What is atherosclerosis?
Atherosclerosis is the buildup of plaque in the inner walls of arteries. It is also called hardening of the arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to organs and other parts of the body. Atherosclerosis is a common cause of heart attacks, strokes, and peripheral artery disease.
What causes atherosclerosis?
Atherosclerosis is caused by damage or injury to the inner lining of the arteries. This damage causes inflammation that allows cholesterol, fatty deposits, cellular waste products, calcium and fibrin to build up in the artery wall. This buildup is called plaque. As more plaque builds up, the arteries narrow and stiffen. This process happens slowly, over many years.
There are several factors that contribute to the development of atherosclerosis:
– High cholesterol – Elevated levels of low-density lipoprotein (LDL or “bad” cholesterol) contribute to plaque buildup. LDL cholesterol accumulates in the walls of the arteries.
– High blood pressure – Increased pressure inside arteries can injure the arterial walls. This makes it easier for plaque to build up.
– Smoking – Chemicals from cigarette smoke damage the lining of the arteries. This damage leads to inflammation and plaque buildup.
– Insulin resistance and diabetes – Having higher than normal levels of blood sugar leads to increased plaque buildup.
– Obesity and physical inactivity – Excess weight and lack of exercise increase your risk for atherosclerosis. Both can lead to other risk factors like high blood pressure and diabetes.
– Family history – Genetic or hereditary factors can increase your risk.
– Chronic inflammation – Chronic inflammatory conditions such as lupus, rheumatoid arthritis and psoriasis can damage the arteries and worsen plaque buildup.
What are the symptoms of atherosclerosis?
Atherosclerosis typically develops slowly over many years. At first, there may be no symptoms. As plaque continues to build up, arteries stiffen and narrow. This can cause symptoms including:
– Angina – Temporary chest pain or discomfort that signals the heart is not getting enough blood. It may feel like pressure or squeezing in the chest.
– Heart attack – A sudden, severe blockage in a heart artery causes a heart attack. This cuts off blood flow and oxygen to the heart muscle.
– Stroke – If blood flow to the brain is suddenly interrupted, it causes a stroke. A stroke occurs when a blood clot blocks an artery leading to the brain.
– Peripheral artery disease – Plaque buildup narrows arteries carrying blood to the legs, arms, stomach or kidneys. This causes symptoms like cramping or fatigue in those areas.
– Erectile dysfunction – Narrowed arteries reduce blood flow to the penis, making achieving and sustaining an erection difficult.
– Carotid artery disease – Plaque buildup in the neck arteries leading to the brain may cause dizziness or confusion. Pieces of plaque can sometimes break off and block blood flow to the brain.
How is atherosclerosis diagnosed?
Diagnostic tests used to detect atherosclerosis include:
– Physical exam – Your doctor will check for signs of reduced blood flow like weak or absent pulses, blood pressure difference between arms or legs, whooshing sounds over arteries, enlarged arteries.
– Blood tests – Can measure levels of blood lipids like cholesterol, triglycerides, and markers of inflammation.
– EKG – Measures electrical signals from the heart. This can detect signs of coronary artery disease.
– Stress test – You exercise on a treadmill while your heart rhythm, blood pressure and EKG are monitored. This tests how the heart works during stress.
– Echocardiogram – Uses ultrasound waves to produce images of the heart. It shows the structure of the heart and pumping function.
– Angiography or arteriography – Dye is injected into the arteries and is viewed using X-ray or CT scans. This allows doctors to view blockages and narrowing.
– Ankle-brachial index – The blood pressure at your ankles is compared with blood pressure in your arm. Lower pressure in the legs signals PAD.
– Carotid ultrasound – High-frequency sound waves help detect plaque buildup in the carotid arteries in the neck.
How is atherosclerosis treated?
Treatment for atherosclerosis aims to open blocked arteries and prevent further plaque buildup. This is done with medications and lifestyle changes. When blockages are severe, procedures to restore blood flow are necessary. Treatment options include:
Medications
– Statins – Lower LDL cholesterol levels in the blood. Statins are the cornerstone in treating atherosclerosis. Examples are atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor).
– ACE inhibitors – Dilate blood vessels and lower blood pressure. Examples: enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace) and captopril (Capoten).
– Antiplatelet agents – Help prevent blood clots. Include aspirin and clopidogrel (Plavix).
– Beta blockers – Treat chest pain and high blood pressure. Help prevent future heart attacks.
– Calcium channel blockers – Relax blood vessels and increase blood flow. Used to treat chest pain. Examples are amlodipine (Norvasc) and diltiazem (Cardizem).
– Nitrates – Relax blood vessels to prevent chest pain. Can be short-acting or long acting.
Procedures
– Angioplasty – A balloon-tipped catheter is inserted into the blocked artery and inflated to open the blockage. Often includes placement of a stent to keep it open.
– Bypass surgery – Vein grafts from another part of your body are used to bypass severely blocked arteries supplying blood to the heart or brain.
– Endarterectomy – Surgical removal of plaque buildup inside the artery. Often done for blocked carotid arteries.
– Atherectomy – A catheter with a small cutting device is used to shave or cut plaque from artery walls.
Lifestyle changes
– Quit smoking
– Follow a heart-healthy diet low in saturated fats
– Reduce sodium intake
– Increase physical activity with daily exercise
– Maintain a healthy weight
– Manage stress levels
– Limit alcohol intake
Can you clear plaque out of arteries without surgery?
There are some nonsurgical approaches that may help reverse atherosclerosis in early stages by addressing modifiable risk factors. However, when blockages become severe, procedures to open arteries are often necessary. Nonsurgical approaches include:
– Cholesterol lowering medications like statins – Statins help stabilize plaque and reduce inflammation in artery walls.
– Improved diet – Eating a Mediterranean style diet high in fruits, vegetables and healthy fats may help reduce plaque buildup.
– Exercise – Regular aerobic activity can lower blood pressure and improve cholesterol.
– Quitting smoking – This reduces damage to artery walls and inflammation.
– Weight loss – Losing excess weight reduces strain on the heart and blood vessels.
– Managing diabetes – Controlling blood sugar and insulin levels can slow the progression of atherosclerosis.
Some supplements and nutraceuticals may also have benefits:
– Red yeast rice – May help lower LDL cholesterol. Should be used cautiously and under medical supervision.
– Coenzyme Q10 – Antioxidant that may stabilize plaque. Found naturally in meat and fish. Also available as supplement.
– Omega-3 fatty acids – Have anti-inflammatory effects that may reduce atherosclerosis progression. Found in fatty fish. Also available as fish oil supplement.
When arteries are only mildly narrowed, making intensive lifestyle changes and optimizing risk factors may help reduce plaque buildup without surgery. But blockages over 70% often require surgical intervention to restore blood flow.
How do doctors remove plaque from arteries during surgery?
Doctors use a few minimally invasive surgical techniques to remove plaque from arteries. Which method is used depends on the individual situation:
Angioplasty and stenting
– A thin catheter with a balloon tip is threaded to the blocked artery.
– The balloon is inflated to compress the plaque and expand the artery.
– Usually a wire mesh stent is permanently inserted to prop the artery open.
– The stent acts like scaffolding and prevents the artery from collapsing or restenosing.
Atherectomy
– Uses a special catheter tipped with a cutting device to remove plaque.
– The catheter is inserted into the blocked artery through a small incision.
– Plaque is shaved or cut away and removed through the catheter.
– It may be combined with angioplasty and stenting.
Laser angioplasty
– Uses laser energy transmitted through a catheter to vaporize plaque.
– The laser separates plaque from the artery wall.
– The fragments are removed or compressed back into the artery wall.
– A stent can be placed afterward to keep the artery open.
Orbital atherectomy
– Uses a high-speed rotating diamond-coated crown attached to the catheter.
– As it spins at high speed, plaque is sanded smooth from the artery wall.
– Blood flow is restored without creating debris.
– It is often used in heavily calcified arteries that can be difficult to treat.
Rotational atherectomy
– Employs a special catheter covered with an abrasive diamond chip.
– As it spins at high speed, it “sands” plaque from the artery wall.
– Plaque debris is flushed out by saline.
– Often done ahead of stenting a heavily calcified blockage.
What happens during bypass surgery for atherosclerosis?
Coronary artery bypass grafting (CABG) redirects blood flow around severely blocked heart arteries using the patient’s own blood vessels. This artery “bypass” restores oxygen supply to the heart muscle. Steps include:
– Chest incision – The sternum is opened to access the heart.
– Preparing blood vessel grafts – Veins from the leg or arteries from inside the chest wall are harvested.
– Accessing heart arteries – The aorta is cross-clamped and cardioplegic solution is used to stop the heart.
– Creating bypasses – One end of the graft vessel is sewn to the aorta, the other end is attached below the blockage. This creates the bypass around the obstruction.
– Restoring blood flow – The aorta cross-clamp is removed to allow blood flow through the new bypass graft.
– Checking patency – Grafts are checked to confirm adequate blood flow through the new connections
– Closing incision – The sternum is wired shut and the overlying muscle tissue and skin closed with sutures.
After CABG surgery, patients spend 1-2 days in the ICU. Recovery time is generally 4-6 weeks. Artery graft patency after 5 years is 50-60%. Patients with multiple bypasses tend to have better long-term results.
Are there natural remedies for removing plaque from arteries?
There is some research looking at natural products that may help stabilize or reduce plaque. However, these remedies have limited evidence and cannot substitute for medical therapies. Natural remedies being investigated include:
– Omega-3 fatty acids – Found in fish like salmon and trout. May have anti-inflammatory effects on arteries. Need more evidence. Should not replace statins.
– Red yeast rice – Contains small amounts of naturally-occurring statin-like compounds. May only provide minimal LDL cholesterol reduction for some people.
– Antioxidants – Vitamin E and polyphenols have antioxidant and anti-inflammatory properties that may benefit plaque. Evidence still inconsistent.
– Garlic – Lab studies suggest garlic may inhibit LDL oxidation and plaque deposition. Small human studies show inconsistent results.
– Ginkgo biloba – Some research shows ginkgo leaf extract may stabilize plaque in carotid and coronary arteries. Evidence still insufficient.
– Curcumin – Active ingredient in turmeric. Lab studies suggest curcumin has anti-inflammatory effects and inhibits atherosclerosis. Human studies are lacking.
– Artichoke leaf extract – May improve cholesterol profile and have antioxidant effects based on limited research.
– Pomegranate juice – Lab research indicates extracts inhibit plaque formation. Small human trials do not show a clear benefit.
More research is still needed on natural remedies. Some may provide modest benefits for stabilizing plaque when combined with traditional medical treatment and lifestyle changes. But they should not replace doctor-prescribed therapies which have stronger evidence.
Can you reverse atherosclerosis once it starts?
It is possible to stop or slow the progression of atherosclerosis in the early stages before significant blockages form in the arteries. However, severely advanced atherosclerosis causing critical narrowing in heart arteries or stroke-producing carotid blockages often cannot be reversed.
Steps that may stabilize or reverse early atherosclerosis include:
– Taking cholesterol and blood pressure medications as prescribed to stabilize damage to arteries.
– Quitting smoking immediately to help stop ongoing injury to the arterial lining.
– Following a Mediterranean style diet high in omega-3 rich fish, fruits, vegetables, whole grains, nuts and healthy oils.
– Getting regular aerobic exercise to lower blood pressure and improve cholesterol profile.
– Losing weight if obese or overweight, to reduce strain on the cardiovascular system.
– Keeping diabetes and blood sugar levels under optimal control to prevent worsening of artery plaque.
– Limiting alcohol and managing stress to decrease inflammation levels in the body.
Once critical blockages form causing angina, heart attack, stroke or other organ damage, atherosclerosis cannot be reversed to normal undamaged arteries. Procedures like angioplasty, stenting or bypass surgery are required at this stage to restore blood supply.
However, with diligent lifestyle changes and medical management, early atherosclerosis can potentially stabilize, avoid complications, and prevent disease progression.
What foods help remove plaque from arteries?
Certain heart-healthy foods may help reduce arterial plaque buildup when combined with medical treatment and lifestyle changes. Beneficial foods include:
– Fatty fish – Salmon, mackerel, tuna, and sardines contain omega-3 fatty acids that reduce inflammation.
– Walnuts – Rich in vitamin E and plant-based omega-3s that may enhance cholesterol profile.
– Olive oil – Provides monounsaturated fats shown to improve HDL and lower LDL cholesterol.
– Avocados – Contain oleic acid that may reduce LDL cholesterol levels in arteries.
– Berries – Strawberries, blueberries and blackberries have polyphenols that decrease inflammation and oxidative stress.
– Green leafy vegetables – Spinach and kale are high in antioxidants like lutein, vitamin C, and beta-carotene.
– Tomatoes – Lycopene gives tomatoes red color and helps fight LDL cholesterol oxidation.
– Beans and legumes – Peas, beans, lentils have soluble fiber that lowers LDL and helps reduce plaque.
– Garlic and onions – Contain sulfur compounds that may inhibit atherosclerosis and stabilize plaque.
– Dark chocolate – High cocoa content provides polyphenols that increase HDL and prevent LDL oxidation.
– Coffee and tea – Both contain antioxidants from polyphenols that may protect arteries.
Incorporating these and other plant-based foods into a heart healthy diet may help stabilize and potentially reverse early atherosclerosis when combined with medical treatment like statins.
Conclusion
Atherosclerosis is a disease that develops over many years and is caused by plaque buildup inside the artery walls. This narrows the arteries and restricts blood flow, leading to complications like heart attack and stroke. Treatment involves medications to improve cholesterol profile and stabilize damage to the arterial lining, as well as procedures like stenting or bypass surgery for severe blockages.
Making intensive lifestyle changes involving diet, exercise, weight management, and avoiding smoking is essential to reduce risk factors. In some cases, these measures may potentially reverse atherosclerosis in the early stages. However, severe, long-standing atherosclerosis often cannot be reversed completely. Going forward, preventing progression and future cardiovascular events through risk factor modification should be the goal.