Atherosclerosis 

Definition

Atherosclerosis is the hardening and narrowing of the arteries in the heart. It is characterised by the build-up of plaque inside the arteries. There are two types of plaques - stable and unstable - which can affect people in different ways.

Stable Plaques

Stable plaques (or lesions) occur when the walls of your coronary arteries, which carry oxygen and nutrients to your heart, become thickened and stiff because of a build-up of fatty deposits. Healthy arteries are elastic and flexible. A person with atherosclerosis will have hardened arteries due to a build-up of fatty substances, particularly cholesterol, which is deposited in the wall of the arteries and may restrict blood flow to the heart.

Atherosclerosis can occur in large arteries throughout your entire body and develops over time. It will often have grave consequences that can lead to heart attack and/or stroke if left untreated.

Unstable Plaques

Unstable plaques can rupture and lead to an acute event such as heart attack, stroke or death without substantial restrictions of blood flow. Unstable plaques are potentially more dangerous than stable plaques as there are no clear symptoms for the former and unstable plaques are also more difficult to diagnose. 

Symptoms

If you have mild atherosclerosis, you may not have any symptoms. Symptoms develop if an artery supplying blood to the heart becomes so narrowed that blood flow is restricted substantially.

Symptoms of moderate to severe atherosclerosis in coronary arteries include:

• Chest pain or angina
• Shortness of breath
• Fatigue or dizziness
• High blood pressure
• High blood cholesterol
• High triglycerides
• Smoking or tobacco
• Insulin resistance or diabetes
• Overweight of obesity
• Lack of regular exercise
• Depression
• Stress
• Inflammation from diseases such as arthritis, lupus or infections

Causes

The exact cause of atherosclerosis is unknown. Scientists do know that it is a slow progressive disease that can begin as early as childhood. The following may contribute to the disease:

• High blood pressure
• High blood cholesterol
• High triglycerides
• Smoking or tobacco
• Insulin resistance or diabetes
• Overweight of obesity
• Lack of regular exercise
• Depression
• Stress
• Inflammation from diseases such as arthritis, lupus or infections

Diagnosis 

As a first step, your doctor will conduct a physical exam, to see if they can find narrowed, enlarged or hardened arteries. They may suggest further diagnostic testing such as:

• Blood tests
• Doppler ultrasound
• Ankle-brachial index
• Electrocardiogram (ECG)
• Stress test
• Cardiac catheterization and angiogram
• CT scan
• Magnetic Resonance Angiography (MRA)

Treatment

The best treatment for atherosclerosis is to lead a healthy lifestyle. However sometimes medication or surgical procedures are necessary. 

Medications

Some medicine can slow or reverse the effects of atherosclerosis including:

• Cholesterol medications

• Anti-platelet medications
• Beta blocker medications
• Angiotensin-converting enzyme (ACE) inhibitors
• Calcium channel blockers
• Diuretics
• Other medications 

Surgical Procedures 

People with more severe forms of atherosclerosis may need to have one of the following procedures:

• Angioplasty and stent placement
• Endarterectomy
• Fibrinolytic therapy
• Bypass surgery

Prevention

Leading a healthy lifestyle is the best way to prevent atherosclerosis. This includes:

• Eat healthily
• Don’t smoke
• Control and maintain a healthy weight
• Exercise regularly
• Have regular check-ups
• Manage unhealthy blood cholesterol
• Control stress

Research into Atherosclerosis