You Wanted to Know: Atherosclerosis


Atherosclerosis is one of my greatest enemies as a heart surgeon. Over the course of a lifetime, atherosclerosis, or hardening and clogging of the arteries, affects nearly all Americans to some degree. Though it can start as early as childhood, it doesn’t usually cause serious problems until later in life, when it can result in heart disease, peripheral arterial disease, strokes and other potentially fatal conditions.

So what gets this deadly process going? That’s what one of our viewers asked me on Twitter:







The initial trigger for atherosclerosis is not definitively known, but is thought to be a result of injury to the innermost layer of the arterial wall, which is called the endothelium. This damage can be caused by high blood pressure, high cholesterol, smoking or diabetes. In response, blood cells, fats, cholesterol, platelets, cellular debris and calcium start to adhere to the affected endothelium. This causes the artery wall to thicken, as your body tries to wall off the injured area.

Over time, the arteries begin to narrow and harden, which can lead to decreased blood flow to muscles and organs. If significant atherosclerosis occurs in peripheral arteries in the legs, for example, this can cause pain with walking due to decreased blood flow. Or, if it occurs in the arteries that feed the kidneys, kidney disease and failure can result.

In addition, pieces of the fatty deposits in the endothelial wall can break off and travel through your bloodstream, or the lining containing the deposits can rupture. In this case, a blood clot can form over the site of the rupture, causing a sharp reduction in or even loss of blood flow to the tissues those vessels normally nourish. If these vessels are in the heart, this process can cause a heart attack. If the clot detaches from the wall, it can also travel to other organs like the brain, resulting in a stroke. Atherosclerosis can also cause artery walls to weaken and possibly burst, as in a ruptured aneurysm, which is often a life-threatening condition.

Fortunately, there are many things you can do to prevent or slow down atherosclerosis, including getting at least 30 minutes of aerobic exercise a day, which helps teach your muscles to use oxygen efficiently, improves circulation and can lower blood pressure and cholesterol. You should also stick to a heart-healthy diet rich in fruits and vegetables and make sure to maintain a healthy weight. If you’re overweight, even losing just five pounds can be enough to help your heart. And of course, if you’re a smoker (or if you use tobacco in any form), quit ASAP – and no excuses. The great thing about atherosclerosis is that with the right changes to your lifestyle, you can reverse it and add healthy years to your life.