To keep your heart healthy, it’s important to eat right, get plenty of exercise, and keep an eye on your blood pressure, blood sugar levels, salt intake, and cholesterol levels. Doing these things can also lower the risk of atherosclerosis (hardening of the arteries), a common, but not often discussed, heart condition that is a leading cause of cardiovascular disease in the United States.

The job of your arteries—a network of tubes—is to transport oxygen- and nutrient-rich blood from your heart to organs and tissues throughout your body. The blood they supply allows organs like the brain, kidneys, liver, and heart to function.

But in atherosclerosis, the walls of the arteries thicken and harden, resulting in a reduction in the amount of blood that reaches those vitally important organs and tissues. When this happens, organs cannot function properly or—in some cases—at all. This can lead to serious health complications, including coronary artery disease, heart attack, stroke, and peripheral artery disease.

Fortunately, by making lifestyle changes, you can lower your risk of developing atherosclerosis and, if you already have atherosclerosis, stop or slow its progression. Other treatments are available that can reduce symptoms and may keep the disease from worsening.

Atherosclerosis is a disease of the arteries in which plaque buildup causes them to narrow and stiffen, leading to serious health complications.

Experts aren’t sure exactly what causes plaques to form, but that formation is a slow process that usually takes place over many years. It begins when the inner wall of an artery becomes damaged by high blood pressure, high blood sugar, high cholesterol, smoking, or other mechanisms. As the body tries to repair the damaged artery walls, various substances (fat, cholesterol, calcium, and other substances found in the blood)—combine to form plaques. Plaques accumulate in the artery wall, causing it to thicken and harden. The plaques protrude inside the artery, making it narrower than normal, reducing and potentially blocking blood flow. 

Sometimes plaques break open, causing blood clots to form. These can completely block blood flow in the affected artery, leading to heart attack or stroke.

Risk factors for atherosclerosis include:

• Smoking and tobacco use
• Overweight or obesity
• High blood pressure
• Physical inactivity
• Diabetes
• High cholesterol (high LDL cholesterol)
• Family history of atherosclerosis (male relative who developed atherosclerosis before age 55 or a female relative who developed the disease before age 65)
• Excessive alcohol consumption (for men, more than two drinks per day and for women, more than one drink per day)
• Unhealthy diet high in saturated and trans fats, salt, and sugar
• Older age (risk increases for men over 45 and women over 55)

Atherosclerosis is slow to develop and usually only causes symptoms when it substantially reduces or blocks blood flow.

Symptoms also vary based on which arteries are involved.

• Coronary arteries. Atherosclerosis in the arteries that deliver blood to the heart can cause chest pain (angina), shortness of breath, and an irregular heartbeat. A blood clot that blocks blood flow to the heart can cause a heart attack. (This condition is known as coronary artery disease.) Angina can manifest in several ways: chest pain or discomfort that comes after physical exertion and is relieved by rest, pain that travels to the jaw or left arm, or atypical indigestion or reflux-like symptoms, any one of which warrants immediate medical attention.
• Carotid arteries. Atherosclerosis in the arteries that deliver blood to the brain can cause paralysis in the limbs or face, stroke, confusion, dizziness, weakness, vision problems, breathing problems, headache, and loss of consciousness. (This condition is known as carotid artery disease.)
• Peripheral arteries. Atherosclerosis in the arteries that transport blood to the arms, legs, and pelvis can cause pain, numbness, and a tingling sensation. (This condition is known as peripheral artery disease.)
• Renal arteries. Atherosclerosis in the arteries that supply the kidneys with blood can cause high blood pressure, loss of appetite, fatigue, nausea, confusion, and swelling of the feet or legs. (This condition is known as renal artery stenosis.)

Diagnosis of atherosclerosis involves a review of your medical history, a physical exam, and one or more diagnostic tests.

Your doctor will ask about your symptoms and whether you have any of the risk factors associated with atherosclerosis. During the physical exam, he or she will check for signs and symptoms of the disease.

In most cases, tests are necessary to diagnose atherosclerosis. Various tests are commonly used, and the choice of test depends on which arteries are affected. These may include:

• Blood tests to check levels of cholesterol, triglycerides, sugar, and certain proteins.
• Electrocardiogram (EKG), a test that measures heart function.
• Imaging tests, such as a computed tomography (CT) scan, magnetic resonance imaging, ultrasound, nuclear heart scan, chest X-ray, angiography, or echocardiography. These tests allow doctors to visually examine the arteries.
• Ankle/Brachial Index (ABI), a test that uses ultrasound to compare the blood pressure in the arm to blood pressure in the ankle.
• Stress tests, which measure heart function (blood pressure, heart rate, and/or EKG) while it is “stressed” by exercise (e.g., walking on a treadmill) or by drugs that cause the heart to beat faster.

Treatment for atherosclerosis includes lifestyle changes, medications, minimally invasive procedures, and surgery. Many of these treatments aim to reduce or eliminate risk factors known to worsen plaque buildup in arteries.

Lifestyle changes. Emphasizing healthy habits can stop or slow the progression of atherosclerosis. Changes to improve lifestyle include:

• Follow a heart-healthy diet
• Stay physically active, exercise regularly, and avoid a sedentary lifestyle
• Lose weight if overweight or obese
• Quit smoking
• Restrict alcohol consumption to two or fewer drinks a day for men and one or fewer drinks a day for women

Medications. You may be prescribed statins or other drugs to reduce cholesterol levels. In some cases, drugs that relax and widen arteries to increase blood flow are prescribed. These medications are frequently accompanied by blood pressure-modifying medications and medications to slow the heart rate to help with the health of the heart for long term survival.

People who have diabetes should follow their doctor’s instructions for maintaining normal glucose levels. This usually involves eating a healthy diet, getting regular exercise, and taking medications to control blood sugar levels.

Less invasive procedures or surgery. When medicines alone are not sufficient, doctors may recommend stents or surgery for the narrowed arteries in the heart, legs, and neck to improve blood flow.

Stents are scaffoldings that utilize metal tubes that can be inserted from a groin artery and delivered to the target narrowed artery. They help by propping open the narrowed segment. Most patients with stents will need blood thinners, such as aspirin and Plavix, so that a clot will not form on the metal scaffolding (your body sees a stent as a foreign substance and will try to react to it).

Not all narrowed arteries are suitable for such interventions and some patients will need “bypass surgery.” In bypass surgery, surgeons take the patients’ own arteries and veins (which can be used safely without any ill effect) and use them to connect above and below the blockage, so as to “bypass” the narrowing.

Such bypasses last several decades, and those patients usually need to take aspirin and other atherosclerosis medications after surgery for the rest of their lives. Some of the veins used in a bypass can narrow over time, as veins are not accustomed to high pressures in the arterial system, but such narrowings can be easily treated with stents.

Below is a list of minimally invasive procedures used to widen or bypass the affected artery:

• Percutaneous coronary intervention (PCI). PCI is used to open narrowed or blocked sections of heart arteries. A surgeon inserts a catheter into an artery in the wrist or groin then guides it to the site of the affected heart artery. The surgeon then inflates a balloon to stretch the artery, opening it wider and, often, inserts a stent—a tube made of mesh wire—into the reopened section of artery. The stent remains in the artery to hold it open and improve blood flow.
• Angioplasty. This procedure is used to treat people with narrowed arteries. It may involve arteries in the heart, legs, or neck. A doctor inserts a tube with a balloon attached to it into the affected artery and maneuvers it to the site of the plaque. The doctor inflates the balloon, which widens the artery and increases blood flow. Sometimes the doctor inserts a stent into the artery where it will remain, propping open the narrowed segment.
• Coronary artery bypass graft (CABG). When a heart artery is blocked or severely narrowed, doctors may perform a bypass graft procedure. This procedure attaches a healthy artery taken from another area of the body to the side of the blocked or narrowed heart (coronary) artery. This allows blood to bypass—or flow around—the section of narrowed artery.  
• Peripheral artery bypass graft. This procedure is similar to CABG, but instead of bypassing a heart artery, the surgeon bypasses a narrowed section of artery elsewhere in the body such as in a leg or arm.
  
• Endarterectomy. This procedure is used to treat plaques in the carotid arteries, which are the arteries that run along the neck and deliver blood to the brain and face, or in the peripheral arteries, which supply blood to other parts of the body, such as the legs. A surgeon makes an incision into the patient’s skin near the site of the narrowed artery, opens the artery, and removes the plaque.

Atherosclerosis is a common disease that can lead to cardiovascular disease, stroke, heart attack, and serious other conditions. However, if you have atherosclerosis, there are measures you can take, along with treatments, to slow or stop the progression of the disease. Studies show that lifestyle changes and getting blood pressure, cholesterol, and blood sugar levels under control can help prevent heart disease, heart attacks, and stroke.

“At Yale medicine, every atherosclerosis patient is cared for by a team of specialists who can diagnose and treat various sequelae of atherosclerosis,” says Yale Medicine cardiac surgeon Pramod Bonde, MD. “Yale medicine consistently ranks as one of the best in the country for the treatment of diseases caused by atherosclerosis; we have world class physicians and support staff.”