply your intestines with blood

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]. Arteriosclerosis can cause disability and death.

Plaque buildup in arteries that supply oxygen-rich blood to the brain can lead to a transient ischemic attack or stroke. Plaque can break off or cause a blood clot that travels to the brain, also causing a stroke. Vascular dementia can result from plaque buildup that reduces blood flow to the brain, causing cognitive decline beyond the normal aging process^[14].

Heart problems from arteriosclerosis can cause aortic aneurysm, arrhythmia (irregular heartbeat), cardiac arrest, and heart failure^[14].

How is it diagnosed?

Diagnosis of an individual suspected of having arteriosclerosis can be based on a physical exam, blood test, electrocardiogram (EKG), and the results of these tests^[6]. To diagnose arteriosclerosis, your healthcare professional examines you and listens to your heart. You usually are asked questions about your symptoms and your family health history^[16].

Your healthcare professional may hear a whooshing sound when listening to your heart with a stethoscope. This whooshing sound is called a bruit^[4]. You may be sent to a doctor trained in heart diseases, called a cardiologist.

Tests may be done to check the health of your heart and arteries. Tests can help diagnose arteriosclerosis and find the cause^[16]:

Blood tests can check blood sugar and cholesterol levels. High levels of blood sugar and cholesterol raise the risk of arteriosclerosis. A C-reactive protein (CRP) test also may be done to check for a protein linked to inflammation of the arteries^[16]. When you should start having your cholesterol tested and how often you should have it tested depends on your risk factors and family history. Testing is done with a blood test known as lipid profile or lipid panel^[17].

Electrocardiogram (ECG or EKG) is a quick and painless test that measures the electrical activity of the heart. During an ECG, sticky patches with sensors attach to the chest and sometimes to the arms or legs. An ECG can show if there’s reduced blood flow to the heart^[16].

Exercise stress tests often involve walking on a treadmill while wearing sticky electrode patches connected to an electrocardiogram machine. If a patient’s health prevents walking, doctors instead use a chemical test, which relies on medication to get the heart rate up. If the heart’s activity is irregular, doctors then perform follow-up testing to isolate the problem^[11].

Doctors may do myocardial perfusion imaging (MPI), which allows them to watch the blood flow in the area near the heart. They may also do a computerized tomography (CT) scan with dye—another way of revealing spots where there is blockage. A coronary calcium scan uses CT imaging to take pictures of the heart’s arteries and can detect calcium deposits that can narrow the arteries^[16].

If any of these tests suggest arteriosclerosis, doctors might have the patient undergo an angiography, an imaging technique that reveals plaque buildups causing obstruction^[11].

Treatment

If you have a diagnosis of arteriosclerosis, work with your healthcare team to set up a treatment plan that works for you^[9]. Sometimes arteriosclerosis can be reversed over time by following a heart-healthy lifestyle and taking medicines. Arteriosclerosis can be treated, and healthy lifestyle habits can help prevent it^[1].

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^[11]. The drugs used most often to reduce LDL cholesterol levels are statins such as atorvastatin (Lipitor) and rosuvastatin (Crestor). Statins block the liver enzyme that promotes cholesterol production^[20].

Procedures and surgery may help people who have dangerous levels of plaque buildup in the arteries of the heart or elsewhere in the body^[9]. Surgical treatment options exist when arteries are severely blocked, though it’s important to note that surgery does not permanently solve a patient’s cardiac problems, even if the surgery is completely successful^[11].

Heart-healthy living is very important for preventing and treating arteriosclerotic plaque buildup throughout your lifetime^[9]. Steps you can take for a healthy lifestyle include:

• Choose heart-healthy foods, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, sodium (salt), and added sugars^[9]
• Be physically active. Regular physical activity can help manage risk factors such as unhealthy cholesterol levels, high blood pressure, overweight, and obesity. 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]
• Quit smoking and avoid secondhand smoke. Research shows that nicotine and flavorings found in vaping products can damage your heart and lungs^[9]

A diet high in saturated fat and cholesterol can raise your cholesterol levels. 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^[17].

Regular aerobic exercise can help fight arteriosclerosis by reducing the amount of fat in your blood, lowering your blood pressure^[17]. Being sedentary lowers your HDL cholesterol levels, so there’s less of it to clear your arteries. Taking brisk walks, cycling, or doing other exercises for 40 minutes three or four times a week can help lower cholesterol and blood pressure^[15].

Carrying around extra weight raises LDL cholesterol levels and lowers HDL cholesterol levels. Dropping 10 percent of your weight improves your numbers^[15].

Very intensive lifestyle changes have been shown to shrink plaque. Eating high-fiber foods can lower cholesterol by as much as 10 percent. Swapping saturated and trans fats for healthy oils, fruits, vegetables, whole grains, poultry, fish and nuts can help^[15].

Prevention and living with arteriosclerosis

You can control most risk factors for arteriosclerosis. Tips can help prevent arteriosclerosis and improve your general health. If you have arteriosclerosis, you may be able to stop it from getting worse^[17].

If you think that you or someone else has symptoms of heart attack or stroke, call emergency services immediately. Every minute matters^[14]. Heart-healthy living, along with ongoing medical care, can help prevent complications of arteriosclerosis and help you have a long, healthy life.

Living healthy with arteriosclerosis is possible with proper management. Everyone can take steps to adopt heart-healthy living. 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^[14].

If you smoke, get help to quit. Stopping smoking doesn’t mean just tobacco or cigarettes. E-cigarettes and vaping can both cause inflammation of the arteries. So can inhaling smoke from other nontobacco products^[17]. Also stay away from places where there is cigarette smoke.

Know your cholesterol and blood pressure levels. High triglyceride levels, combined with high LDL cholesterol levels, or low HDL cholesterol levels can lead to arteriosclerosis^[15]. Talk with your healthcare provider about your target cholesterol levels.

Strive for weight loss if needed. Being overweight or obese increases risk factors. Make fitness your goal and incorporate regular physical activity into your routine^[15].

Doctors especially want to target the softer plaques before they rupture. Research has shown that intensive lowering of cholesterol levels can regress earlier stages of arteriosclerosis^[12]. An extensive body of evidence supports the fundamental causal role of lipoproteins in the development of arteriosclerosis.

If you have warning signs of arteriosclerosis, tell a healthcare provider. Early treatment can lower your risk of life-threatening complications^[5]. Plaque buildup can take away years of life, especially for people who have complications^[14].