Diagnosis

Your doctor will perform a physical exam and ask questions about your personal and family health history. You may be referred to a doctor that specializes in heart diseases (cardiologist).

Your doctor may hear a whooshing sound (bruit) when listening to your arteries with a stethoscope.

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

  • Blood tests. Your doctor will order blood tests to check your blood sugar and cholesterol levels. High levels of blood sugar and cholesterol raise your risk of atherosclerosis. A C-reactive protein (CRP) test also may be done to check for a protein linked to inflammation of the arteries.
  • Electrocardiogram (ECG or EKG). This simple and painless test records the electrical signals in your heart.
  • Exercise stress test. If your signs and symptoms occur most often during exercise, your doctor may recommend this test. You'll walk on a treadmill or ride a stationary bike while you're connected to an ECG. 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 otherwise be missed.

    If you're unable to exercise, you may be given a medication that mimics the effect of exercise on your heart.

  • Echocardiogram. This test uses sound waves to show how well blood moves when the heart beats and through your arteries. Sometimes it is combined with exercise stress testing.
  • 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 determine the degree of any blockages, as well as the speed of blood flow in your arteries.
  • Ankle-brachial index (ABI). This test can tell if you have atherosclerosis in the arteries in your legs and feet.

    During an ABI test, your doctor compares the blood pressure in your ankle with the blood pressure in your arm. An abnormal difference may be a sign of peripheral vascular disease, which is usually caused by atherosclerosis.

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

    During this procedure, a doctor inserts a thin, flexible tube (catheter) into a blood vessel and to your heart. Dye flows through the catheter. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.

  • Coronary calcium scan. Also called a heart scan, this common test uses computerized tomography (CT) imaging to create detailed pictures of your heart. It can show calcium deposits in the artery walls. Results of the test are given as a score. When calcium is present, the higher the score, the higher your risk of heart disease.
  • Other imaging tests. Your doctor may also use magnetic resonance angiography (MRA) or positron emission tomography (PET) to study your arteries. These tests can show hardening and narrowing of large arteries, as well as aneurysms.

Treatment

Lifestyle changes, such as eating a healthy diet and exercising, are the first treatment for atherosclerosis — and may be all that you need to treat your atherosclerosis. But sometimes, medication or surgical procedures may be needed.

Medications

Many different drugs are available to slow — or even reverse — the effects of atherosclerosis. Here are some medications used to treat atherosclerosis:

  • Statins and other 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.

    Statins are commonly prescribed to lower cholesterol, improve artery health and prevent atherosclerosis. There are many other types of cholesterol-lowering medications. Another common type is a cholesterol absorption inhibitor called ezetimibe (Zetia). You may need more than one type of cholesterol medication.

  • Blood thinners. Your doctor may prescribe blood-thinning medications, such as aspirin, to reduce your risk that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
  • Blood pressure medications. Drugs to lower blood pressure don't help reverse atherosclerosis but instead prevent or treat complications related to the disease. For example, certain blood pressure medications can help reduce your risk of a heart attack.
  • Other medications. Your doctor may prescribe other medications to control health conditions that raise your risk of atherosclerosis, such as diabetes. And, specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, may be prescribed.

Surgery or other procedures

Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage, your doctor may recommend one of the following surgical procedures:

  • Angioplasty and stent placement. This procedure — also called percutaneous coronary intervention (PCI) — helps open a clogged or blocked artery. Your doctor inserts a catheter into the diseased artery. A second catheter with a deflated balloon on its tip is passed through the first catheter to the blockage. Your doctor inflates the balloon, widening the artery. A mesh tube (stent) is usually left in the artery to help it open.
  • Endarterectomy. Sometimes, plaque buildup 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.
  • Coronary artery bypass surgery. During this type of open-heart surgery, your doctor takes a healthy blood vessel from another part of the body to create a bypass around the blocked artery, redirecting blood flow. Sometimes the bypass is a graft made of synthetic material.

Lifestyle and home remedies

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

  • Stop smoking. Smoking damages your arteries. Quitting smoking is the best thing you can do to keep your arteries healthy and prevent atherosclerosis complications.
  • Exercise most days of the week. Regular exercise improves blood flow, lowers blood pressure, and reduces your risk of conditions that increase the risk of atherosclerosis and heart disease.

    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.

  • Lose extra pounds and maintain a healthy weight. If you're overweight, losing even just a few pounds can reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Ask your doctor what your target weight should be.
  • Eat healthy foods. A heart-healthy diet full of 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. Grab an apple, a banana or carrot sticks as a snack. Read nutrition labels as a guide to control the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes.

  • 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
  • Barley
  • Beta-sitosterol (found in supplements and some margarines, such as Promise Activ)
  • Blond psyllium (found in seed husk and products such as Metamucil)
  • Calcium
  • Cocoa
  • Fish oil
  • Garlic
  • Green tea
  • Oat bran (found in oatmeal and whole oats)
  • Sitostanol (found in supplements and some margarines, such as Benecol)

Talk to your doctor before adding any of these or other 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, 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 avoid eating and drinking for a certain amount of hours before the tests.
  • Write down any symptoms you're experiencing. Atherosclerosis is a risk factor for heart disease. Always tell your doctor if you have symptoms such as chest pains or shortness of breath. Such information helps your doctor decide how to best 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 goes with you may remember something that you missed or forgot.
  • Be prepared to talk about your diet and exercise habits. If you don't already eat a healthy diet or exercise, your doctor can give you tips on how to get 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 exercise?
  • How often do I need a cholesterol test?
  • What are the alternatives to the primary treatment 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?
  • 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 getting more exercise. These are simple ways to protect yourself against atherosclerosis and its complications, including heart attack and stroke.