What Is Atherosclerosis?

Atherosclerosis is a chronic, progressive disease in which fatty deposits, called plaque, build up in the walls of arteries.

These plaques are formed by deposits of cholesterol and other fats, calcium, and large inflammatory cells called macrophages. Once plaque is present in an artery, it can cause several kinds of problems.

This article discusses the causes, effects, and treatment of atherosclerosis.

What Is the Main Cause of Atherosclerosis?

The fundamental underlying cause of atherosclerosis has not been fully established.

However, many factors that contribute to atherosclerosis have been identified, including:

• Genetic predisposition—the propensity for atherosclerosis clearly runs in families. Anybody whose close relatives (parents, siblings, uncles, and aunts) have had atherosclerosis ought to take every opportunity to reduce their own risk factors.
• Cholesterol abnormalities—high blood levels of LDL cholesterol and low levels of HDL cholesterol are associated with atherosclerosis
• Hypertension
• Smoking
• Sedentary lifestyle
• Obesity, especially abdominal obesity
• Diabetes

In Western cultures, arteries commonly show early changes of atherosclerosis even in childhood and adolescence. Atherosclerosis begins as a gradual, progressive disease that commonly will have develops over decades before it ever begins to produce symptoms.

Health Effects of Atherosclerosis

First, plaques can protrude into the artery, eventually causing a partial or complete obstruction of blood flow. Stable angina is an example of a medical condition produced by a gradually worsening plaque.

Second, plaques can cause arterial thrombosis. Arterial thrombosis occurs when a plaque suddenly ruptures, causing a thrombus (blood clot) to form. The thrombosis can lead to a sudden occlusion of the artery. One medical problem produced by plaque rupture is acute coronary syndrome (ACS).

Third, plaques can weaken the wall of the artery causing a ballooning out of the artery to form what is called an aneurysm. The rupturing of an aneurysm often produces severe internal bleeding. A ruptured aortic aneurysm is an example of such an event.

Other common medical problems caused by atherosclerosis include stroke, peripheral artery disease, and kidney disease.

Affected Arteries

The arteries atherosclerosis commonly affects include:

• Coronary arteries, leading to angina and myocardial infarction (heart attack)
• Cerebrovascular circulation (brain arteries), leading to stroke
• Renal arteries, leading to kidney disease
• Aorta, leading to aortic aneurysm
• Blood vessels of the arms and (especially) the legs, leading to peripheral artery disease and claudication, ulceration, skin changes, and slow healing

In the United States, atherosclerosis causes more death and disability than any other disease. Plaque buildup shortens life expectancy, 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.

How Is Atherosclerosis Treated?

Treatment for atherosclerosis tends to be difficult, expensive, invasive, and/or risky because healthcare providers are treating the results of atherosclerosis—heart attacks, strokes, kidney failure, peripheral artery disease, and more.

By far, the best “treatment” for atherosclerosis is to do everything you can to prevent it from occurring in the first place. If it is already present, the next best "treatment" is to take every available measure to keep it from progressing.

These steps include:

• Eating a healthy diet
• Getting plenty of exercise
• Losing weight or maintaining a healthy weight
• Not smoking
• Keeping your blood pressure in a healthy range
• Manage cholesterol levels

Other treatments for atherosclerosis may include:

• Medications: Anticoagulants and antiplatelet medicines (to decrease blood clotting), cholesterol-lowering medicines, and blood pressure medicines.
• Angioplasty: A long thin tube (catheter) is threaded through a blood vessel to the heart where a balloon is inflated to create a bigger opening in the vessel to increase blood flow.
• Coronary artery bypass: A piece of a healthy vein is taken from elsewhere in the body and attached above and below the blocked area of a coronary artery to let blood flow around the blockage of one or more arteries.

Summary

Atherosclerosis is a condition in which plaque builds up in the walls of arteries. The cause is not entirely understood, but many factors are associated with plaque build-up. There are many serious health effects when atherosclerosis progresses. The best treatment is to prevent plaque buildup by making healthy lifestyle choices.