|Also Listed As:
|| Arteries, Hardening of;
Arteriosclerosis; Coronary Artery Disease
Atherosclerosis is a slow, complex disease in which fatty substances,
cholesterol, cellular waste products, calcium, and other substances build up in
the inner lining of an artery. This buildup is called plaque. Atherosclerosis is
derived from the Greek words athero (meaning gruel or paste) and sclerosis
(meaning hardness). The effects of atherosclerosis differ depending upon which
arteries in the body narrow and become clogged with plaque. For example, plaque
buildup in the vessels that supply the heart with oxygen-rich blood may cause
chest pain and lead to a heart attack while plaque buildup in the arteries that
supply blood to the brain may result in a stroke.
According to the Centers for Disease Control, heart disease is the leading
cause of illness and death in the United States and most other Western
countries. Close to one million deaths per year in the United States alone are
attributable to heart disease, double the number of deaths from cancer. Because
atherosclerosis is highly preventable and the risk factors are well-documented,
preventive measures such as lowering blood pressure and LDL ("bad") cholesterol
levels, smoking cessation, losing weight, and increasing physical activity
should be followed.
|Signs and Symptoms|
Atherosclerosis shows no symptoms until a significant percentage (40%) of a
vessel becomes obstructed with plaque and a complication occurs. Symptoms vary
depending upon which arteries in the body narrow and become clogged with plaque.
Coronary Artery Disease (CAD)
CAD is caused by plaque buildup
in the vessels that supply the heart with oxygen-rich blood. When the tissues of
the heart begin to become deprived of oxygen (ischemia), chest pain (angina)
occurs. If the artery becomes completely blocked, cells in the heart begin to
die and a heart attack may occur. Symptoms of CAD are usually triggered by
physical exercise, sexual activity, exposure to cold weather, anger, or stress.
The most common symptoms of CAD include:
- Chest pain (generally a heavy, squeezing, or crushing sensation with
possible burning or stabbing pains)
- Abdominal, neck, back, jaw, or shoulder/arm pain
- Nausea and vomiting
- Unexplainable fatigue and/or extreme fatigue after physical activity
- Shortness of breath
- Depression and/or anxiety
Cerebrovascular disease is caused by
plaque buildup in the arteries that supply the brain with oxygen-rich blood.
Cerebrovascular disease causes transient ischemic attack (a sudden loss of brain
function with complete recovery within 24 hours) and stroke. Symptoms may
- Weakness or paralysis on one side of the body
- Garbled speech and/or inability to comprehend speech
- Loss of vision in one eye
- Paralysis of facial muscles
- Muscle weakness
- Impaired senses
- Poor coordination
- Involuntary, jerky movements on one side of the body
- Rapid, repititious, involuntary eye movement
Peripheral Artery Disease
Peripheral artery disease is caused
by plaque buildup in the arteries that supply the extremities of the body (such
as the hands and feet) with oxygen-rich blood. Symptoms may
- Pain, aching, cramps, numbness or sense of fatigue in the muscles of
the lower extremities
- Diminished pulses in the extremities
- Decreased muscle mass
- "Bruits" (blowing sounds that the physician hears with a stethoscope
that indicates turbulence in blood flow)
- Hair loss
- Thickened nails
- Smooth, shiny skin surface
- Skin that is cold to the touch
Many researchers believe that atherosclerosis is caused by damage to the
innermost layer of the artery known as the endothelium. High blood pressure,
elevated LDL ("bad") cholesterol, an abnormal accumulation of homocysteine (an
amino acid produced by the human body), tobacco smoke, diabetes, hormonal
changes following menopause, and infection are all thought to contribute to
endothelial damage. Once the endothelium is damaged, it becomes easier for fats,
cholesterol, cellular waste products, calcium, and other substances to become
deposited in the artery wall. This buildup thickens the endothelium
significantly. As a result, the diameter of the artery shrinks, blood flow
decreases, and oxygen supply is dramatically reduced. Blood clots may also form
on top of the plaque or damaged endothelium, thereby blocking the artery, and
completely cutting off blood supply.
Because many people do not have the classic risk factors of atherosclerosis
(such as cigarette smoking and high blood pressure), it is possible that there
may be other contributing factors or causes of atherosclerosis, such as
inflammation from an infection or autoimmune disease.
- Male gender
- Lowered levels of the hormone estrogen following menopause
- Older age
- High blood pressure
- High LDL ("bad") cholesterol and/or high triglycerides
- Elevated homocysteine levels
- Low HDL ("good") cholesterol
- Family history of atherosclerosis (which may be related to learned
behavior rather than genetic factors)
- Cigarette smoking and regular exposure to second-hand smoke
- Diabetes mellitus
- Insulin resistance
- Obesity, particularly in the abdominal region
- Sedentary lifestyle
- Diets high in saturated fat and trans fatty acids
A healthcare practitioner can determine your risk for heart disease by
conducting a variety of tests. Blood tests detect elevated levels of
cholesterol, homocysteine, and blood clotting factors. A stress test (otherwise
known as an exercise tolerance test) monitors heart rate and blood pressure
while an individual walks on a treadmill or rides a stationary bicycle. An
electrocardiogram (ECG) is used during a stress test to measure and record the
electrical activity of the heart. ECGs can detect abnormal heart rhythms, scar
formation in the heart muscle from a prior heart attack, and areas of decreased
blood flow when the heart is strained (as with physical activity). Advanced
imaging techniques used during a stress test (such as an ultrasound) can
determine precise areas of decreased blood flow to the heart. Angiograms (or
angiography) can reveal arterial damage and plaque buildup.
Making careful lifestyle choices is an important first step in preventing
atherosclerosis. Some healthy habits include:
- Achieving and maintaining normal weight
- Controlling high blood pressure, high cholesterol, diabetes, and other
disorders that may contribute to the buildup of plaque in arteries
- Avoiding cigarette smoking and second-hand smoke
- Eating a diet low in saturated and hydrogenated fats and cholesterol,
and high in starches, fiber, fruits, and vegetables
- Exercising 3 hours per week or more (such as 30 minutes per day, 6
days per week)
- Reducing stress
Atherosclerosis shows no symptoms until a complication (such as chest pain or
a heart attack) occurs. For this reason, lifestyle choices such as achieving and
maintaining a normal weight, lowering blood pressure and cholesterol, exercising
regularly, quitting smoking, and reducing stress, are all important steps in
preventing atherosclerosis. Once a complication occurs, however, surgery and
other Procedures may be required to remove plaque from clogged arteries or to
create a detour around a blocked artery. Medications are often prescribed to
lower cholesterol or blood pressure and to prevent an initial or recurrent
complication. Healthy diets designed to lower cholesterol, blood pressure, and
excess body weight are essential in the treatment of atherosclerosis. Nutrition
and dietary supplements, such as vitamin E, omega-3 fatty acids, and folate
(vitamin B9) may be effective when used in addition to certain medications.
Herbs, such as hawthorn, have also shown promise in lowering cholesterol levels
and reducing the risk of heart disease.
The following medications are used to prevent development of atherosclerosis
and to reduce recurrent complications such as heart attack and stroke in those
with the condition.
- Statins (such as lovastatin, pravastatin, simvastatin, atorvastatin,
- Bile acid sequestrants (such as cholestyramine, colestipol, and
- Fibric acid derivatives (such as gemfibrozil, fenofibrate, and
Blood Pressure Lowering Drugs
The following medications are used to control blood pressure, prevent
development of atherosclerosis, and slow the progression of the disease. They
are also used to lower heart rate, thereby reducing the work load or strain on
- Beta-blockers (such as acebutolol, atenolol, metoprolol, nadolol, and
- Angiotensin-converting enzyme (ACE) inhibitors (such as benazepril,
captopril, enalapril, lisinopril, and ramipril)
- Calcium-channel blockers (such as amlodipine, felodipine, nifedipine,
nicardipine, and verapamil)
- Alpha/beta blockers (such as labetalol)
Blood Thinning Drugs, Platelet Inhibitors
- Aspirin—first choice platelet inhibitor for
preventing and treating atherosclerosis; reduces risk of transient ischemic
attack (TIA), stroke, and heart attacks
- Ticlodipine—for individuals who can not take
aspirin (due to allergies, for example) or do not improve from aspirin; has more
side effects than aspirin
- Dipyridamole—not as effective as aspirin when
used alone but may be used in combination with aspirin or warfarin (another
blood thinner); often used after bypass surgery
- Clopidogrel—reduces risk of heart attacks
- Glycoprotein IIb/IIIa receptor agonists (such as abciximab,
eptifibatide, lamifiban, and tirofiban)—used when
awaiting or just following an angioplasty
Blood Thinning Drugs, Anticoagulants
- Heparin—used intravenously in the hospital
following a TIA, stroke, or heart attack
- Low molecular weight heparin—administered by
self-injection following a stroke or for coronary artery disease
- Warfarin—used to prevent stroke in
individuals who have irregular heart rhythms
Blood Thinning Drugs, Thrombolytics
The following medications are used in the hospital just after a heart attack.
They are most effective when used within three hours of a stroke or heart
- Recombinant Tissue Plasminogen Activator (rTPA)
- Nitrates—used to relax the vessels that
supply the heart with blood; these medications reduce chest pain
|Surgery and Other Procedures|
An angiography (an X-ray examination of blood vessels) is often performed to
determine whether a surgical or other procedure is necessary. In the case of
atherosclerosis, this test is performed to examine blood vessels in a particular
location such as the heart, brain, or lower extremities. Several different
procedures (surgical and non-surgical) may be performed depending upon the
location and severity of atherosclerosis
The following nonoperative techniques may be performed on individuals with
coronary and peripheral artery disease:
- Angioplasty—a procedure used to widen
narrowed arteries. A surgeon inserts a catheter with a deflated balloon into the
narrowed part of the artery. The balloon is inflated, widening the inner
diameter of the blood vessel so blood can flow more easily. The balloon is then
deflated and the catheter is removed. This procedure may also include the
placement of a permanent stent (wire mesh) that holds the artery open and
improves blood flow. Angioplasty with stent placement is considered the safest
and most effective procedure for atherosclerosis.
- Atherectomy—a procedure to remove plaque from
the arteries using a laser catheter or a rotating shaver
- Laser revascularization—a procedure in which
a laser creates multiple channels through the heart muscle into the main pumping
chamber of the heart. These channels fill with blood from the pumping chamber
which then supplies oxygen and needed nutrients to the heart muscle. It is used
to relieve severe chest pain in individuals who have no other treatment options.
Bypass surgery—a procedure that reroutes or bypasses
blood around clogged arteries to improve blood supply to affected areas such as
the heart or the lower extremities
Minimally invasive bypass surgery—this procedure
creates a small incision rather than the broad opening in the chest wall created
during regular bypass surgery
Endarterectomy—a procedure primarily used to remove
plaque in the carotid (a major artery located in the front of the neck) or
|Nutrition and Dietary Supplements|
Healthy eating habits can help reduce high blood cholesterol, high blood
pressure, and excess body weight -- three of the major risk factors for heart
disease. The American Heart Association (AHA) has developed dietary guidelines
that help lower fat and cholesterol intake and reduce the risk of heart disease.
The main goal of these guidelines is to promote an overall healthy eating
pattern, maintain an appropriate body weight, and reach desirable cholesterol
and blood pressure levels. The AHA does not recommend very low-fat diets as
these diets may lead to deprivation of essential fatty acids as well as an
undesired reduction in HDL ("good") cholesterol levels. The AHA also advises
against high-protein diets due to the lack of scientific evidence supporting
their weight-loss effectiveness or any other claims of health benefits. In
general, Western diets are considered to be too high in protein, particularly
animal protein (which is high in fat and cholesterol). In adults, high levels of
protein can cause kidney damage and bone loss.
The AHA recommends the following to prevent the development or progression of
- A variety of fruits and vegetables (5 to 9 servings/day)
- A variety of grain products, with an emphasis on whole grains (6 or
- At least 2 servings of fish per week
- Limit total fat intake to <30% and saturated fat to <10% of
energy. Replace dietary saturated fats and trans fatty acids with
monounsaturated and polyunsaturated fats (including foods rich in omega-3 fatty
acids). Food sources of omega-3 fatty acids include fatty fish (such as salmon),
flaxseed and flaxseed oil, soybean oil, canola oil, and nuts.
- Limit dairy products to low-fat or fat free items (2 to 4
- Limit sodium intake to 6 grams per day
- Limit alcohol intake to 2 drinks/day for men and 1 drink/day for women
- Maintain a healthy body weight by matching calorie intake to energy
needs; this includes a moderate level of regular physical activity (30 to 60
minutes within target heart range most days per week)
In addition to the recommendations listed above, the AHA suggests that
individuals who have heart disease or are at a high risk of developing heart
disease consider the more specialized diets below:
Diets for People with High Cholesterol
The National Cholesterol Education Program (NCEP) recommends saturated fat
intake of no more than 7% of total calories, cholesterol limited to less than
200 mg/day, little to no trans fatty acids (such as fried foods), intake of both
plant stanols/sterols (2 grams/day) and soluble fiber (10 to 25 grams/day),
weight loss, and exercise. Studies have also shown that replacing dietary animal
protein with soy protein may reduce total cholesterol, LDL ("bad") cholesterol,
and triglycerides (a major form of fat in the blood) without affecting HDL
("good") cholesterol levels. The AHA also recommends a diet high in unsaturated
fat diet rather than a very low-fat diet for individuals with atherogenic
dyslipidemia (a condition marked by high triglycerides, low HDL cholesterol,
obesity, high blood pressure, and/or diabetes).
Diets for People with High Blood Pressure
The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes a diet
rich in fruits, vegetables, and low-fat or non-fat dairy products to provide
high intake of potassium, magnesium, and calcium sources. Sodium intake should
be less than 6 g/day. Weight loss, regular physical activity, and limiting of
alcohol intake are also very important factors for lowering blood pressure.
The Mediterranean Style Diet is comprised of whole grains, fresh fruits and
vegetables, fish, olive oil, and moderate, daily wine consumption. Unlike the
AHA diets, the Mediterranean Style Diet is not low in all fats; it is low in
saturated fat but high in monounsaturated fatty acids. In a long-term study of
423 patients who suffered a heart attack, those who followed a Mediterranean
Style Diet had a 50% to 70% lower risk of recurrent heart disease compared with
controls who received no special dietary counseling. The intervention diet
emphasized bread, root and green vegetables, daily intake of fruit, fish and
poultry, olive and canola oils, margarine high in alpha-linolenic acid (an
omega-3 polyunsaturated fatty acid found in flaxseed, walnuts, and canola oil),
along with discouragement of ingestion of red meat and total avoidance of butter
Supplements and Vitamins
Folic Acid, Vitamin B6, Vitamin B12, Betaine
Many studies indicate that patients with elevated levels of the amino acid
homocysteine are roughly 1.7 times more likely to develop coronary artery
disease and 2.5 times more likely to suffer from a stroke than those with normal
levels. Homocysteine levels are strongly influenced by dietary factors,
particularly vitamin B9 (folic acid), vitamin B6, vitamin B12, and betaine.
These substances help break down homocysteine in the body. Some studies have
even shown that healthy individuals who consume higher amounts of folic acid and
vitamin B6 are less likely to develop atherosclerosis than those who consume
lower amounts of these substances. Despite these findings, the AHA reports that
there is insufficient evidence to suggest that supplementation with betaine and
B vitamins reduce the risk of atheroscerlosis or that taking these supplements
prevents the development or recurrence of heart disease. The AHA does not
currently recommend population-wide homocysteine screening, and suggests that
folic acid, as well as vitamin B6, B12, and betaine requirements be met through
diet alone. Individuals at high risk for developing atherosclerosis however,
should be screened for blood levels of homocysteine. If elevated levels are
detected, a healthcare practitioner may recommend supplementation.
Omega-3 Fatty Acids
There is strong evidence that omega-3 fatty acids (namely EPA and DHA) found
in fish oil can help prevent and treat atherosclerosis by inhibiting the
development of plaques and blood clots. In one study of 223 patients with
coronary artery disease, those who received fish oil supplements daily for 2
years demonstrated a significant improvement in symptoms compared to those who
did not receive the supplements. A second study of heart attack survivors found
that daily supplementation with omega-3 fatty acids dramatically reduced the
rate of death, subsequent heart attacks, and stroke.
Studies suggest that patients who take L-carnitine supplementation soon after
suffering a heart attack may be less likely to suffer a subsequent heart attack,
die of heart disease, and experience chest pain and abnormal heart rhythms. In
addition, people with coronary artery disease who use L-carnitine along with
standard medication may be able to sustain physical activity for longer periods
Evidence suggests that antioxidants may play a role in the prevention of
atherosclerosis. Antioxidants are believed to prevent fatty buildup in the
arteries by suppressing the oxidation of LDL ("bad") cholesterol. They may also
reduce the likelihood of blood clot formation and may help relax blood vessels
thereby improving blood flow. Currently, however, combined data from
epidemiologic studies and clinical trials do not provide convincing evidence for
the benefits of antioxidant supplementation, as opposed to intake from dietary
Population-based studies suggest that vitamin E supplements may help prevent
the development and progression of heart disease. Several recent well-designed,
large-scale studies comparing vitamin E to placebo, however, have not confirmed
these findings. More research is currently underway to determine whether vitamin
E helps protect against atherosclerosis.
A few studies suggest that consuming high levels of vitamin C may protect
against heart disease, but not all studies confirm this relationship. It is
recommended that people who have low levels of this nutrient should take vitamin
C (either through diet or supplements) to prevent atherosclerosis and its
Beta-carotene and other carotenoids
Despite beliefs by the scientific community and the general public,
beta-carotene does not appear to protect against atherosclerosis and may even
increase the risk of atherosclerosis complications in people who smoke. There is
some preliminary evidence, however, that other carotenoids (such as lutein and
zeaxanthin), particularly from dietary sources, may prevent plaque buildup in
carotid blood vessels. More research is needed to determine whether these
carotenoids may be helpful in the prevention of atherosclerosis.
Low blood levels of this antioxidant may worsen atherosclerosis. Cigarette
smoking and alcohol ingestion are believed to contribute to selenium deficiency.
It is not known, however, whether selenium supplementation has any influence on
the development or progression of atherosclerosis.
Coenzyme Q10 (CoQ10)
Researchers believe that CoQ10 inhibits blood clot formation and boosts
levels of antioxidants. One study found that people who received daily CoQ10
supplements within 3 days of a heart attack were significantly less likely to
experience subsequent heart attacks and chest pain and were also less likely to
die of the condition than those who did not receive the supplements.
Test tube, animal, and some population-based studies suggest that the
flavonoids quercetin, resveritrol, and catechins (all found in high
concentration in red wine) may help reduce the risk of atherosclerosis. By
acting as antioxidants, there nutrients appear to protect against the damage
caused by LDL cholesterol. Rigorous studies in humans are needed to confirm
Low levels of vitamin D may increase the risk of calcium build-up in the
arteries, a significant component of atherosclerotic plaque. Atherosclerotic
plaque build up in blood vessels can lead to a heart attack or stroke. More
research is needed to understand the practical implications of this possible
relationship between low vitamin D levels and atherosclerosis.
Low levels of melatonin in the blood have been associated with heart disease,
but it is not clear, whether melatonin levels are low in response to having
heart disease or if low levels of melatonin predispose people to developing this
condition. In addition, several studies in rats suggest that melatonin may
protect the hearts of these animals from the damaging effects of ischemia. It is
not known from this information, however, whether melatonin supplements may help
prevent or treat heart disease in people. More research and scientific
information is needed before conclusions can be drawn.
- Hawthorn (Crataegus monogyna): Used traditionally as a remedy
for cardiovascular diseases. Animal and laboratory studies demonstrate that this
herb has antioxidant properties that help protect against the formation of
plaques and may help control high cholesterol and high blood pressure.
- Garlic (Allium sativum): Clinical trials have shown that fresh
garlic and garlic supplements may lower cholesterol levels, prevent blood clots,
and destroy plaque.
- Green Tea (Camellia sinensis): Population studies indicate that
the antioxidant properties of green tea may prevent atherosclerosis,
particularly coronary artery disease.
- Gugulipid (Commiphora mukul): Used in Ayurvedic medicine to
treat high cholesterol levels. Certain ingredients in this herbal remedy may
have antioxidant properties and may therefore convey health benefits similar to
hawthorn, garlic, and green tea.
- Pseudo ginseng root/notoginseng root (Panax notoginseng): Used
in Traditional Chinese Medicine to treat chest pain and coronary artery disease.
Laboratory studies suggest this herb may help prevent blood clots and protect
against the formation of plaques.
Acupuncture may be particularly useful for reducing risk factors for heart
disease. It is considered an excellent treatment for people who wish to quit
smoking and some studies indicate that it may aid in weight loss as well as
cholesterol and blood pressure reduction.
Although few studies have examined the effectiveness of specific homeopathic
remedies, professional homeopaths would recommend appropriate treatments to
reduce the risk of atherosclerosis based on their knowledge and experience.
Homeopathic prescriptions for atherosclerosis would include remedies to lower
high blood pressure and cholesterol. Before prescribing a remedy, homeopaths
take into account a person's constitutional type. In homeopathic terms, a
person's constitution is his or her physical, emotional, and intellectual
makeup. An experienced homeopath would assess all of these factors when
determining the most appropriate remedy for each individual.
|Massage and Physical Therapy|
Although few studies have examined the effectiveness of massage therapy on
atheroslerosis, massage has a relaxing effect and it has been shown to reduce
stress-related hormone levels. Lowering stress hormone levels postively
influences cholesterol and blood pressure and may therefore reduce the risk of
heart disease. In addition, relaxation techniques may help individuals comply
with habits necessary to reduce risk of atherosclerosis, such as dieting,
quitting smoking, and exercising. Also, at least one study has found that
massage can lower blood pressure.
|Prognosis and Complications|
Some complications of atherosclerosis include:
- Coronary artery disease
- Heart failure which leads to fluid buildup in the lungs and legs
- Abnormal heart rhythms
- Heart attack
- Inadequate blood supply to certain parts of the body (such as the
lower limbs or gastrointestinal tract)
- Kidney failure
The outlook for atherosclerosis varies from person to person. Atherosclerosis
is a progressive disease that frequently leads to complications. It is important
for individuals with atheroscerlosis to work closely with their healthcare
practitioners to ensure that they receive the most appropriate treatments for
their condition. Such care will enable individuals to prevent and lower their
risk of suffering recurrent complications.
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|Review Date: December 2001|
|Reviewed By: Participants in the review process include: Robert A. Anderson, MD, (June
1999) President, American Board of Holistic Medicine, East Wenatchee, WA;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor Integrative Medicine,
Boston, MA; Peter Hinderberger, MD, PhD, (June 1999) Ruscombe Mansion Community
Health Center, Baltimore, MD; Sherif H. Osman, MD, (June 1999) President,
Medical Staff Harford Memorial Hospital, Falston General Hospital, Bel Air, MD;
David Winston, (June 1999) Herbalist, Herbalist and Alchemist, Inc., Washington,
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