What Is Arteriosclerosis?

Arteriosclerosis is a group of vascular diseases that involve the thickening and loss of elasticity of the walls of arteries. Once popularly described as the "hardening of arteries." the condition causes the progressive restriction of blood flow to organs and tissues.

Arteriosclerosis (arterio- meaning artery and -sclerosis meaning hardening) occurs when abnormalities known as lesions form in the innermost layer of the arterial wall, called the intima. Over time, the lesions start to fill with cellular waste, causing the walls to harden, thicken, and stiffen.

There are several different forms of arteriosclerosis, which can vary by the types of vessels affected and/or differences in the disease process. Atherosclerosis is by far the most common of these.

This article provides an overview of arteriosclerosis, including the types, symptoms, treatment, and prevention.

Types

There are three major types of arteriosclerosis: atherosclerosis, arteriolosclerosis, and Mönckeberg medial calcific sclerosis.

Atherosclerosis

Atherosclerosis is a form of arteriosclerosis in which deposits of fats, cholesterol, calcium, and other substances form on the walls of an artery. The accumulation of these deposits, called plaque, causes the blood vessel to narrow. High cholesterol, obesity, smoking, diabetes, and hypertension (high blood pressure) are all contributing risk factors.

When severe, atherosclerosis can lead to coronary artery disease (CAD), a major cause of heart attack and stroke. Atherosclerosis occurring in the blood vessels of the kidneys can cause a condition known as renal artery stenosis. Atherosclerosis in the vessels that carry blood from the heart (particularly those of the lower limbs) is referred to as peripheral artery disease (PAD).

Arteriolosclerosis

Arteriolosclerosis is similar to atherosclerosis except that it occurs in smaller arteries and arterioles (tiny blood vessels that branch off into capillaries). These are the blood vessels that are tasked with delivering nutrients to cells.

The risk of arteriolosclerosis is higher in people with uncontrolled diabetes and hypertension, both of which can inflict significant damage on smaller blood vessels. Aging is also a contributing factor, as is the use of certain drugs (like calcineurin inhibitors).

Mönckeberg Medial Calcific Sclerosis

Mönckeberg medial calcific sclerosis is a rare condition in which calcium accumulates in the middle muscular layer of an artery, called the tunica media. Older age is the major contributing factor given that most people over 65 will experience some level of calcification (calcium buildup) in blood vessels.

The exact cause of Mönckeberg medial calcific sclerosis remains unknown. What scientists do know is that the incidence is higher in people with diabetes, chronic kidney disease (CKD), lupus, and hypervitaminosis D (toxic levels of vitamin D)—all of which are associated with calcium imbalance.

Symptoms

It is possible to have arteriosclerosis for many years without experiencing symptoms. Warning signs of a clogged artery are usually felt when arteries are severely narrowed. Symptoms of arteriosclerosis depend on which blood vessel is occluded (blocked). 

Coronary Arteries

Symptoms of coronary artery disease (CAD) include:

• Squeezing pain or feeling of pressure in the chest, neck, back, arms, jaw, or shoulders
• Angina or chest pain that worsens with activity and subsides with rest
• Shortness of breath

Cerebral Arteries

Symptoms of an acute cerebral arterial occlusion to the brain include:

• Facial drooping
• Inability to move your arms or legs
• Vision problems
• Difficulty understanding others or sudden development of slurred speech
• Sudden severe headache
• Numbness or weakness of the limbs or face
• Loss of balance or dizziness

Peripheral Arteries

Signs and symptoms of peripheral artery disease (PAD) include:

• Leg pain
• Difficulty walking
• Change in leg color
• Coldness in the lower leg or foot
• Poor wound healing
• Hair loss on the legs

Renal Arteries

Symptoms of acute renal arterial occlusion of the kidneys include:

• Back pain
• Decreased urine output
• Blood in the urine
• Flank or side pain
• Symptoms of high blood pressure such as headache, changes in vision, and swelling

Causes

Risk factors for arteriosclerosis can vary by the disease type (atherosclerosis, arteriolosclerosis, or Mönckeberg medial calcific sclerosis) and may include:

• Unhealthy blood cholesterol levels: This can include high LDL cholesterol and/or low HDL cholesterol.
• High blood pressure: This is defined as sustained high blood pressure over 130/80 millimeters of mercury (mmHg).
• Smoking: This can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't allow enough oxygen to reach the body's tissues.
• Diabetes: With this disease, the body's blood sugar level is too high, which can damage blood vessels.
• Insulin resistance: This is a precursor or feature of diabetes in which the body doesn't use insulin properly to manage blood sugar. It worsens all other arteriosclerosis risk factors including high blood pressure and unhealthy cholesterol levels.
  
• Obesity: The extra weight is related to other health conditions.
• Sedentary lifestyle: A lack of physical activity or exercise puts you at higher risk of developing high blood pressure, diabetes, high blood cholesterol levels, and overweight or obesity, thereby increasing your risk of arteriosclerosis.
• Unhealthy diet: Foods that are high in saturated and trans fats or salt can contribute to plaque and increase blood pressure. 
• Older age: As you get older, your risk for arteriosclerosis increases. We all develop some arteriosclerosis as we age, but as you age lifestyle factors can worsen the condition. Quitting smoking, limiting alcohol, eating a balanced diet, and exercising can stop the impact of arteriosclerosis on our blood vessels.
• Family history of early heart disease: Your genes can paint a picture of what your heart health will look like in the future. Although having a close family member experience a heart attack does not mean that you will, you may want to consider getting tested for genetic conditions if there is a pattern in your family.

Diagnosis

A diagnosis of arteriosclerosis is not usually made with lab tests or imaging alone. Healthcare providers take your complete medical history, family history, and the results of a physical exam into account when making a diagnosis.

Some tests used to diagnose arteriosclerosis-related diseases include:

• Electrocardiogram (ECG), which measures heart electric activity
  
• Echocardiogram, which visualizes the heart with sound waves
• Blood tests, including cholesterol, glucose, and a complete blood count (CBC)
  
• Angiography, which uses a special dye and X-ray to visualize blood flow
• Computed tomography (CT), which uses a series of X-rays to create three-dimensional "slices" of internal structures
• Doppler ultrasound, which visualizes internal structures using reflected sound waves
• Stress testing, which measures heart activity during physical activity
• Cardiac catheterization, a surgical procedure in which a catheter is fed through a vein to the heart to locate blockages
  

Treatment

A combination of lifestyle changes and medications are used to manage and prevent arteriosclerosis. If you experience symptoms, medical procedures can be used to unclog the narrowed artery and alleviate your painful symptoms.

Lifestyle Changes

Eating a low-sodium diet consisting of fruits and vegetables and avoiding unhealthy fats are key to limiting your risk of developing arteriosclerosis. Avoiding cigarette smoking (including secondhand smoke), maintaining a healthy weight, and exercising regularly are also important.

Some additional measures that you can take to mitigate your risk of arteriosclerosis are:

• Limiting high blood pressure: Do this by avoiding stressful situations, managing diabetes, and taking blood pressure medications as prescribed.
• Maintaining proper cholesterol levels: You can do this via diet and medication.
• Frequently checking your blood sugar: Do this if you have diabetes, and keep your blood sugars within a normal range (less than 140 mg/dL after eating).

Medications

HMG-CoA reductase inhibitors, better known as statins, are the primary medications to fight arteriosclerosis and have been shown to slash cardiovascular deaths by 20% when taken as recommended. They block the enzyme HMG-CoA reductase in the liver, interfering with the body's production of cholesterol and limiting the formation of more plaque in the body.

Some commonly prescribed statins are:

• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Mevacor (lovastatin)
  
• Pravachol (pravastatin)
• Zocor (simvastatin)

Statins can be mild, moderate, or high intensity. A healthcare provider will choose which statin to prescribe based on your 10-year risk of having a heart attack or stroke.

If you meet any of the following criteria your healthcare provider may recommend that you start on statin therapy:

• History of cardiovascular disease including angina
• High LDL levels (over 190 mg/DL)
• Age 40 to 75 with diabetes
• A 10-year risk of 7.5% or more based on your ASCVD score

Nitrates, beta-blockers, and calcium channel blockers are also used to treat coronary artery disease and manage symptoms of angina.

One or more anti-platelet medications such as aspirin, dipyridamole, and Plavix (clopidogrel) can be used to prevent strokes.

Angioplasty

Angioplasty is a minimally invasive procedure used to widen narrowed or obstructed arteries or veins, typically to treat atherosclerosis. It is done as part of cardiac catheterization and can be performed in a number of ways:

• Balloon angioplasty: A small balloon is guided into the target blood vessel via a catheter and inflated so that the blocked area is opened.
• Atherectomy: This procedure involves shaving off the edges of atherosclerotic plaque along the intima or inner wall of the blood vessel.
• Laser angioplasty: A laser is used to vaporize the atherosclerotic plaque.
• Coronary artery stent placement: In this procedure, a tiny mesh wiring is guided into the coronary artery via a catheter. The mesh coil is expanded to open the blocked area. Most stents are also coated with anticoagulation drugs to prevent clotting. The stent is left in place to keep the artery open and allow blood flow.

Coronary Bypass Surgery

Coronary artery bypass surgery is the most commonly used procedure to alleviate symptoms of angina or chest pain as a result of coronary artery disease.

During this procedure, a healthy vein called a graft is taken from one area of the body and used to redirect blood flow around a blockage. The veins used for the graft are usually taken from the leg or chest wall. Sometimes more than one artery needs to be bypassed (such as occurs with a triple bypass).

Prevention

The best way to decrease your risk of having a cardiovascular event such as a heart attack or stroke is to prevent arteriosclerosis by eating a diet rich in fruits and vegetables, exercising regularly, never smoking, controlling your blood pressure, maintaining a healthy weight, and managing your cholesterol levels. 

There is no cure for arteriosclerosis, but treatment can slow or halt the worsening of the disease. As such, it is important to take medications as prescribed and not to alter or stop treatment if you feel better.

When to Call a Doctor

If you begin to experience symptoms of arteriosclerosis such as chest pain, shortness of breath, sudden slurred speech, or difficulty with your vision, you may be having a heart attack or stroke. This is a medical emergency. If you or a loved one experiences any of these symptoms, seek immediate medical attention.

Early diagnosis and treatment not only stops arteriosclerosis from worsening, but it may also be life-saving. Some medical interventions, such as the use of Activase (recombinant tissue plasminogen activator), is only effective if given within four and a half hours of stroke symptoms.

If your symptoms are not severe but appear different from symptoms you have experienced in the past, you may want to call your healthcare provider. Changes in medication, uncontrolled blood sugar, high blood pressure, and poor diet can all trigger a flare-up of symptoms.

Summary

Arteriosclerosis is a condition in which arteries become hardened and narrowed, usually due to cholesterol plaque. It affects millions of people in the United States. It can lead to problems like a heart attack, stroke, peripheral artery disease, and kidney damage.

Although there are some risk factors you can't control, like age and family history, there are many that you can. Changes in lifestyle (such as quitting cigarettes, eating a healthy diet, losing weight, and exercising) can greatly reduce your risk of vascular diseases. If you have arteriosclerosis, work closely with your healthcare providers to manage your condition.