Atherosclerosis

What is atherosclerosis

Atherosclerosis comes from the Greek words athero (meaning paste or gruel) and sclerosis (hardness). Atherosclerosis is a condition which causes narrowing and hardening of the arteries when they become blocked with plaque, due to cholesterol mainly, but also other substances.

Arteries are the blood vessels which carry oxygen-rich blood from the lungs to all the cells of the body and if they become blocked in any way, this prevents the oxygen getting to the cells and this can cause a number of serious effects in the body, primarily in the heart, which can suffer from oxygen starvation and a heart attack can ensue.

The plaque that builds up in the walls of the arteries (over a period of time) is made up of the following:

• cholesterol
• fatty substances
• calcium
• other substances

The plaque build-up inside the artery wall makes it difficult for blood to flow properly through the arteries.

There are two types of plaque associated with atherosclerosis, with one even worse than the other:

• Hard and stable – causes the artery walls to thicken and harden, generally stays in the same place in the arteries
• Soft and unstable – this type will often break off from the artery wall and enter the bloodstream where it can cause even more health problems by causing a clot that partially or totally blocks the blood flow. The organ that is served the blood from the blocked artery may become severely damaged or die as a result (heart attack and stroke)

Even if a clot doesn’t form, there could be excessive bleeding into the plaque which can also have serious repercussions.

Facts about atherosclerosis

• Atherosclerosis can actually being in childhood!
• Scientists do not yet known exactly what causes atherosclerosis in some people and not others, but one theory proposed is that atherosclerosis starts because the inner most layer of the artery (the endothelium) becomes damaged.
• Atherosclerosis can develop into heart attack and stroke, leading to death from either of these conditions
• While atherosclerosis is a slow clogging of the arteries, that normally affects older people, some people may develop heart attack and stroke even in their 30’s due to this condition from an unhealthy diet and lack of exercise
• Research shows that people who are 40 and generally healthy, have about a 50% chance of developing serious atherosclerosis in their lifetime
• Most adults older than 60 have some form of atherosclerosis in their arteries, but generally do not have any noticeable symptoms
• Atherosclerosis is the leading cause of illness and death in all Western countries
• Atherosclerosis can lead to serious diseases and complications that may be life threatening, such as heart attack and stroke

Symptoms of atherosclerosis

Sometimes atherosclerosis does not cause any symptoms at all until the condition has progressed to an advanced (and dangerous) stage, when the artery is blocked to about 40%.

In some cases, the only symptoms are heart attack and stroke, when the blockage completely obstructs blood flow, or when some of the blood clot breaks up and travels to the heart or brain.

In general, symptoms of atherosclerosis depend on which of the arteries are affected by the blockage.

blockage in the aorta (the heart’s main artery) symptoms

• Abdominal, neck, back, jaw, or shoulder, arm pain
• Chest pain (angina)
• Shortness of breath
• Sweating
• Weakness or lethargy

Blockage in the arteries leading to the brain symptoms

• Difficulty speaking
• Dizziness
• Droopy muscles on side of the face
• Loss of balance or coordination
• Slurred speech
• Sudden numbness or weakness in the arms or legs
• Sudden severe headache
• Sudden trouble walking

Blockage in the main arteries of the legs or arms symptoms

• Hair loss
• Gangrene (an extreme and severe symptom)
• Pain, aching, numbness or fatigued feeling in the leg affected (intermittent claudation)
• Skin that is cold to the touch
• Thicker nails

Causes of atherosclerosis

The cause of atherosclerosis is not known, but scientists believe it can start in childhood to young adulthood, where the walls of the arteries become damaged.

When the artery wall is damaged, the body sends platelets, which are red blood cells that clump together at any injury point in the body to repair the damage. Inflammation is part of the healing process with the platelets. If the damage to the artery wall continues, it may then form scar tissue and over time, cholesterol and other fatty waste substances can accumulate at the scar tissue and harden, which may narrow the artery and cause it to have improper blood flow.

If any part of the fatty deposits in the artery break off or rupture, they can enter the blood stream and cause a blood clot which can damage the heart (heart attack) or the brain (stroke). A blood clot may not be so severe, but it can still partially or totally block blood flow to other organs and cause adverse health effects.

Potential causes of atherosclerosis

Some of the theories proposed about what can cause the damage to the artery walls which can then lead to atherosclerosis are:

• Diabetes – the health risks of diabetes are many, including the possible damage to the artery walls, which can lead to atherosclerosis
• Genetics – research suggests that some people may just be born with slightly defective arteries, which may be more prone to being damaged in some way without having any other risk factors present
• High homocysteine levels – recent research suggests that having high levels of the amino acid by-produce homocysteine, may increase the risk for developing all forms of heart disease, including atherosclerosis
• Inflammation – some recent research suggests that chronic inflammation in the arteries, may cause damage to the arteries.
• Nutritional deficiencies – some research suggests that nutritional deficiencies of the antioxidant nutrients may play a part in causing some of the damage to the artery walls. This is because the antioxidants may prevent some of the oxidative damage to the artery walls and if they are in deficit, the damage may occur more severely
• Poor lifestyle and diet choices – a diet that consists mainly of processed foods, that are high in saturated fats, sugar and calories not only cause weight gain, but it also causes high levels of cholesterol and triglycerides in the blood, which may be part of the reason that the artery walls get damaged and get clogged. The poor diet choices, in combination with an inactive lifestyle greatly increase the health risks associated with high blood levels of cholesterol and triglycerides, which may cause the damage to the artery walls
• Smoking – cigarettes, another poor lifestyle choice can significantly increase risk damage to the artery walls, especially in combination with poor dietary choices and an inactive lifestyle.

Prevention of atherosclerosis

Non-preventable risk factors

Atherosclerosis may be unpreventable in certain circumstances:

• Diabetes – some forms of diabetes may be unpreventable (diabetes type 1 and possibly some cases of gestational diabetes). Diabetes, even type 1, can still cause a number of adverse effects on the arteries and on heart health and may be implicated in the development of atherosclerosis, especially if it is not managed well (with medication and lifestyle changes)
• Genetics – some people are just born with artery walls that either can become easily damaged or are defective in some way and so this can create an unavoidable risk in the development of atherosclerosis

Preventable risk factors

There may be a number of ways to prevent atherosclerosis from occurring:

• Don’t drink alcohol excessively – excessive intake of alcohol can cause damage to the artery walls and increase risk of developing atherosclerosis
• Increase physical activity – adequate physical activity is required every day (at least 30 minutes) to help condition the heart, ensure proper circulation and blood flow and significantly reduce the risk of heart disease such as atherosclerosis
• Lower blood cholesterol – blood levels of LDL (“bad”) cholesterol should be kept lower than 100 mg/dL to prevent high cholesterol levels, which are implicated in causing atherosclerosis. High LDL cholesterol may clog up the arteries and cause a blockage
• Lower homocysteine levels – the condition called hyperhomocysteinemia occurs when there are high levels of the amino acid by-product homocysteine in the blood. Research suggests that having high blood levels of homocysteine may be a factor that increases likelihood of developing atherosclerosis, so reducing homocysteine levels would help to prevent atherosclerosis from developing
• Lower saturated fat diet – a diet high in saturated fat (high fat dairy, red meat, processed and junk foods) is a known risk factor for the development of atherosclerosis. Reducing the amount of saturated fat in the diet, by choosing lower fat dairy, limit red meat in the diet and strictly limit processed and junk foods may help to prevent risk of atherosclerosis
• Manage blood pressure – high blood pressure (hypertension) is another known risk factor for damaging the artery walls and increasing risk for heart disease such as atherosclerosis. People with high blood pressure need to reduce their blood pressure to prevent the risk of developing atherosclerosis
• Manage weight – a healthy weight range needs to be maintained to help avoid a number of adverse health issues, such as atherosclerosis. Men need to ensure their waist measurement is less than 94cm and women less than 80cm
• Reduce the risk of type 2 diabetes – people who have type 2 diabetes are at greater risk of developing atherosclerosis due to the adverse effects of the condition on the arteries and the heart
• Stop smoking – people who smoke are at high risk of developing adverse health effects, including heart disease such as atherosclerosis. People who smoke must give it up to reduce risk of heart disease

Complications of atherosclerosis

There are a number of serious complications that can occur as a result of atherosclerosis:

• Aneurysms – atherosclerosis can increase risk for an aneurysm occurring. An aneurysm causes a bulging out and widening of an artery or vein which may burst suddenly if the pressure on the aneurysm is too great and this can be serious and life threatening. In some cases, the aneurysm may slowly leak rather than bursting suddenly. An aneurysm can occur anywhere in the body, including the heart
• Cerebrovascular disease – if artery affected is near the brain and the plaque blockage ruptures or breaks off and it travels to the brain, it can cause a stroke to occur. Stroke can cause temporary to permanent brain damage and even death if the damage to the brain is severe enough. In addition to this, a temporary blockages in an artery in or near the brain can cause transient ischaemia attacks (TIAs), which are basically mini strokes, that cause no immediate brain injury. While TIAs are not serious, they can indicate that there is damage to some of those arteries that lead up to the brain and that a stroke could occur due to this artery damage
• Coronary artery disease – if the artery affected is near the heart and the plaque blockage is stable, it can cause angina (or chest pain) on any type of exertion. If any of the plaque break off or rupture, this can cause a heart attack if the clot travels to the heart. In a heart attack, some or all of the heart muscle may die which is can be very serious and life threatening
• Peripheral artery disease – if the arteries affected are in the legs especially or arms, the plaque blockages can cause poor circulation which may contribute to poor wound healing or cause pain when walking. Severe peripheral artery disease may lead to gangrene which may lead to an amputation

When to see a doctor about atherosclerosis

Anyone who has any of the symptoms of atherosclerosis needs to see a doctor to have a consultation in order to diagnose this condition or rule it out. Early intervention is preferable, to enable proper treatment and reduce risks of complications.

People who have existing atherosclerosis need to consult their doctor on a regular basis, to review their conditions, to monitor their medications (adjusting it if necessary) and to monitor their symptoms.

Diagnosis of atherosclerosis

Initial diagnosis of atherosclerosis involves the following tests:

• Medical history – the doctor will ask a series of questions about symptoms, such as the onset, duration and severity and if a certain part of the body is more affected than other parts. The doctor will also ask if you you smoke, have a sedentary lifestyle or have any of the other risk factors for atherosclerosis
• Physical examination – the doctor will do a simple physical examination, including listening to your heart with a stethoscope, measuring your blood pressure and measuring your pulse to determine if it is weak at all and to view any possible signs of the condition on your body

After initial consultation, the following test is normally requested, to check if there is any underlying heart disease:

• Blood test – this is the most common test that is requested after initial consultation, to determine blood levels of cholesterol, triglycerides, homocysteine, glucose and possibly C-reactive protein

Diagnostic tests

If the initial diagnosis warrants it, the doctor may also request a number of other tests to confirm (or rule out) atherosclerosis:

• Angiogram – an angiogram involves the injection of a special dye which is then viewed under a special x-ray (while you are lying down). The x-ray machine shows images of the dye as it circulates through your blood, which can effectively show any narrowing of arteries or blockages in any arteries
• CT scan – a computerised tomography (CT) scan involves lying down on a table that goes into a large circular opening that takes cross-sectional images of the arteries that may be affected. The CT scan can provide images of hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls
• Electrocardiogram (ECG) – an electrocardiogram is a test which records electrical activity of the heart and involves being hooked up with electrical wires to a special machine that records the electrical activity of the heart. An ECG can reveal if the heart rhythm is normal, if there has been a previous heart attack, as well as an impending heart attack
• Other imaging tests – there are a few other diagnostic imagining tests that can be used to diagnose atherosclerosis, such as doppler ultrasound, which is a special type of ultrasound that is used to measure blood pressure at specific points as this can provide information about the artery blockage and the ankle brachial index, which is used for diagnosing blockages or narrowing in the arteries in the legs or arms and involves measuring the blood pressure at the ankle with the blood pressure in the arm and if this difference is abnormal, it can indicate atherosclerosis
• Ultrasound – an ultrasound is a diagnostic scan which uses radio waves to provide images of the soft tissues of the body. An ultrasounds involves lying down and having a radiology technical use a special probe on the body, which is hooked up to a special machine that provides images of the parts of the body under the skin it is rolling over. An ultrasound can provide images of hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls

Conventional treatment of atherosclerosis

Treatment of atherosclerosis usually consists of a combination of dietary and lifestyle modifications and medication. If the condition is severe, surgery may also be recommended as a last resort treatment (but it may be necessary for prolonging life):

Dietary modifications

There are a number of dietary modifications which will be recommended to help reduce symptoms and risk of complications:

• Eat enough legumes and wholegrains – the diet needs to include adequate amounts of legumes (chickpeas, peas, beans and soya beans) as well as wholegrains to ensure that the diet has adequate fibre, as well as the various nutrients that the legumes and wholegrains provide. Adequate fibre intake can help to reduce the amount of LDL (“bad”) cholesterol in the blood
• Eat enough “good” fats – you need to ensure the diet includes adequate amounts of the “good” fats which are the polyunsaturated fats, from foods such as olive oil, safflower oil, sunflower oil, olives (but take care that they are not too salty), avocado, as well as all types of nuts and seeds
• Eat more fruit – you need to eat 2-3 portions of fruit every day to provide all the vitamins, minerals and antioxidants necessary for good health
• Eat more fish – you need to have 2-3 portions of oily fish intake in the diet each week as they contain the beneficial anti-inflammatory omega-3 fatty acids. The fish which are most recommended are: mackerel, salmon, sardines, trout, tuna. It is better to eat fresh fish that is wild, as it has more omega-3 content, but canned fish can also be eaten too on occasion
• Eat more vegetables – you need to eat 5-7 portions of vegetables every day to provide all the vitamins, minerals and antioxidants necessary for good health
• Limit intake of saturated fat – foods that are high in saturated fat (full cream milk, cheese, butter, sour cream, as well as red meat, any fried foods, any processed foods, any take-away or junk foods) need to be limited in the diet, to help reduce levels of cholesterol and triglycerides as well as reduce risk of possible blockage build-up in the arteries

Lifestyle modifications

There are a number of lifestyle modifications which will be recommended to help reduce symptoms and risk of complications:

• Exercise regularly – you need to exercise for at least 30 minutes every day to help condition the heart and increase proper blood circulation, which may help to prevent worsening of symptoms and risk of complications. If you have a severe form of atherosclerosis, consult your doctor about the best exercise program which you should engage in, because you may need to do a more gentler form of exercise to reduce possible complications (due to your condition)
• Limit alcohol intake – women should only have one drink and men only 1-2 drinks per day at the most, with at least 2-3 days being alcohol free
• Reduce stress – some form of relaxation therapy is needed to help reduce any stress in your life and reduce this risk factor for atherosclerosis. Examples of relaxation therapy are: dancing, having a bath, meditation, tai chi, visualisation, yoga
• Stop smoking – it is vital for heart health to stop smoking and to stop being around people who smoke and breathing their unfiltered smoke, as it has exactly the same adverse effects on the arteries as if you smoked yourself

Medication

There are a number of medication options available for treating the atherosclerosis, which depend on the reason for the condition developing and may help to slow (or even reverse) the effects of atherosclerosis. A doctor will prescribe the appropriate medication (or combination of medications) from the following:

• Anti-coagulant medications – these medications are prescribed when a blood clot has been diagnosed (or suspected) in order to thin the blood and dissolve the blood clot. Examples of anti-coagulant medications are: heparin and warfarin (Coumadin^®)
• Anti-platelet medications – these medications reduce the amount of platelets in the blood, which are the blood cells that cause the inflammation to initiate healing. The anti-platelet medications thin the blood, which reduces risk of blood clots forming. This medication is often prescribed at a low dose to be taken every day. The most common form of anti-platelet medication prescribed is: aspirin
• Blood pressure lowering medications – these medications are prescribed to lower high blood pressure, which is a known risk factor for damaging artery walls and causing atherosclerosis. Examples of these medications are: angiotensin-converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers, diuretics
• Cholesterol lowering medications – these medications help to lower LDL (“bad”) cholesterol in the blood and are prescribed for people whose blood tests show a higher than normal level of LDL (“bad”) cholesterol. The cholesterol lowering medications may help to reduce (or even reverse) the amount of fatty plaque build-up in the affected arteries, as well as ensuring other arteries are not clogged up too. Examples of cholesterol lowering medications are: bile acid sequestrants, cholesterol absorption inhibitors, fabric acid derivatives, niacin and statins. Statins are the most commonly prescribed medication for lowering LDL (“bad”) cholesterol, as they have fewer side effects than the other types of medications and have few adverse interactions with other types of medications

Surgery

There are a number of surgical options, from the least invasive, to more invasive surgery that can be performed, usually as a last resort when medication and dietary and lifestyle modifications have not been successful and there is significant loss of quality of life, or if the condition is life threatening:

• Angioplasty – this procedure is used to help widen arteries that have narrowed. This involves insertion of a catheter with a deflated balloon into the narrowed part of the artery. Once inside the artery, at the point of narrowing, the balloon is inflated which widens the artery and helps enable better blood flow. Once the artery has been widened enough, the balloon is deflated and the catheter removed. Some people may require a permanent way to widen the artery. This involves placing a wire mesh (stent) during the balloon procedure which helps to hold the artery open wider so that blood flow is improved
• Atherectomy – this procedure involves the removal of the plaque blockage from the affected artery (or arteries) with the use of a laser catheter or rotating shaver. The catheter is inserted into the artery that is narrowed with the plaque build-up to remove it. After an atherectomy, an angioplasty is often performed, using just the balloon to widen the artery or using a stent for a more permanent widening
• Bypass surgery – this is serious open heart surgery that involves opening up the chest to perform the surgery. This surgery involves redirecting or bypassing the clogged up coronary artery with another healthy artery. The healthy artery can be on which is around the same area, or it could be a vein that is cut from the leg that is used (in more serious cases, where there are no healthy arteries around the heart). This surgical procedure helps to improve blood flow and oxygen to the heart. If more than one artery is clogged up, this surgery may need to be performed a number of times, until there is proper blood flow and oxygen flow around the heart
• Endarterectomy – this procedure involves removing plaque build-up in the carotid (neck) or peripheral arteries. This procedure significantly helps to reduce risk of stroke and is most beneficial in people with blockage of up to 60% in the carotid barberries
• Minimally invasive bypass surgery – this is a less invasive heart surgery which is performed when there are only one or two affected arteries with plaque build-up. This procedure uses a number of small incisions in the chest to enable the surgeon to re-route or bypass the clogged up arteries with healthier ones. This surgery is still in evaluation mode, so it is not yet the mainstream surgery recommended for bypass surgery

Alternative / complementary treatment of atherosclerosis

The lifestyle and dietary recommendations are the same as those which are recommended by conventional medicine.

The other alternative/complementary recommendations should be discussed with your doctor to ensure they are safe for you and are not going to produce adverse health effects in combination with any medications you may be taking.

Herbs

There are some herbs which may help reduce symptoms and risk of complications (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Garlic (Allium sativum) – several studies have suggested that fresh garlic or garlic supplements may lower cholesterol levels, prevent blood clots by ensuring the blood is less “sticky” and thinned as well as dissolving plaque build-up. People taking any type of blood thinning medications must not take garlic supplements, as this combination could increase the risk of internal bleeding
• Olive leaf (Olea europaea) – some studies have shown that olive leaf extract may have potent antioxidant as well as anti-inflammatory effects on the arteries, which may reduce incidence of plaque build-up, lower cholesterol levels and helps to normalise blood pressure levels to normal
• Psyllium (Plantago psyllium) – studies show that psyllium, a “weed”, which is an excellent source of natural fibre, helps to reduce cholesterol levels and also helps to normalise blood glucose levels. People who have diabetes and take insulin should discuss taking psyllium with their doctor before trying it

Vitamins

There are a number of vitamins which may help reduce symptoms and risk of complications (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Betacarotene – the antioxidant betacarotene is required for the health of the arteries, as it helps to reduce oxidative damage that free radicals or any inflammation may cause. Since betacarotene is less toxic and is the precursor to vitamin A, it has been most often recommended instead of vitamin A in supplements. Recent studies suggest that betacarotene supplements must not be used by people who are current or former smokers or who currently drink excessive amounts of alcohol, as it may increase their risk of a number of cancers. It is recommended to get your betacarotene from the food in your diet (orange and dark green coloured fruits and vegetables have the highest amounts of betacarotene)
• Bioflavonoids – the bioflavonoids, together with vitamin C help to ensure the walls of arteries and other blood vessels are strong and healthy
• Folic acid – studies show that folic acid may be useful in reducing blood levels of homocysteine, which is one of the risk factors for atherosclerosis, heart disease and stroke
• Vitamin A – the antioxidant vitamin A is vital for the health of the arteries, as it helps to reduce oxidative damage that free radicals and inflammation may cause to the arteries. Vitamin A recommended intakes must not be exceeded in supplements, as they can produce toxic side effects
• Vitamin B6 – all of the B vitamins are essential for heart health, but especially vitamin B6, which helps to lower blood levels of homocysteine, which is one of the risk factors for atherosclerosis, heart disease and stroke
• Vitamin B12 – all of the B vitamins are essential for heart health, but especially vitamin B12, which helps to lower blood levels of homocysteine, which is one of the risk factors for atherosclerosis, heart disease and stroke
• Vitamin C – the antioxidant vitamin C, together with the bioflavonoids, help to ensure the walls of arteries and other blood vessels are strong and healthy
• Vitamin E – the antioxidant vitamin E is vital for the health of the arteries, as it helps to reduce oxidative damage that free radicals and inflammation may cause to the arteries. In addition to this, vitamin E helps to thin the blood, which may significantly decrease the risk of blood clots forming. People taking any type of blood thinning medications must talk to their doctor about using any vitamin E supplements in combination with their medications, as it may not be advised to do so

Minerals

There are a number of minerals which may help reduce symptoms and risk of complications (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Magnesium – the mineral magnesium helps to reduce spasms in the arteries as it helps to relax the arteries and also helps to improve cellular metabolism. Magnesium also helps to maintain normal heart rhythm and reduces risk of calcium depositing in the plaque in artery walls
• Potassium – the mineral potassium is needed to ensure electrolytes are balanced (and there is not too much sodium in the blood, which increases blood pressure). Potassium is also required to ensure that the nerve function is healthy and normal. If you have been prescribed a diuretic, your doctor may also prescribe a potassium supplement too, as the diuretics may excrete too much potassium from the body
• Selenium – some studies show that the antioxidant mineral selenium may help to protect the heart against oxidative damage and heart disease. A severe lack of selenium in the diet may cause a type of heart disease called Keshan’s disease

Other nutrients

There are a number of other nutrients which may help reduce symptoms and risk of complications (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Carnitine – the amino acid carnitine is very beneficial for improving the function of the heart. Research shows that carnitine is a key regulator of fatty acid metabolism, which helps to ensure that cholesterol levels are normal (by eliminating excess levels of cholesterol so that they do not circulate in the blood and risk plaque build-up in the arteries) which may help to reduce risk of atherosclerosis. One study showed that combining carnitine with Simvastatin (a cholesterol-lowering drug) in people with diabetes helped to reduce their cholesterol levels better than just with Simvastatin alone. Studies also show that carnitine helps to reduce inflammation which is associated with atherosclerosis
• Carnosine – studies show that the amino acid-like substance, carnosine can reduce the oxidation of LDL (“bad”) cholesterol, which may form plaque build-up in the artery walls and this is due to carnosine’s potent antioxidant function. Studies show that carnosine may have very a important function in reducing the risk of atherosclerosis, but more research is needed to confirm initial findings
• Co-enzyme Q10 – studies show that coenzyme Q10 may prevent blood clots from forming and may boost the function of the other antioxidant nutrients in the body, as well as boosting the mitochondria of the heart, enabling it to function better. Other studies suggest that there is evidence to support the therapeutic value of CoQ10 as an adjunct to standard medical therapy in congestive heart failure. Several other studies show that people who take statins (a medication for lowering LDL (“bad”) cholesterol levels) have lowered levels of coenzyme Q10. People taking statins need to seek their doctor’s advice about trying some coenzyme Q10 supplements
• Lipoic acid – several studies show that alpha-lipoic acid has anti-inflammatory, antioxidant properties, which help to reduce fatty plaque build-up in the artery walls, associated with atherosclerosis. The studies also showed that alpha-lipoic acid helps to reduce triglycerides (fat) levels in the blood
• Omega-3 fatty acids – many studies have shown that omega-3 fatty acids (DHA and EPA found in fish oil can help prevent atherosclerosis from worsening or even prevent it from developing, by stopping the development of plaque and blood clots in the arteries. Many studies have also shown that omega-3 fatty acids may help to prevent heart disease, lower blood pressure and reduce the level of triglycerides (fats) in the blood. The Australian Heart Foundation recommends people eat at least two servings of oily fish (mackerel, salmon, sardines, trout, tuna) per week to reduce the risk of heart disease. People with existing atherosclerosis and who want to reduce their blood pressure or triglycerides levels can try an omega-3 fatty acid supplement, but need to talk to their doctor before doing so, because many medications may not work well in combination with omega-3 supplements and increase the risk of internal bleeding (especially blood thinning medications)
• Quercetin – the flavonoid quercetin is a part of the bioflavonoids, so it has the same protective effects on the artery walls, strengthening the walls and reducing the risk of atherosclerosis from developing and since quercetin has antioxidant properties it reduces oxidative damage to the arteries and may prevent oxidation of cholesterol which reduces the risk of plaque build-up in the artery walls
• Taurine – several studies suggest that taurine may be beneficial in reducing levels of LDL (“bad”) cholesterol and may also prevent oxidation of the LDL cholesterol, so that plaque build-up in the artery walls is also prevented

Dietary modifications

There are a number of dietary modifications which may help reduce symptoms and risk of complications:

• Eat enough legumes and wholegrains – the diet needs to include adequate amounts of legumes (chickpeas, peas, beans and soya beans) as well as wholegrains to ensure that the diet has adequate fibre, as well as the various nutrients that the legumes and wholegrains provide. Adequate fibre intake can help to reduce the amount of LDL (“bad”) cholesterol in the blood
• Eat enough “good” fats – you need to ensure the diet includes adequate amounts of the “good” fats which are the polyunsaturated fats, from foods such as olive oil, safflower oil, sunflower oil, olives (but take care that they are not too salty), avocado, as well as all types of nuts and seeds
• Eat more fruit – you need to eat 2-3 portions of fruit every day to provide all the vitamins, minerals and antioxidants necessary for good health. Many fruits are rich in folic acid, which can reduce levels of homocysteine in the blood
• Eat more fish – you need to have 2-3 portions of oily fish intake in the diet each week as they contain the beneficial anti-inflammatory omega-3 fatty acids. The fish which are most recommended are: mackerel, salmon, sardines, trout, tuna. It is better to eat fresh fish that is wild, as it has more omega-3 content, but canned fish can also be eaten too on occasion
• Eat more vegetables – you need to eat 5-7 portions of vegetables every day to provide all the vitamins, minerals and antioxidants necessary for good health. You especially need to eat enough leafy green vegetables, to ensure you get enough folic acid, which is one of the vitamins that can help reduce the levels of homocysteine in the blood
• Limit intake of saturated fat – foods that are high in saturated fat (full cream milk, cheese, butter, sour cream, as well as red meat, any fried foods, any processed foods, any take-away or junk foods) need to be limited in the diet, to help reduce levels of cholesterol and triglycerides as well as reduce risk of possible blockage build-up in the arteries

Lifestyle modifications

There are a number of lifestyle modifications which may help reduce symptoms and risk of complications:

• Exercise regularly – you need to exercise for at least 30 minutes every day to help condition the heart and increase proper blood circulation, which may help to prevent worsening of symptoms and risk of complications. If you have a severe form of atherosclerosis, consult your doctor about the best exercise program which you should engage in, because you may need to do a more gentler form of exercise to reduce possible complications (due to your condition)
• Limit alcohol intake – women should only have one drink and men only 1-2 drinks per day at the most, with at least 2-3 days being alcohol free
• Reduce stress – some form of relaxation therapy is needed to help reduce any stress in your life and reduce this risk factor for atherosclerosis. Examples of relaxation therapy are: dancing, having a bath, meditation, tai chi, visualisation, yoga
• Stop smoking – it is vital for heart health to stop smoking and to stop being around people who smoke and breathing their unfiltered smoke, as it has exactly the same adverse effects on the arteries as if you smoked yourself

Alternative treatments

• Acupuncture – studies show that acupuncture may be useful to reduce some of the risk factors associated with atherosclerosis, as well as assisting with stopping smoking. Acupuncture may be a useful adjunct to any other treatments prescribed

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with atherosclerosis

Research shows that more people may have atherosclerosis and that it may actually start in childhood, so managing and preventing worsening of symptoms and serious complications is vital to be able to have a good quality of life.

Self care strategies

There are a number of strategies that may be useful for people who have been diagnosed with atherosclerosis:

• Add more fibre to the diet – adequate amounts of fibre (about 30 grams per day) are required in the diet to help ensure that the digestive system is healthy and to help reduce levels of LDL (“bad”) cholesterol in the blood, which may help reduce the amount of plaque build-up in the arteries
• Don’t smoke or be around smokers – smoking cigarettes can damage the artery walls and lead to atherosclerosis. In addition to this, smoking depletes the body of the antioxidants, especially vitamin C, which is required to ensure the artery walls are strong and healthy. Not only should you not smoke, but you should also not be around other people who smoke, as their smoke has exactly the same effect on your arteries
• Eat more fruit – you need to make sure you eat at least 2-3 portions of fruit every day, ensuring that you have at least a few servings of cherries and berries each week. Fruit contains a number of vitamins and minerals and the cherries and berries contain the potent antioxidants anthocyanadins, which may be useful in preventing oxidative damage to the artery walls, plus the fruit helps to reduce cholesterol, blood pressure and triglycerides levels
• Eat more vegetables – you need to ensue that you have at least 5-7 portions of vegetables every day, with at least 1-2 of those portions being leafy green vegetables, which are packed full of folic acid, fibre, vitamins and minerals. The folic acid may help to reduce homocysteine levels which is implicated in atherosclerosis, plus the vegetables help to reduce cholesterol, blood pressure and triglycerides levels
• Exercise regularly – in order to help condition the heart and improve circulation, a regular exercise program is required. Your doctor will advise you on the type of exercises you may be able to engage in, depending on your condition and the severity of your symptoms. If you can exercise, you should try to do so for at least 30-45 minutes every day (but only with your doctor’s approval) because some arrhythmia may be brought about by exercise
• Limit alcohol – alcohol puts a lot of stress on the arteries and the heart and is implicated in the worsening of atherosclerosis. Women should have no more than one drink and men should have no more than two drinks per day, with at least two days of the week being alcohol free
• More oily fish in the diet – you need to make sure you eat at least two portions of oily fish each week, to increase your intake of the omega-3 fatty acids, which reduce inflammation and are vital for heart health. The best types of oily fish are: mackerel, salmon, sardines, trout, tuna and should be wild and fresh (canned fish should be eaten less regularly)
• Reduce stress – prolonged amounts of stress can increase the amount of the stress hormone cortisol, which creates a great deal of inflammation everywhere in the body and it can also damage the artery walls and the heart. Reducing stress is vital to ensuring better heart, artery and cardiovascular health. There are a number of excellent stress-reduction strategies: dancing, having a bath, meditation, tai chi, visualisation, yoga
• Regular doctor visits – you need to see your doctor on a regular basis, in order to monitor your symptoms, the progression of your condition and to adjust medications (if you are getting any side effects). You can also ask your doctor’s advice about any supplements you want to take in addition to your medications (if you are taking any) to make sure that it is safe to do so. Your doctor may request regular blood tests to monitor your cholesterol, triglycerides and blood pressure levels as part of the monitoring of your condition

Caring for someone with atherosclerosis

Partner

People who have a partner with atherosclerosis, can help them with a number of strategies:

• Don’t smoke – if you smoke, only do so outside the house (and car) and never smoking near your partner as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms
• Exercise program – encourage your partner to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your partner. Walking will most likely be advised, so go for regular walks with your partner, when your schedule permits
• Healthy diet – you need to ensure to cook healthy and fresh foods with your partner and remove (or limit) processed foods, junk foods and saturated fats from your diet to help reduce their temptation to eat these types of foods. Always have lots of fresh fruit and vegetables, as well as nuts and seeds for healthy snacks
• Limit alcohol – your partner should not be indulging in large amounts of alcohol as it can worsen their condition, so try to make sure that there is less alcohol in your evening meals at home and when you go out socially

Friends

People who have a friend with atherosclerosis, can help them with a number of strategies:

• Don’t smoke – if you smoke, only do so outside the house (and car) and never smoking near your partner as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms

Parents

Parents who have a child with atherosclerosis (and this is occurring with more frequency today), can help them with a number of strategies:

• Add some garlic and ginger to the diet – both garlic and ginger have anti-inflammatory and blood thinning properties, which helps to reduce risks of blood clots and worsening of symptoms. Ensure you talk to your doctor before adding large amounts of garlic and ginger to your child’s diet, as it may not be advisable with certain types of medications
• Antibiotics before and after dental work – either ensure you give your child the antibiotics or remind them to take them before (1 hour) and after (6 hours) any dental work, to prevent any possible infection in the tooth from affecting the heart
• Exercise program – encourage your child to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your child
• Healthy diet – ensure to cook healthy and fresh food, provide healthy lunches and snacks for your child, remove (or limit) processed foods and junk foods and saturated fats from the diet
• Oily fish every week – oily fish such as mackerel, salmon, sardines, trout or tuna should be part of your child’s diet at least two times a week. The fish can be steamed, grilled, baked or even fried, but only with good quality cold pressed, extra virgin olive oil. The fish provides omega-3 fatty acids, which are essential for good heart health
• Stop smoking near your child – if you smoke, only do so outside the house (and car) and never smoking near your child as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms

References

Last reviewed and updated: 14 May 2024