Atherosclerosis

Call local emergency services now for possible heart attack or stroke: new chest pressure or pain, severe breathlessness, sudden one-sided weakness or numbness, trouble speaking, sudden loss of balance or vision, or a sudden severe headache. Do not drive yourself. A brief episode can be a transient ischaemic attack and still needs urgent assessment. A limb that suddenly becomes very painful, pale, cold, numb or weak is also an emergency. Do not delay care to try a home remedy or aspirin.

What is atherosclerosis?

Atherosclerosis is a disease of medium and large arteries in which cholesterol-containing plaque develops within the artery wall. Plaque contains fat, inflammatory cells, calcium and fibrous tissue. Over time it may narrow the channel and reduce blood flow. If a plaque ruptures or erodes, a clot can form at that site; part of a clot or plaque can also travel and block a smaller vessel.

Atherosclerosis is one form of arteriosclerosis, a broader term for thickening and loss of elasticity in arteries. It can affect arteries supplying the heart, brain, kidneys, intestines or limbs. The result depends on the vessel involved: coronary artery disease, stroke or transient ischaemic attack, peripheral artery disease, kidney problems and other complications are possible. Plaque does not make an event inevitable, and risk can often be lowered substantially.

Symptoms depend on the artery

Atherosclerosis usually develops slowly and may cause no symptoms for years. In coronary arteries it can cause pressure, tightness or discomfort in the chest, breathlessness or reduced exercise tolerance. In arteries to the brain it may cause transient or lasting weakness, numbness, speech, vision or balance problems. Narrowing in the legs can cause aching or cramping with walking that settles with rest, slow-healing wounds, or a cooler foot. Kidney-artery disease may contribute to difficult-to-control blood pressure or reduced kidney function.

These symptoms have other possible causes, and atherosclerosis cannot be confirmed from symptoms alone. New, severe or rapidly changing symptoms need prompt assessment; the emergency warning signs above need immediate action.

Risk is assessed as a whole

Important risk factors include smoking, high LDL cholesterol, high blood pressure, diabetes, chronic kidney disease, older age, family history and existing cardiovascular disease. Physical inactivity, an eating pattern high in salt or highly processed foods, excess alcohol, poor sleep, air pollution and some inflammatory conditions can also contribute. Access to nutritious food, safe places to exercise and healthcare affects what changes are realistic.

No single factor determines a person's future. Someone can develop disease without every typical risk factor, while a healthy-looking or active person is not automatically protected. A clinician may use a validated cardiovascular-risk calculator together with cholesterol, blood pressure, medical history and personal circumstances. Lipoprotein(a), which is largely inherited, may be measured at least once when available because it can refine risk in some people.

How it is diagnosed

Assessment starts with the symptom pattern, examination, family and medical history, medicines and risk factors. Tests often include blood pressure, a lipid profile, glucose or HbA1c and kidney function. An electrocardiogram records the heart's electrical activity; it does not directly show plaque. The next test should match the suspected vascular territory and whether the situation is urgent.

Depending on the question, clinicians may use an ankle-brachial index, ultrasound, CT angiography, coronary CT, stress imaging, MRI or catheter angiography. Not everyone needs an invasive test or a whole-body scan. Some tests identify narrowing or reduced flow, while others show plaque or its complications. Results are interpreted alongside symptoms and overall risk rather than in isolation.

Reducing risk and slowing disease

A sustainable heart-healthy pattern emphasizes vegetables, fruit, whole grains, pulses, nuts and appropriate unsaturated fats, while limiting tobacco, excess salt and highly processed foods. Activity should be built up to a level that is safe for the person's symptoms and abilities. Support for stopping smoking, sleep, weight goals and alcohol reduction should be practical and non-judgmental.

Medicines are based on overall risk and existing disease. Statins are the foundation of cholesterol-lowering treatment for many people with atherosclerotic cardiovascular disease or sufficiently high risk; another lipid-lowering medicine may be added when needed. Blood-pressure and diabetes treatment lowers associated risk but does not physically remove plaque. Take prescribed medicines consistently and discuss side effects rather than stopping on your own.

Do not start aspirin to prevent a heart attack or stroke without clinical advice. For many people without established cardiovascular disease, bleeding risk outweighs or narrows the benefit. Antiplatelet or anticoagulant treatment is appropriate in selected conditions, but the medicine and duration depend on the diagnosis. Supplements, garlic or “natural blood thinners” cannot replace proven treatment and may interact with it.

When procedures are considered

Angioplasty and stenting, endarterectomy or bypass surgery may restore blood flow in selected people. A procedure may be urgent when circulation is suddenly threatened, or planned for severe symptoms or particular anatomical patterns. The choice depends on the artery involved, severity and location of disease, expected benefit, other health conditions, procedural risk and the person's preferences.

A procedure treats a specific narrowing; it does not remove the underlying tendency to form plaque elsewhere. Risk-reducing medicines, healthy routines and follow-up therefore continue. Never stop prescribed antiplatelet medicine after a stent without speaking to the treating team.

Living well and following up

Keep an up-to-date medicine list and know which changes should trigger a call. Follow-up may track symptoms, blood pressure, cholesterol, diabetes or kidney health and help adjust a plan that is not tolerable or affordable. Routine repeated scans are not automatically useful when symptoms and clinical findings are stable.

Atherosclerosis can lead to heart attack, stroke, limb-threatening ischaemia and organ damage, but outcomes vary. Stopping smoking, controlling cholesterol and blood pressure, managing diabetes, staying appropriately active and responding quickly to warning symptoms can make a meaningful difference. Anxiety after a vascular diagnosis is common and deserves support as part of care.