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.

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.”