Diagnosis

During a physical exam, your doctor may find signs of narrowed, enlarged or hardened arteries, including:

  • A weak or absent pulse below the narrowed area of your artery
  • Decreased blood pressure in an affected limb
  • Whooshing sounds (bruits) over your arteries, heard using a stethoscope

Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

  • Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test.

    Your doctor should tell you ahead of time if this test will be performed during your visit.

  • Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
  • Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet.

    Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.

  • Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
  • Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity.

    Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise.

    An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.

    In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.

  • Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked.

    A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.

  • Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

Treatment

Lifestyle changes, such as eating a healthy diet and exercising, are often the most appropriate treatment for atherosclerosis. Sometimes, medication or surgical procedures may be recommended as well.

Medications

Various drugs can slow — or even reverse — the effects of atherosclerosis. Here are some common choices:

  • Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too.

    Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis.

  • Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
  • Beta blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta blockers reduce the risk of heart attacks and some heart rhythm problems.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks.
  • Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina.
  • Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.
  • Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed.

Surgical procedures

Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:

  • Angioplasty and stent placement. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area.

    The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.

  • Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's called a carotid endarterectomy.
  • Fibrinolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may use a clot-dissolving drug to break it apart.
  • Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.

Lifestyle and home remedies

Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

  • Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications.
  • Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently.

    Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes.

    Aim to exercise at least 30 minutes most days of the week. If you can't fit it all into one session, try breaking it up into 10-minute intervals.

    You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television.

  • Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in refined carbohydrates, sugars, saturated fat and sodium — can help you control your weight, blood pressure, cholesterol and blood sugar.

    Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes.

  • Lose extra pounds and maintain a healthy weight. If you're overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis.

    Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes.

  • Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.

If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.

Alternative medicine

It's thought that some foods and herbal supplements can help reduce your high cholesterol level and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor's OK, you might consider these supplements and products:

  • Alpha-linolenic acid (ALA)
  • Barley
  • Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)
  • Black tea
  • Blond psyllium (found in seed husk and products such as Metamucil)
  • Calcium
  • Cocoa
  • Cod liver oil
  • Coenzyme Q10
  • Fish oil
  • Folic acid
  • Garlic
  • Green tea
  • Oat bran (found in oatmeal and whole oats)
  • Sitostanol (found in oral supplements and some margarines, such as Benecol)
  • Vitamin C

Talk to your doctor before adding any of these supplements to your atherosclerosis treatment. Some supplements can interact with medications, causing harmful side effects.

You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure, reducing your risk of developing atherosclerosis.

Preparing for your appointment

If you think you may have atherosclerosis or are worried about having atherosclerosis because of a strong family history of heart disease, make an appointment with your doctor to have your cholesterol level checked.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, be sure to ask whether there's anything you need to do in advance, such as restrict your diet. Many blood tests, including cholesterol and triglycerides, require that you fast beforehand.
  • Write down any symptoms you're experiencing. Atherosclerosis seldom has symptoms, but it is a risk factor for heart disease. Knowing you have symptoms such as chest pains or shortness of breath can help your doctor decide how aggressively to treat your atherosclerosis.
  • Write down key personal information, including a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you're taking.
  • Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
  • Be prepared to discuss your diet and exercise habits. If you don't already eat a healthy diet or exercise, you can talk to your doctor about challenges you might face in getting started.
  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For atherosclerosis, some basic questions to ask your doctor include:

  • What tests will I need?
  • What's the best treatment?
  • What foods should I eat or avoid?
  • What's an appropriate level of physical activity?
  • How often do I need a cholesterol test?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • Do you have a family history of high cholesterol, high blood pressure or heart disease?
  • What are your diet and exercise habits like?
  • Do you or did you smoke or use tobacco in any form?
  • Have you had a cholesterol test? If so, when was your last test? What were your cholesterol levels?
  • Do you have discomfort in your chest or pain in your legs with walking or at rest?
  • Have you had a stroke or unexplained numbness, tingling or weakness of one side of your body or difficulty speaking?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against atherosclerosis and its complications, including heart attack and stroke.