Atherosclerosis

Atherosclerosis is a buildup of plaque (mainly cholesterol deposits) within the arteries. This thickening of the artery walls decreases the flow of blood and oxygen to vital body organs and extremities, which can lead to severe cardiovascular diseases, such as:

Coronary heart disease (CHD) occurs when plaque builds up in the lining of the coronary arteries. The resulting narrowing of the arteries prevents blood and oxygen from flowing easily to the heart muscle, which may cause angina (pain, discomfort, or pressure in the chest). If blood flow is completely blocked by plaque or by a blood clot that forms inside the narrowed coronary artery, a heart attack may occur.
Carotid artery disease, also called carotid artery stenosis or carotid artery occlusive disease, is characterized by the narrowing of the carotid arteries, the main blood vessels carrying oxygenated blood to the brain. This is most commonly related to atherosclerosis in the artery. If the narrowing becomes severe enough to block blood flow to the brain, or if a piece of plaque breaks off and obstructs blood flow, a stroke may occur.
Peripheral artery disease (PAD) is a slow and progressive circulation disorder affecting the arteries that supply the legs or arms with blood and is usually caused by atherosclerosis. In the United States, about seven million people have peripheral artery disease. It is frequently found in people with coronary artery disease.

Cardiovascular specialists at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center offer comprehensive, compassionate and innovative inpatient and outpatient services to adults with conditions related to atherosclerosis. We offer a broad range of diagnostics and cutting-edge medical, interventional and surgical therapies, including coronary angioplasty and stenting, coronary artery bypass grafting surgery, transmyocardial revascularization and carotid endarterectomy.

Risk Factors for Atherosclerosis

Risk factors that are associated with atherosclerosis include:

High levels of cholesterol, triglycerides
Hypertension (high blood pressure)
Smoking
Type 1 diabetes
Obesity
Physical inactivity

Symptoms of Atherosclerosis

Atherosclerosis often does not display any symptoms until an artery has become severely narrowed or blocked. When symptoms are apparent, they depend on the artery affected:

Coronary artery disease

Chest pain (angina)
Shortness of breath during exertion, at rest or while lying flat
Weight gain
Weakness and fatigue
Dizziness or lightheadedness
Nausea, vomiting, and cold sweats
Sense of indigestion or heartburn
Palpitations (abnormal heartbeat)

Carotid artery disease (potential warning signs of a stroke)

A sudden weakness or even paralysis of a leg, arm or hand.
Transient (lasting a short time) slurring, garbled or inappropriate speech.
Transient blindness or severe blurring of vision in one eye.
A transient, one-sided facial droop.

Peripheral artery disease

Intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest)
Diminished pulses in the legs and the feet
Non-healing wounds over pressure points, such as heels or ankles
Numbness, weakness or heaviness in muscles when walking
Pain in the toes or feet, often at night while lying flat
Gangrene (dead tissue due to lack of blood flow)

Some of these symptoms are common to many medical conditions and may not indicate atherosclerosis. If you experience any of these symptoms or have concerns, consult your doctor.

Diagnosis of Atherosclerosis

At BWH, our atherosclerosis specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. In order to diagnose and determine treatment for atherosclerosis, a complete medical history, a thorough physical exam, and one or more of the special diagnostic tests below will be provided.

Angiogram
Cardiac catheterization (coronary angiogram)
CT scan
Peripheral vascular testing
Magnetic resonance angiogram
Vascular ultrasound
Vascular nuclear medicine
Blood pressure comparison - Comparing blood pressure in the ankles to that of the arms may help detect a constriction in blood flow.

Treatment for Atherosclerosis

Our cardiovascular specialists develop individualized treatment plans for patients based on:

Age
Overall health
Medical history
Severity and form of the disease
Tolerance for specific medications or procedures
Expectations for course of the disease
Presence of other conditions

Treatment for atherosclerosis, ranging from lifestyle changes to surgery, may include:

Medication

Statins and other medications to lower LDL cholesterol and/or triglycerides.
Antiplatelet and anticoagulants medications to reduce clotting.
Vasodilators to relax the muscle in the heart and vessel walls, causing blood pressure to fall.
Beta-blockers to make the heart beat slower and with less force by reducing nerve impulses to the heart and blood vessels.
Angiotensin converting enzyme (ACE) inhibitors to prevent the production of angiotensin II, a hormone that causes blood vessels to narrow.

Interventional and surgical procedures

Coronary angioplasty and stenting
Coronary artery bypass grafting (CABG surgery)
Transmyocardial revascularization
Carotid endarterectomy
Peripheral artery angioplasty and stenting
Bypass surgery of legs
Rotational Atherectomy - With some complex blockages, special devices can be used to cut away plaque deposits inside the blood vessel. Rotational atherectomy is often used to treat blockages with calcium build-up.

What You Can Expect

The BWH Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation or the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with atherosclerosis. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Download Cardiac Surgery: A Guide for Patients

Multidisciplinary Care

Patients benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiac surgeons, vascular surgeons, endovascular surgeons, cardiovascular imaging experts and radiologists, and anesthesiologists, all expert in atherosclerosis. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Appointments and Locations

Resources

Learn more about atherosclerosis in our health library

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.