What are the symptoms?
Atherosclerosis symptoms often don’t start until an artery is very narrow or blocked. Many people don’t know they have plaque buildup until they have a medical emergency like a heart attack or stroke.
You may notice symptoms of atherosclerosis if your artery is more than 70% blocked. You can have symptoms in different parts of your body, depending on the location of the blockage. Affected locations may include:
Heart
Coronary artery disease (CAD, which can lead to a heart attack) happens in the arteries that supply blood to your heart.
You may experience:
- Shortness of breath (dyspnea) during light physical activity.
- Chest pain or discomfort (angina).
- Pain in your back, shoulders, neck, arms or belly.
- Feeling dizzy or lightheaded.
- Heart palpitations.
- Fatigue.
- Nausea or vomiting that may feel like indigestion.
Digestive system
Mesenteric ischemia happens when you don’t have enough blood flow in parts of your digestive system. You may experience:
- Pain or cramping in your belly (abdomen) after eating.
- Bloating, nausea and vomiting.
- Diarrhea.
- Unintentional weight loss due to “food fear” (fear of pain after eating).
Legs and feet
Peripheral artery disease (PAD) refers to poor blood flow in the arteries in your limbs.
You may experience:
- Muscle pain (intermittent claudication).
- Burning or aching pain in your feet and toes when you rest, especially when lying flat.
- Changes in skin color (like redness).
- Cool skin on your feet.
- Frequent skin and soft tissue infections, often in your legs or feet.
- Sores on your feet or toes that don’t heal.
Kidneys
With renal artery stenosis (narrowing of the arteries that take blood to your kidneys), you may experience:
- Markedly elevated blood pressure that doesn’t respond to multiple medications.
- Changes in how often you pee.
- Swelling (edema).
- Feeling drowsy or tired.
- Skin that feels dry, itchy or numb.
- Headaches.
- Unexplained weight loss.
- Nausea, vomiting or loss of appetite.
Brain
With carotid artery disease, the first symptoms are usually a transient ischemic attack (TIA) or stroke.
You may experience:
- Dizziness.
- Drooping on one side of your face.
- Loss of feeling, loss of muscle strength or weakness on one side of your body.
- Severe headache.
- Slurred speech or difficulty forming words.
- Vision loss in one eye. You may notice a dark shade coming down over your field of sight.
What causes atherosclerosis?
Researchers believe atherosclerosis causes may include:
- High LDL cholesterol and triglyceride levels.
- Tobacco products.
- High blood pressure.
- Diabetes.
These factors can damage your artery’s inner lining (endothelium). This causes atherosclerosis to begin. The damage usually occurs slowly and over time.
Stages of atherosclerosis
The stages of atherosclerosis happen over many years and include:
- Endothelial damage and immune response. Damage to your endothelium triggers chemical processes that cause white blood cells to travel to the injury site. These cells gather and lead to inflammation within your artery.
- Fatty streak formation. This is the first visible sign of atherosclerosis. It’s a yellow streak or patch of dead foam cells at the site of endothelial damage. In this case, foam cells are white blood cells that consume cholesterol to try to get rid of it. Continued foam cell activity causes further damage to your endothelium.
- Plaque growth. Dead foam cells and other debris keep building up, turning a fatty streak into a larger piece of plaque. A fibrous cap (made of smooth muscle cells) forms over the plaque. This cap prevents bits of plaque from breaking off into your bloodstream. As the plaque grows, it gradually narrows your artery’s opening (lumen), so there’s less room for blood to flow through.
- Plaque rupture or erosion. In this stage, a blood clot forms in your artery due to plaque rupture or plaque erosion. Plaque rupture happens when the fibrous cap that covers the plaque breaks open. With plaque erosion, the fibrous cap stays intact, but endothelial cells around the plaque get worn away. Both events lead to the formation of a blood clot. The clot blocks blood flow and can lead to a heart attack or stroke.
What are the risk factors for atherosclerosis?
There are many risk factors for atherosclerosis. You may be able to change some of these risk factors, but not others (like age).
Risk factors include:
- Being older than age 45 (for people assigned male at birth or AMAB).
- Being older than age 55 (for people assigned female at birth or AFAB).
- Family history of premature cardiovascular disease. This means a close biological family member who’s AMAB received a cardiovascular disease diagnosis before age 45. Or, one who’s AFAB got a diagnosis before age 55.
- Diabetes.
- High blood pressure (hypertension).
- High cholesterol (hyperlipidemia), especially high LDL cholesterol or high levels of a specific lipoprotein called lipoprotein (a).
- Metabolic syndrome.
- Smoking or tobacco use.
- Lack of physical activity.
- Eating foods high in saturated fat, trans fat, sodium and sugar.
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What are the complications of atherosclerosis?
Atherosclerosis interferes with the normal workings of your cardiovascular system. It can limit or block blood flow to various parts of your body, including your heart and brain. Possible complications of reduced blood flow include:
- Carotid artery disease.
- Coronary artery disease.
- Heart attack.
- Arrhythmia (abnormal heart rhythms).
- Heart failure.
- Mesenteric ischemia.
- Peripheral artery disease.
- Chronic kidney disease (CKD).
- Renal artery stenosis.
- Stroke.
- Transient ischemic attack (TIA).
- Aneurysms and rupture of blood vessels from weakened artery walls.
Early diagnosis and treatment of atherosclerosis can help you avoid or delay complications.
