Atherosclerosis: Information & Doctors Specializing in Atherosclerosis

Atherosclerosis is a chronic, progressive vascular disease. Over the course of many years, it causes the arteries to gradually narrow and harden.

Arteries are the blood vessels that carry blood—which is usually rich in oxygen—away from the heart. The blood travels through the arteries to the body’s organs, muscles, and tissues. The blood contains nutrients and thus ensures that these parts of the body can continue to function.

These changes in the blood vessels result in circulatory disorders. Over time, they reduce blood flow, leading to a decreased supply of oxygen to organs and body parts.

The best-known cause of arteriosclerosis is atherosclerosis. In this condition, blood lipids, among other substances, are deposited in the vessel walls (see below).

Arteriosclerosis and atherosclerosis are often used interchangeably, though this is not entirely correct. Rather, arteriosclerosis is the consequence of atherosclerosis.

The narrowing and hardening of the arteries characteristic of arteriosclerosis are caused by what are known as plaques. These are deposits of

• blood lipids,
• blood clots,
• connective tissue, and
• calcium

in the walls of the arteries. Colloquially, atherosclerosis is therefore also referred to as arterial calcification or hardening of the arteries.

Older people, in particular, frequently suffer from atherosclerosis. The disease occurs primarily in men aged 40 and older and in women after menopause.

The complications of atherosclerosis are the leading cause of death in Western industrialized countries.

In principle, atherosclerosis can develop in any artery in the body. However, it occurs particularly frequently at points where blood flow encounters physical obstacles. This is the case, for example, at vascular bifurcations, such as at

• the carotid artery,
• the aorta, and
• the bifurcation of the femoral arteries.

In addition, atherosclerosis frequently develops in the

• coronary arteries, 
• the arteries supplying the brain, and 
• leg arteries.

The exact causes leading to the development of atherosclerosis have not yet been fully elucidated. However, there are various theories and explanatory models for the mechanism underlying the development of atherosclerosis, including:

• “Response-to-injury” theory: Primary damage to the inner layer of the blood vessel wall could promote the deposition of plaques
• Lipid theory: Certain blood fats (lipids)—specifically LDL cholesterol—may be responsible for the development of atherosclerosis

Regardless of these theories, several risk factors for the development of atherosclerosis are known. These include

• high blood pressure
• elevated blood lipid levels
• a diet high in fat and calories
• being overweight
• high blood sugar levels (diabetes mellitus)
• lack of exercise
• Smoking 
• Stress

In addition, conditions such as

• chronic kidney failure,
• hyperthyroidism,
• rheumatoid arthritis, or
• metabolic disorders such as gout

increase the risk of atherosclerosis. Other risk factors include a

• genetic predisposition,
• advanced age, and
• being male.

Atherosclerosis develops very slowly and often progresses asymptomatically for decades. Thus, 20 to 40 years can pass during which plaques gradually build up in the vessel walls. The progressive narrowing and hardening of the arteries do not cause the first symptoms until much later.

If atherosclerosis begins as early as adolescence, those affected may experience symptoms such as poor circulation in the legs as early as age 30 to 40. In most cases, however, the first symptoms do not appear until later in life.

The specific symptoms caused by atherosclerosis depend on which sections of the blood vessels are affected.

Coronary arteries: These arteries supply the heart muscle. When blood flow through the coronary arteries is reduced, those affected experience a tightness in the chest or pain on the left side of the chest (angina pectoris). Arteriosclerosis of the coronary arteries is known as coronary heart disease. In the worst-case scenario, it can trigger a heart attack.

The coronary arteries supply the heart with oxygen © lom123 | AdobeStock

Carotid artery: Memory problems or dizziness may result. In the worst-case scenario, a stroke can occur. A stroke can be recognized by symptoms such as neurological deficits and dysfunction of the nervous system, such as paralysis or speech disorders.

Pelvic and leg arteries: Reduced blood flow to the calf and thigh muscles. This condition is known as peripheral arterial disease (PAD). Typical symptoms include severe muscle pain that occurs after walking short distances. Erectile dysfunction may also occur.

Renal arteries: This results in impaired kidney function—in the worst case, leading to kidney failure—as well as high blood pressure.

To diagnose atherosclerosis, the treating physician uses various diagnostic procedures. As a first step, the physician takes a detailed medical history and performs a physical examination.

As part of the medical history, the doctor reviews the patient’s medical history by asking about their

• lifestyle habits,
• symptoms, and
• previous medical conditions

. The physical examination includes, among other things, listening to the heart, the aorta, or the carotid arteries with a stethoscope, as well as measuring blood pressure.

If these examinations confirm a suspicion of atherosclerosis, further tests and examinations will follow. These include, for example,

• a blood test to determine cholesterol and blood sugar levels
• a stress ECG to determine the extent of coronary heart disease
• a Doppler ultrasound of the carotid arteries to detect narrowing of the carotid arteries and assess the risk of a stroke
• an angiography to visualize the blood vessels using contrast dye

Atherosclerosis can be treated either

• conservatively with medication and lifestyle changes, or
• surgically through an operation

. Which treatment approach is used in each individual case depends on the extent of the arterial calcification.

Conservative Treatment of Atherosclerosis

Conservative, i.e., non-surgical measures are often sufficient to treat atherosclerosis. They slow the progression of arterial calcification.

Conservative treatment generally consists of lifestyle changes and medication. Lifestyle changes include, in particular,

• reducing excess weight
• a healthy diet
• physical activity and exercise
• quitting smoking

As part of drug therapy for atherosclerosis, medications are used, for example, that inhibit blood clotting and are thus intended to prevent the formation of blood clots (thrombi). This is intended to prevent a heart attack or stroke.

In addition, medications are often prescribed to treat

• lipid disorders (so-called lipid-lowering drugs),
• high blood pressure, and
• diabetes mellitus

are also frequently prescribed.

Surgical Treatment of Atherosclerosis

If atherosclerosis has progressed to the point where there is a risk of a heart attack, stroke, or blockage of the leg arteries, surgical treatment is necessary to widen the narrowed blood vessel. For example, balloon angioplasty may be performed or a bypass graft may be implanted.

In balloon angioplasty, a balloon catheter is guided through the bloodstream to the narrowed site and inflated. This widens the vessel, allowing blood to flow freely again.

In bypass surgery, the surgeon creates a detour that diverts blood around the narrowed section of the vessel. To do this, the surgeon uses a blood vessel from the patient’s own body—usually taken from the lower leg—or a synthetic vascular graft.

To prevent the development of atherosclerosis, you should 

1. reduce or eliminate known risk factors and
2. treat conditions associated with an increased risk of atherosclerosis.

For example, people who are overweight should aim to lose weight. Smokers should quit smoking or at least cut back. People with diabetes should ensure that their blood sugar levels are properly controlled. Patients with high cholesterol levels should follow a low-cholesterol diet and regularly monitor their cholesterol levels and blood pressure.

Furthermore, a healthy, balanced, and low-fat diet, along with regular exercise, are effective measures for preventing atherosclerosis. For example, healthy individuals should walk at a moderate pace for at least 150 minutes per week.

Specialists in atherosclerosis include internists or cardiovascular specialists (cardiologists, vascular surgeons, or cardiac surgeons). A primary care physician can also perform certain tests and then refer the patient. They ask the patient about their lifestyle habits and conduct a risk assessment. A blood test provides information about blood sugar and cholesterol levels. The doctor uses a stethoscope to listen for abnormal blood flow sounds.