Overview
Arteriosclerosis (atherosclerosis) is the buildup of cholesterol, fat, calcium, and other substances on the inner walls of arteries, causing the artery walls to harden and narrow. Although it is a natural process developing with aging, some factors accelerate it.
Atherosclerosis is the foundation of many serious conditions such as heart attack, stroke, and peripheral artery disease. It is a leading cause of death worldwide.
Symptoms
It does not cause symptoms in early stages. When the artery is significantly narrowed, symptoms appear based on the affected organ:
Coronary arteries (heart):
- Chest pain (angina)
- Shortness of breath
- Heart attack
Brain arteries:
- Sudden arm-leg weakness
- Speech disorder
- Facial paralysis
- Transient ischemic attack (TIA)
- Stroke
Leg arteries (peripheral artery disease):
- Leg pain when walking (claudication)
- Cold hands, feet
- Delayed wound healing
- Leg ulcers, gangrene (advanced)
Kidney arteries:
- High blood pressure
- Kidney failure
Penile arteries:
- Erectile dysfunction
Causes and Process
- The inner surface of the artery (endothelium) is damaged
- LDL cholesterol accumulates in the artery wall
- Inflammation
- Fatty plaques form
- Calcium accumulates, plaque hardens
- Artery narrows
- If plaque ruptures, a clot forms and blocks the artery
Risk Factors
Non-modifiable:
- Age (men 45+, women 55+)
- Family history
- Sex
Modifiable:
- High LDL cholesterol
- High blood pressure
- Smoking
- Diabetes
- Obesity
- Sedentary lifestyle
- Stress
- Unhealthy diet (saturated fat, trans fat, salt)
- Excessive alcohol
- High homocysteine
- Chronic inflammatory diseases
Complications
- Coronary artery disease, heart attack
- Stroke, transient ischemic attack
- Aneurysm
- Peripheral artery disease
- Kidney failure
- Erectile dysfunction
- Intestinal ischemia
- Death
When to See a Doctor
- Regular check-ups if risk factors are present (yearly over age 40)
- Chest pain, shortness of breath
- Leg pain when walking
- Sudden neurological symptoms (emergency!)
- Early screening if family history exists
Diagnosis and Treatment
Diagnosis:
- Blood tests: lipid profile (LDL, HDL, triglycerides), HbA1c, hsCRP
- Blood pressure measurement
- ECG, echocardiography
- Carotid ultrasound
- Ankle-Brachial Index (ABI)
- Coronary CT angiography, calcium score
- Coronary angiography
- MR angiography
Treatment:
1. Lifestyle changes (foundation):
- Healthy, Mediterranean-style diet
- Regular exercise (150 min per week)
- Quit smoking
- Healthy weight
- Stress management
2. Medication:
- Statin (atorvastatin, rosuvastatin): Lowers LDL, stabilizes plaques
- Ezetimibe: Additional lipid lowering
- PCSK9 inhibitors: Evolocumab, alirocumab (high-risk)
- Bempedoic acid
- Antiplatelet: Aspirin, clopidogrel (prevents clots)
- ACE inhibitors, ARBs: Blood pressure, vascular protection
- Beta blockers
- Diabetes treatment
3. Interventional:
- Angio + stent
- Bypass surgery
- Carotid endarterectomy
- Peripheral vascular interventions
Prevention
Nutrition (most important):
- Mediterranean diet
- Plenty of vegetables, fruits, whole grains
- Fish (twice a week, omega-3)
- Olive oil, nuts (moderate)
- Less red meat, processed meat
- Less salt, less sugar
- Avoid saturated fat and trans fat
- High-fiber diet
Exercise:
- At least 150 minutes of moderate aerobic activity per week
- 2 days of strength training per week
Other:
- Quit smoking (most critical)
- Maintain a healthy weight
- Keep blood pressure, sugar, and cholesterol under control
- Manage stress
- Get enough sleep
- Limit alcohol
- Regular health check-up
- Monitor your diabetes
- Early screening if family history exists
- Adequate vitamin D, omega-3