Atherosclerosis: Symptoms, Causes, Stages & Treatment

Atherosclerosis is the buildup of plaque, made of fat and cholesterol, in the arteries. Plaque development can hinder blood flow, affecting vital organs like the brain, heart, and kidneys.  

Based on the latest ‘Global Burden of Disease’ study (GBD) results, India has a global death burden of about 27 % due to Cardiovascular Diseases (CVDs). That’s more than 185 deaths per hundred thousand individuals as of 2019. Thus necessitating health awareness and effective treatment of primary indicators like atherosclerosis.

Atherosclerosis doesn't occur overnight. The pathogenesis of atherosclerosis is progressive and can be divided into four main stages:

1. Endothelial Cell Disruption: The inner lining of arteries can get damaged (Endothelial Dysfunction). Factors like high blood pressure, cholesterol overload, and inflammation facilitate the lining cells to cause blood flow issues and plaque formation.
2. Fatty Streak Formation: Cholesterol accumulates in artery walls, attracting immune cells, particularly macrophages. Consuming cholesterol, macrophages transform into foam cells, forming fatty streaks, indicating atherosclerosis.
3. Plaque Development: As the condition progresses, fatty streaks form plaques (atheroma). It becomes sticky deposits containing cholesterol, inflammation cells, smooth muscle cells, and tissue. Thus restricting blood supply and causing health problems in the specific location of narrowed arteries.
4. Plaque Rupture: During this stage, unstable plaques can disintegrate. This leads to the release of fats in the blood, causing blood clots. Thus resulting in an obstructed blood supply.

As atherosclerosis progresses, it can lead to some serious complications. Unexpected heart attacks, strokes, or ongoing circulation problems in the legs can happen. These problems often arise because of the narrowed arteries and the potential plaque break down, causing blood clots.

Atherosclerosis often conceals its presence without apparent warnings. It's imperative to recognise the subtle signs and symptoms of atherosclerosis. These include :

1. Angina: It is often described as a heavy, squeezing, or tight sensation in the chest and may radiate to the arms, neck, jaw, or back. When atherosclerosis narrows the coronary arteries, it can restrict the flow of oxygen-rich blood to the heart muscle. This deprivation triggers chest pain or angina.  
2. Difficulty Breathing: Atherosclerosis can also manifest as gradual shortness of breath as if the air is thinning. Climbing stairs or exerting oneself becomes an uphill battle. The narrowed arteries limit the blood flow, making the body struggle for the oxygen it desperately needs.
3. Fatigue: As arteries narrow, it becomes more challenging for the heart to pump blood efficiently. This can lead to persistent tiredness, even after a full night's rest. It's like the body is constantly running a marathon, sapping energy reserves.
4. Numbness or Weakness: Sometimes, one might experience numbness or weakness, like a limb falling asleep. This happens when atherosclerosis targets the arteries supplying the brain.    
5. Confusion: When atherosclerosis affects the cerebral arteries, it can impair blood flow to the brain, potentially causing cognitive decline. Memory lapses, difficulty concentrating, and a decline in overall mental sharpness can be subtle hints of this impact.    
6. Dizziness: Atherosclerosis can cause lightheadedness and a sense of unsteadiness due to reduced oxygen transport to the brain. It is a subtle clue that is often ignored by many.
7. Vision Changes: When blood flow to the eyes is compromised due to atherosclerosis, it can result in vision issues. Individuals may experience blurry vision, difficulty focusing, or temporary vision loss.  
8. Erectile Dysfunction: In men, atherosclerosis can affect the arteries responsible for blood flow to the genitals. This can lead to erectile dysfunction (ED).

A range of factors can directly influence the pathophysiology of atherosclerosis. These include:

1. Cholesterol Invasion: Bad cholesterol is a major cause of atherosclerosis. It can easily penetrate the endothelium. Once inside the arterial wall, it becomes a target for oxidation, leading to inflammation.  
2. Inflammation of Arteries: It can be both a healing response and a chronic destructive force in atherosclerosis. White blood cells, driven by inflammatory signals, gorge on oxidised cholesterol, transforming into foam cells and contributing to plaque formation.
3. Fibrous Cap Formation: Over time, the body attempts to contain the growing fatty deposits by constructing a fibrous cap over it. This comprises collagen, cellular debris and smooth muscle cells that hold the deposits together. However, in the process, it further narrows the arteries and impedes blood flow.
4. Calcification: Sometimes, calcium deposits can infiltrate the plaques, turning them into hardened, brittle structures. These calcified plaques can get unstable and more prone to rupture. Ultimately leading to the formation of blood clots within the artery.

Several risk factors can accelerate the various causes of atherosclerosis outlined above. They are listed below:

Modifiable Risk Factors

Individuals can control certain atherosclerosis risk factors. These include:

1. Poor Diet: Consumption of saturated and trans fats, cholesterol, fried snacks, red meat, and sugar must be avoided. It contributes significantly to atherosclerosis pathogenesis, promoting plaque accumulation in arteries.
2. Sedentary Lifestyle: Lack of exercise not only feeds obesity but also weakens blood vessels, making it easier for plaque to form.
3. Smoking: It inflames arteries and promotes blood clot formation. The toxic chemicals in tobacco smoke damage the blood vessel lining. It also creates an environment favourable to atherosclerosis.
4. High Blood Pressure: This condition gradually weakens the arterial walls. The constant pressure on the blood vessels can lead to endothelial damage. This paves the way for plaque buildup.
5. Alcohol Consumption: High blood pressure, obesity, and irregular beating of the heart (arrhythmia) are direct possible consequences of uncontrolled consumption of alcohol. All of them align with atherosclerosis.
6. Obesity: High-fat content in the body(especially around the abdomen) releases inflammatory cytokines (chemical messengers) that signal plaque formation.
7. Diabetes: Oxidative damage to the endothelium is promoted by high blood glucose. This further leads to the recruitment of inflammatory complexes(inflammasomes) to the affected site.
8. Stress: Hormones can affect blood vessel function, increasing plaque formation risk. Unmanaged stress can lead to unhealthy coping mechanisms like overeating, smoking, and excessive alcohol consumption, negatively impacting arterial health.  

Non-Modifiable Risk Factors

Some atherosclerosis risk factors can develop naturally, and individuals cannot keep them in check. These include:

1. Age and Gender: Atherosclerosis progression trend is generally observed to begin in the 20s and worsen after 45. Men have a higher risk, while women typically experience it after reaching menopause, approximately after age 55.  
2. Family History: Sometimes, atherosclerosis can run in the family, indicating a genetic predisposition. Genetic factors can influence cholesterol metabolism, inflammation responses, and other processes related to atherosclerosis. Unlike other risk factors, this cannot be controlled.
3. Underlying Medical Conditions: Certain inflammatory conditions, such as rheumatoid arthritis, lupus(inflammation in the entire body), and infections like HIV, can be hidden risk factors for atherosclerosis.

The good news is that atherosclerosis risk factors can be controlled. It is possible even to prevent its onset. The most common preventive strategies include:

Adopt a Heart-Healthy Diet

1. Consume more fruits and vegetables.
2. Have whole grains instead of refined grains.
3. Go for lean protein sources like poultry, fish, and legumes.
4. Avoid fried and processed foods.
5. Include healthy fats from sources like olive oil, nuts and fish.

Regular Physical Activity

1. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.
2. Add strength training exercises at least two days a week.
3. Regular physical exercise reduces coronary heart disease risk.
4. Select activities you enjoy to make exercise a sustainable habit.

Stop Smoking

1. Seek support from counselling or medications.
2. Create a smoke-free environment to minimise exposure to tobacco.

Control Blood Pressure

1. Monitor blood pressure regularly and follow medical advice.
2. Adopt a diet low in sodium and limit alcohol consumption.
3. Take prescribed antihypertensive medications as directed.

Manage Cholesterol Levels

1. Discuss cholesterol management with the doctor to reduce LDL levels and improve HDL levels.
2. Consider statin therapy(medicine against bad cholesterol) to reduce cholesterol if recommended.

Manage Diabetes

1. Monitor blood glucose levels as advised by a doctor.
2. Follow a diabetes management plan, which may include medication, insulin, or lifestyle changes.

Weight Management

1. Achieve and maintain a healthy weight through calorie control and physical activity.
2. Set realistic weight loss goals.

Stress Management

1. Incorporate stress-reduction techniques like meditation and relaxation into your daily routine.
2. Seek professional help if you experience chronic stress or anxiety.

Regular Health Check-Ups

1. Schedule routine check-ups with a primary care physician or cardiologist.
2. Follow recommended screenings for cholesterol, blood pressure, and diabetes.

Before conducting any specific test, doctors will first check the medical history and take a basic physical test. When doctors need to find out if someone has atherosclerosis, they have several methods at their disposal:

1. Blood Tests: Atherosclerosis often begins with high cholesterol levels. Elevated CRP levels and inflammation are other key factors in atherosclerosis. It also helps in identifying the increased risk and chances of disease development.  
2. Electrocardiogram (ECG or EKG): ECGs record the heart's electrical activity and can detect signs of reduced blood flow due to atherosclerosis (e.g., during physical activity).
3. Stress Tests: These tests, often combined with ECG, evaluate how well the heart works under stress and can reveal signs of reduced blood flow due to atherosclerosis.
4. Angiography: This imaging technique visualises blood flow across the body, particularly for atherosclerosis affecting coronary arteries (coronary angiography). It involves injecting a special dye into coronary arteries and taking X-ray images to detect blockages or narrowing. Angiography of other arteries, such as renal or abdominal arteries, may also be performed to assess blood supply.
5. CT Scans: These scans can show coronary arteries and detect calcified plaque, a symptom of atherosclerosis. They provide detailed images to assess the risk. It determines the coronary artery calcium (CAC) score, measuring calcium deposits in coronary arteries. A high score indicates atherosclerosis and a higher risk of heart events. 
6. MRI: It can assess atherosclerosis in various arteries of the body, especially the carotid and aortic arteries. It can also identify areas of plaque that might rupture and cause clots.
7. Echocardiography: Along with angiography, it provides detailed images of the coronary arteries to visualise plaque composition and location. This technique utilises ultrasound to examine the heart.  
8. Carotid Ultrasound: This painless test uses sound waves to create detailed images of the carotid arteries in the neck. It shows if there's plaque buildup, narrowing, or blockages in these important arteries, which can lead to strokes.
9. Ankle-Brachial Index (ABI) test: This simple test measures blood pressure in the arms and legs. A significant difference can suggest PAD (one of the types of atherosclerosis) in the legs.

Note: The tests prescribed might vary from patient to patient, depending on their specific condition.

Preparing for the Diagnosis   

Getting ready for an atherosclerosis diagnosis requires following certain steps to ensure the accuracy and usefulness of the diagnostic process. Here are some recommendations on how to prepare for the diagnosis:

1. Put together the health history, including any past heart issues, surgeries, or treatments. Keep notes about your symptoms and dosages of medications
2. Be ready to talk about daily habits, like diet, exercise level, alcohol use, and smoking. 
3. Tell the doctor if anyone in the family has had heart disease or atherosclerosis.
4. Write down any questions about atherosclerosis, the tests to undergo, and potential treatments.

Some common questions that can be asked include:

1. What is the definition of atherosclerosis, and how does it affect my arteries and overall health?
2. What are the stages of atherosclerosis?
3. How can I manage or mitigate my risk factors of atherosclerosis?
4. What diagnostic tests or procedures will I need, and what do they entail?
5. What is the best atherosclerosis treatment option available for my condition?
6. What is the long-term outlook for my condition?
7. Are there any warning signs or symptoms of atherosclerosis I should be particularly vigilant about?

When facing atherosclerosis, treatment aims to stop its progress, tackle symptoms, and control risks. Treatment options can be divided into three categories: non-surgical techniques, medicines, and surgical techniques:

Non-surgical techniques

These are the initial methods that can be adopted for atherosclerosis prevention. These broadly include:

Home Remedies

These steps can be employed by any individual without the need for medications. These include:

1. Exercising regularly
2. Adopting a diet low in fat and high in fibre and protein
3. If working from home or a desk job, take breaks to move around and stretch the body
4. Avoid smoking and excessive alcohol consumption

Ayurvedic Treatment

From ancient times, several natural substances have been used to address atherosclerosis symptoms. These include:

1. Garlic, guggul, arjuna, and turmeric have been traditionally used to support cardiovascular health.
2. Amla is rich in vitamin C and antioxidants and is believed to reduce the onset of atherosclerosis.

Medications

There are several types of medications that the doctor can prescribe depending on the underlying causes of atherosclerosis:

1. Statins: It can lower bad cholesterol levels, thus reducing the chance of fatty build-up in the arteries.
2. Antihypertensive Medications: Individuals with high blood pressure may receive medicines like ACE inhibitors, beta-blockers, or calcium channel blockers to keep them in control.
3. Blood Thinners: In certain cases, the doctor may suggest these medicines to reduce the viscosity of blood to lower the risk of blood clots in people with heart problems and clogged arteries.

Surgical Procedures

When non-surgical procedures and medications fail to control atherosclerosis, surgical procedures are often employed for atherosclerosis treatment. These include:

Minimally Invasive Procedures

These procedures involve fewer incisions and take less time for recovery. These include:

1. Angioplasty and Stent Placement: Angioplasty entails using a catheter with a deflated balloon to widen narrowed arteries, often followed by the placement of a stent (a small mesh tube) to maintain artery patency.
2. Carotid Endarterectomy: Surgical removal of plaque from the carotid artery in the neck can reduce the risk of stroke.
3. Atherectomy: This procedure removes plaque buildup from arteries using a specialised catheter equipped with a cutting device or laser.

Invasive Surgical Techniques

When medications and other remedies fail to reduce plaque buildup, surgical techniques can be employed to treat severe cases of atherosclerosis. Some of them are listed below:

1. Coronary Artery Bypass Grafting (CABG): CABG surgery involves creating new blood pathways to bypass blocked coronary arteries, typically in severe cases of coronary artery disease.
2. Carotid Artery Stenting: This procedure entails inserting a stent into the carotid artery to open narrowed segments and reduce the risk of stroke.
3. Peripheral Artery Bypass Surgery: It establishes new blood vessel routes in the legs to bypass blocked arteries and improve blood flow.
4. Aneurysm Repair: Surgical correction of a weakened or bulging artery (aneurysm) can prevent rupture.

Note: A given atherosclerosis treatment option does not apply to every patient. The procedures selected depend on the condition and the patient's medical history.

Cost of Atherosclerosis Treatment

The cost of atherosclerosis treatment can vary significantly depending on several factors. These include the severity of the condition, the patient's health status, the chosen treatment approach, and the hospital/city in which the treatment is received.

Prognosis and Survival Rate

Prognosis

Atherosclerosis prognosis depends on factors like plaque buildup, location, health, and management. It can progress slowly without major issues. Lack of proper treatment can lead to severe complications like heart attacks, strokes, or coronary artery disease. 

Survival rate

Atherosclerosis can lead to complex cardiovascular diseases like myocardial infarction and strokes. Thus, atherosclerosis treatment is an early risk detection and alleviation. It can significantly reduce cardiovascular disease-related mortality by 5%. Although survival rates depend on severity, treatment, quality of care, and the patient. The comprehensive integration of the heart-healthy lifestyle and medical interventions subsequently increases the life expectancy by almost ten years. 

Depending on the location of the blocked arteries, atherosclerosis has been given different names in medicine:

1. Coronary Artery Disease (CAD): It is driven by coronary atherosclerosis and target arteries. These arteries nourish the heart muscle with oxygen and nutrients. When plaques narrow or block them, people can experience chest pain (angina) or, in severe cases, heart attacks.
2. Peripheral Artery Disease (PAD): It is linked to peripheral atherosclerosis and often affects the legs, arms, or pelvis. It results in leg pain (claudication) and slower wound healing. Severe cases can lead to tissue damage or gangrene(tissue death).
3. Carotid Artery Disease: Atherosclerosis builds up in the neck, targeting the carotid arteries. It blocks blood flow to the brain. When the plaques burst to form clots, it can lead to strokes or "mini-strokes"(Transient Ischemic Attack- TIA).
4. Renal Artery Stenosis: The origination of artery blockage can be in the kidneys. Plaque buildup narrows renal arteries, resulting in high blood pressure and kidney problems.
5. Aortic Atherosclerosis: This happens when the aorta, the largest artery in the body, is affected by atherosclerosis. It can lead to aortic aneurysms, dissections, and other life-threatening scenarios.
6. Cerebrovascular Disease: Cerebral atherosclerosis occurs in the brain arteries. It increases the risk of strokes and TIAs.
7. Coronary Microvascular Disease(MVD): Microvascular atherosclerosis goes unnoticed until it affects the smaller heart blood vessels. Chest pain and discomfort persist, even when the larger coronary arteries appear healthy.
8. Multifocal Atherosclerosis: In this condition, plaque buildup happens in various vascular territories, increasing the risk of complications in different parts of the body.

When to Consult a Doctor?

People are advised to consult a doctor for atherosclerosis if they:

1. Experience chest discomfort or pain for more than 5 minutes.  
2. Have shortness of breath or fatigue during light physical activity like brisk walking or while doing household chores.  
3. Notice sharp, stinging leg pain or numbness while walking.  
4. Have a family history of heart disease.
5. Have hypertension, cholesterol, or diabetes.
6. Are over 40 and have multiple risk factors.

Atherosclerosis patients should intake less saturated and trans fats, cholesterol, sodium, and refined sugar content. Instead, focus on consuming whole, nutrient-rich foods for cardiovascular health. Here is an example of such a diet plan:

Breakfast

1. Start your day with a bowl of oatmeal cooked with low-fat milk or water. Add a handful of fresh berries or sliced bananas for natural sweetness and fibre.
2. Opt for whole grain idli or dosa made with a combination of urad dal and whole wheat or oats. Serve with a side of coconut chutney and sambhar.
3. Prepare upma using semolina (rava) or dalia and load it with colourful vegetables like carrots, peas, and bell peppers. Use minimal oil for cooking.

Mid-Morning Snack

1. Enjoy a small bowl of yoghurt, which is rich in protein and probiotics.

Lunch

1. Opt for brown rice or chapati as your base. Pair it with a lentil-based curry (dal) and various vegetable dishes like bhindi masala or saag.
2. Have one or two whole wheat chapatis with a side of vegetable curry and a cucumber or mixed green salad.

Afternoon Snack

1. Prepare a fresh fruit salad with seasonal fruits like papaya, apple, orange, and pomegranate. Sprinkle a pinch of chaat masala for flavour.
2. Snack on a small handful of mixed nuts, including almonds, walnuts, and pistachios. Nuts provide healthy fats and protein.

Dinner

1. Incorporate fish into your diet. Cook the fish with minimal seasoning for a healthy source of omega-3 fatty acids.
2. Try millet-based dishes like bajra khichdi or jowar roti with a side of green leafy vegetables and a light curry.

Atherosclerosis is a progressive disease causing plaque buildup in arteries. It also contributes to increasing the risk of heart attack and stroke risk. Preventive measures include a low-fat diet, physical activity, managing risk factors, and timely diagnosis. 

HexaHealth offers comprehensive treatment options for atherosclerosis, including personalized plans, medications, surgery, and expert guidance. We are dedicated to answering all your health-related questions and concerns.

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