Hardening of the arteries

 

Alternative Names

Atherosclerosis; Arteriosclerosis; Plaque buildup - arteries

Definition

Hardening of the arteries, also called atherosclerosis, occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can block the arteries and cause problems throughout the body.

Hardening of the arteries is a common disorder.

Causes

 

Hardening of the arteries often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them.

Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them.

These blockages starve tissues of blood and oxygen. This can result in damage or tissue death. It is a common cause of heart attack and stroke.

High blood cholesterol levels can cause hardening of the arteries at a younger age.

For many people, high cholesterol levels are due to a diet that is too high in saturated and trans fats. Other risk factors are heavy alcohol use, lack of exercise, and being overweight.

Other factors that can contribute to hardening of the arteries include:

  • Diabetes
  • Family history of hardening of the arteries
  • High blood pressure
  • Smoking

Symptoms

Hardening of the arteries does not cause symptoms until blood flow to part of the body becomes slowed or blocked.

If the arteries supplying the heart become narrow, blood flow can slow down or stop. This can cause chest pain (stable angina), shortness of breath, and other symptoms.

Narrowed or blocked arteries may also cause problems in the intestines, kidneys, legs, and brain.

Exams and Tests

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Hardening of the arteries can create a whooshing or blowing sound ("bruit") over an artery.

The 2008 United States Preventive Services Task Force (USPSTF) guidelines on screening for lipid disorders in adults recommend:

  • Beginning screening at age 20 if you are at increased risk for atherosclerosis
  • Getting a first screening test by age 35 in men, and age 45 in women if you are not at increased risk

Note: This guideline is being updated.

A number of imaging tests may be used to see how well blood moves through your arteries.

Treatment

Lifestyle changes will reduce your risk of hardening of the arteries. Thing you can do include:

  • Quit smoking. This is the single most important change you can make to reduce your risk of heart disease and stroke.
  • Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
  • Limit how much alcohol you drink. Recommended limits are one drink a day for women, two a day for men.
  • Get regular physical activity. Exercise with moderate intensity (e.g., brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 - 90 minutes a day. Talk to your doctor before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.

The 2007 United States Preventive Services Task Force (USPSTF) guidelines on screening for high blood pressure recommend screening for all adults:

  • Every 2 years, if their blood pressure was less than 120/80 mmHg at their most recent reading
  • Once a year if their blood pressure was 120 - 139/80 - 89 mmHg

Notes: This guideline is currently being updated.

If your blood pressure is high, it is important for you to lower it and keep it under control.

  • Most people should keep their blood pressure below 140/90 mmHg. However, you doctor may recommend a different target depending on your age and other health conditions.
  • If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure may need to be lower. Ask your doctor what your blood pressure should be.

Your doctor may want you to take medicine for abnormal cholesterol levels or for high blood pressure if lifestyle changes do not work. This will depend on:

  • Your age
  • Whether you have heart disease or other blood flow problems
  • Whether you smoke or are overweight
  • Whether you have diabetes or other heart disease risk factors

Your doctor may suggest taking aspirin or another medicine to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your doctor.

Losing weight if you are overweight and reducing blood sugar if you have diabetes or pre-diabetes can help reduce the risk of developing atherosclerosis.

Outlook (Prognosis)

Hardening of the arteries cannot be reversed once it has occurred. However, lifestyle changes and treating high cholesterol levels can prevent or slow the process from becoming worse. This can help reduce the chances of having a heart attack and stroke as a result of atherosclerosis.

Possible Complications

In some cases, the plaque is part of a process that causes a weakening of the wall of an artery. This can lead to a bulge in an artery called an aneurysm. Aneurysms can break open (rupture). This causes bleeding that can be life threatening.

References

Screening for Lipid Disorders in Adults, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm. Accessed May 13, 2014.

Screening for High Blood Pressure in Adults, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspshype.htm. Accessed May 13, 2014.

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 47.

Libby P. The vascular biology of atherosclerosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 43.

Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 70.

Review Date: 5/13/2014
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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