Hardening of the 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 narrow or completely block the arteries and cause problems throughout the body.

      Hardening of the arteries is a common disorder.

  • Alternative Names
    • Atherosclerosis; Arteriosclerosis; Plaque buildup - arteries; Hyperlipidemia - atherosclerosis; Cholesterol - atherosclerosis

  • Causes
    • Atherosclerosis

      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 fats and trans fats.

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

  • 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.

      Screening for high blood pressure is recommended for all adults who are at least 18 years old. Additional screening recommendations include:

      • Once a year for adults beginning at age 40 years and for persons at increased risk for high blood pressure. Increased risks include people with high-normal blood pressure (130-139/85-89mmHg), people who are overweight or obese, and African Americans.
      • Screening every 3 to 5 years for adults 18 to 39 years old with blood pressure less than 130/85mmHg who do not have other risk factors.

      Cholesterol testing is recommended in all adults. The major national guidelines differ on the suggested age to start testing.

      • Screening should begin between ages 20 to 35 for men and ages 20 to 45 for women.
      • Repeat testing is not needed for five years for most adults with normal cholesterol levels.
      • Repeat testing may be needed if lifestyle changes occur, such as large increase in weight or a change in diet.
      • More frequent testing is needed for adults with a history of high cholesterol, diabetes, kidney problems, heart disease, stroke, and other conditions

      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. Things 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 (such as brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 to 90 minutes a day. Talk to your provider before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.

      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, your provider 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 provider what your blood pressure should be.
      • Do not stop or change high blood pressure medicines without talking to your provider.

      Your provider 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 provider 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 provider.

      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
    • Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957-967. PMID: 26724178

      Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

      Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 70.

      Libby P. The vascular biology of atherosclerosis. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 41.

      Siu AL, on behalf of the US Preventive Services Task Force. Screening for high blood pressure in adults. US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163:778-786.

      US Preventive Services Task Force Draft Recommendation Statement. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. Accessed June 3, 2016.

      US Preventive Services Task Force Topic Page. Screening for lipid disorders in adults. Accessed May 13, 2014.