Atherosclerosis: Do you know the symptoms or causes, risks, prevention?

Atherosclerosis: Do you know the symptoms or causes, risks, prevention?
Photo source: Getty images

Atherosclerosis is a disease of the arteries. The wall of the artery is affected by a disease process. It takes place over a long period of time and is progressive due to negative conditions.


Atherosclerosis = hardening of the arteries, and therefore vascular disease, which has various causes and serious consequences.

On this topic, one is very often interested in what the disease is and what its causes are. Though also, what symptoms does it manifest and which vessels it affects (aorta, arteries of the lower limbs or other vessels). Furthermore, in the article you will also read about its prevention and treatment.

The initial stage of the disease can be influenced by lifestyle and medication. The late phase is a risk of serious complications such as heart attack or stroke.

Atherosclerosis is a long-term progressive disease that affects the arteries.

More precisely, medium and large. It can affect any artery in the human body, such as the aorta, coronary (heart) or cerebral vessels, but also the arteries of the lower extremities. This is damage to the inner layer of the vessel wall, through which fats and other blood components subsequently penetrate.

Atherosclerosis from the Greek athéré, meaning porridge or much, and scleros referring to hard tissue.

These substances are deposited in the wall of the vessel, which over time causes a narrowing of the lumen, ie the inner diameter of the artery. This narrowing has a negative effect on the blood flow and the altered flow is a risk for the formation of blood clots, ie thrombi. A blood clot forms even if this bearing ruptures.

Long-term enlargement of the atherosclerotic lesion, i.e. the atherosclerotic plaque, results in impaired blood flow to the cells and tissues. These are insufficiently oxygenated and supplied with blood. If the coronary arteries are altered in this way, coronary heart disease develops.

Interesting information: about coronary heart disease in an article at Zdravoteka.

The narrowing of cerebral vessels is due to a deterioration in the functioning of the central nervous system, such as memory disorders, and in the vessels of the lower extremities, ischemic disease of the lower extremities. The arteries of the kidneys, eyes and other organs may also be affected.

Acute narrowing of the lumen vessel or complete blockage creates life-threatening conditions.

The result is a ruptured atherosclerotic plaque, followed by thrombosis (platelet deployment) on the damaged part of the vessel. The thrombus formed (blood clot) partially or completely, prevents the flow of blood. For example, angina pectoris or heart muscle infarction might occur.

Another mechanism is if the blood clot is torn off and travels through the vascular system. A blood clot causes a blood vessel in another part of the body to become clogged. The thrombus torn off in this way is called an embolus and causes embolization. Lung embolism is well known and dangerous when the embolus comes from the lower limbs or from the heart to the brain.

Read aslo the follwoing articles:
Pulmonary embolism
Angina pectoris
Myocardial infarction
Thromboembolic disease

What layers does a vessel have?

The blood vessels, along with the blood, transport substances and gases in the body.

From the heart to the organs, tissues, and cells, they bring important oxygen, nutrients, and other blood components. The heart serves as a pump that pushes blood into the body and sucks it back out of the body. An important role of blood vessels is the drainage of metabolic products and waste products to the organs that remove them from the body.

The vessels are either blood or lymphatic, the blood vessels are divided into:

  • arteries, that carry blood from the heart, in most cases oxygenated (except for small blood circulation)
  • veins, that supply blood to the heart, in most cases deoxygenated
  • capillaries, are the smallest vessels and exchange of gases and other substances

The vascular wall has three basic layers, which are listed in the table

Layer  Description
Tunica intima is the inner layer of the vessel and has three parts:
  • endothelial cells
  • which attach to the lamina basalis, or basal lamina
  • subendothelial layer
endothelial cells have a number of important functions, such as:
  • control vascular tone
  • homeostasis
  • angiogenesis
  • have a protective function
  • interfere with the mechanism of inflammation
  • reduce oxidative stress
Tunica media it is largely made up of smooth muscle cells
there are also elastic fibers
in larger vessels, these smooth muscles contract and dilate
it affects vascular tone, blood flow and blood pressure
Tunica adventitia layer with collagen ligament on the outer surface of the vessels
protective layer
in addition to collagen, there are, for example, elastic fibers
it also contains the vessels and nerves to supply the vessels themselves


Cardiovascular disease (CVD), which is also caused by atherosclerosis, is one of the most common causes of morbidity and death worldwide. The highest increase in these diseases has been recorded since the 17th century, ie the beginning of industrialization.

Negative interaction is attributed to smoking, reduced exercise, and intake of a high-calorie diet. Overweight, obesity, hypercholesterolemia (increased blood cholesterol levels) and diabetes also contribute to an increased incidence of cardiovascular disease.

Atherosclerosis has been referred to in the past as a degenerative disease of old age. New findings have changed the view of the disease. The exact causes of the onset and progression of the disease are still not fully known. The importance is attached to the content and properties of the atherosclerotic plaque. These facts determine the risk of complications such as stroke, heart attack or ischemic disease of the lower extremities.

The study of atherosclerosis provided the basis for several theories of the cause of this disease. Atherosclerosis is a process that has a multifactorial origin and is largely influenced by lifestyle and drugs.

The table shows the known theories of hardening of the arteries

Theory Description
Lipid in 1913 by Russian pathologist Nikolai Nikolayevich Anichkov, the main cause is the penetration and storage of lipids into the vascular wall and the formation of foam cells
Thrombogenic incorporation of a thrombus into a vessel wall 
endothelial damage in both theories as a basis for the development of atherosclerosis impaired vascular endothelial function allows disease changes in the vascular wall
damage response hypothesis from 1856, the German physician Rudolf Ludwig Karl Virchow described the AS hypothesis as a consequence of mechanical damage
modified Virchow hypothesis 1973 American pathologist Russell Ross and John Glomsetfor,      AS is not only mechanical damage but also result of other factors such as immunity, toxins, nicotine, viruses, bacteria, and high fats

Various changes at the endothelial cell level provide the basis for the development of atherosclerosis. It develops chronically from youth to old age. Initially, the endothelium is affected, through which substances from the blood pass into the vascular wall. With the participation of the inflammatory reaction, the damage progresses. The atherosclerotic process is divided into 6 stages.

In the table below the stages of the atherosclerotic process 

Stage Description
I. stage
  • dysfunction, dysfunction, endothelium
  • increased permeability to lipids (fats, LDL)
  • presence of inflammatory cells (monocytes and T lymphocytes)
  • macrophages + LDL foam cells are formed 
II. stage
  • increased number of foam cells
  • formation of fat strips
  • as the first sign of atherosclerotic damage to the artery wall
  • these bands progress due to the action of risk factors, they increase
  • or consist of a given state
  • this phase is reversible, i.e. reversible
  • they disappear after the risks have been eliminated or treated
III. stage
  • fat strips grow
IV. stage
  • a lipid core is formed
  • formation of a fibrous cap above the core 
V. stage
  • maturation of the atherosclerotic plaque
  • fat accumulation in the lipid core
  • death, decomposition of fats in the lipid core
VI. stage
  • lipid core growth
  • risk of complications 

The disease has a multifactorial basis. There are several mechanisms and risk factors involved in the development of atherosclerosis that can or cannot be influenced. The uncontrollable risk factors for AS include age, male gender, genetic, hereditary predisposition. 

In coronary heart disease, the risk age is 45 years for men and 55 for women.

The controllable risk factors for the development of AS are:

  • high levels of fats in the blood and impaired fat metabolism
  • high dietary fat intake
  • overweight and obesity
  • high blood pressure
  • metabolic syndrome
  • diabetes, Diabetes mellitus
  • systemic inflammation
  • infections with viruses and bacteria
  • smoking
  • excessive alcohol consumption
  • stress and depression
  • lack of exercise
  • low proportion of fruits and vegetables in the diet
  • low levels of antioxidants

TIP: Read articles about the health effects of smoking and alcoholism in our website.   

Atherosclerotic plaque contains and can be...

Various particles are deposited in the atherosclerotic plaque.

The best known are fats, and thus LDL- type lipoproteins (LDL are high cholesterol particles). Subsequently, endothelial cells, smooth muscle cells, inflammatory cells such as monocytes, macrophages, T lymphocytes, but also platelets are also present. 

The atherosclerotic plaque is divided into:

  • stable atherosclerotic plaque
  • features a necrotic lipid core
  • which is covered with a thick fibrous cap
  • reduces the lumen, ie the inner diameter of the vessel
  • this worsens the blood supply to the organ or tissue
  • unstable atherosclerotic plaque also referred to as vulnerable plaque
  • has a thin fibrous cap
  • risk of rupture
  • subsequent thrombosis, ie platelet aggregation
  • partial or complete occlusion of the vessel

Atherosclerosis is a long-term process that has been evolving over several years, even for decades. It first takes place unnoticed and unrecognizably, ie asymptomatically. Only when the changes and damage to the vessel wall are severe do they manifest themselves in various difficulties. Of course, these depend on where the damage is located.


Coronation of the arteries has been going on for years. So in the first stages, the disease is not recognized and does not affect a person's health. It is only over time that the atherosclerotic plaque grows that difficulty with blood flow occurs.

Atherosclerosis is not widespread. It causes multiple deposits in the arteries across the body. It mainly affects medium and large arteries. And these are mainly the aorta, heart vessels, carotid or femoral arteries. But it also affects the arteries of the kidneys, eyes and lower limbs.

Aterosklerózou postihnutá cieva - prierez
Atherosclerosis - hardening of the artery. Photo source: Getty images

How atherosclerosis manifests itself thus also depends on the site and the vessel whose inner diameter it shrinks.

Neurological problems, such as memory impairment or dementia, will be present when the carotid and cerebral vessels are affected. Acute cerebrovascular damage causes a stroke. With a typical image such as a disorder of speech, mobility, consciousness or behavior.

The long-term process on the coronary arteries causes chronic ischemic heart disease and stable angina pectoris.

If the atherosclerotic plaque ruptures, an acute coronary syndrome occurs, such as unstable angina or myocardial infarction, and sudden cardiac death in the case of extensive heart damage. Aortic aneurysm is also described as one of the causes of atherosclerosis.

TIP: Article about aneurysm.

Atherosclerosis of the lower limb vessels is manifested by worsening of the blood supply to the legs and typical claudications. Claudications, professionally also known as Intermittent claudications, are exertional pain in the lower limbs. The affected person is forced to slow down or stop completely when walking in pain. After resting, for a few minutes, the pain subsides.

If the blood vessels of the eye are affected, there is a risk of visual impairment and even blindness. Atherosclerosis can cause erectile dysfunction, but also ischemia (bloodlessness) of any other organ or gangrene (death) on the periphery of the body.


Diagnosis is based on anamnesis, clinical picture.

The presence of several risk factors predetermines the onset of the disease. Atherosclerosis should be suspected in a person who has been healthy so far and repeatedly measures high blood pressure.

Then it is necessary to think about possible complications and other diseases. Various examinations are added. These include laboratory blood tests, biochemistry, but also blood counts and inflammatory parameters. Plus, imaging tests such as ECHO, USG, X-ray are performed. The ECG is important.

Differential diagnosis is required for angina pectoris or chest pain, which may include coronary angiography. For neurological problems, it is angio CT or MRI. For the exclusion or confirmation of CHD stress tests such as ergometry.

For lower limb pain, for example, it is Duplex Doppler ultrasonography. This test uses ultrasound to measure blood pressure and blood flow.


The disease has a long course. Man is not born with atherosclerosis. It has been evolving for many years from a young age due to negative risk factors. At first it does not cause any problems, it is asymptomatic, ie asymptomatic.

The first signs of the disease occur according to the location and extent of the damaged vessel. Neurological, heart problems, weakness, fatigue, shortness of breath may be present. A serious threat to health and life occurs especially if an atherosclerotic plaque ruptures.

Platelets, ie platelets, are placed on the damaged vascular wall. Thrombosis occurs and this further reduces the inner diameter of the vessel. Blood flow and flow are deteriorating. This is followed by difficulties.

For example, in the form of a sudden stroke (NCMP, CMP) or as anginal chest pain in angina pectoris. Complete non-blood flow to heart muscle cells ends in heart attack.

If the problem is physical exertion, walking a long distance or on the stairs, a person is short of breath, swollen feet, it is necessary to think about ischemic heart disease. Atherosclerosis should also be considered in lower limb pain that occurs when walking.

Acute deterioration can also be indicated by a change in skin color (blue, purple, pale to gray), it is colder to the touch. The pain is ischemic. The same is well known to everyone, from cases where in a lying or in an uncomfortable, unnatural position an unpleasant and very painful tingling in the limb occurs.

Atherosclerosis - diet, and exercise + other forms of prevention

First aid for people suffering from atherosclerosis is diet and exercise.

Changing the overall lifestyle along with adjusting the menu should be the first choice. In this case, preventive examinations by a general practitioner and possibly by specialists, such as an internist or cardiologist, are also important.

Adequate exercise and rational nutrition are the basis for prevention. Prevention is important and aims to prevent the disease itself. And since childhood. Children are less active nowadays, which contributes to their overweight and obesity. Overweight or obesity in children and adolescents is at risk. It causes the development of the disease in adulthood.

We provide interesting information in the article below: Obesity in children and young people, what to do against it?

Exercise as such helps in every age. Daily exercise of lower intensity for at least 30 - 40 minutes a day is suitable. Or physical activity several times a week with higher intensity. Strength training is inappropriate, but rather a movement that stirs the blood in the body, such as running, brisk walking, cycling, swimming.

At an older age and in case of health restrictions, regular walks are also suitable.

Another type is static exercise and weight training, and it is important to breathe. Naturally, not in a person who suffers from heart disease. He should be familiar with his options from the doctor. Regarding the increase in physical activity and exercise, attention should be paid to gradual change. Impact loading can result in damage to the musculoskeletal system, joints and muscles.

As part of a lifestyle change, it is recommended to limit smoking. A small amount of alcohol is said to reduce the risk of cardiovascular disease. However, regular daily consumption of large amounts of alcohol has negative effects on the whole body.

As for the diet, there can be several types of diets, such as the French diet. The Mediterranean diet has an alleged preventive effect against cardiovascular disease. In both cases, there is an increased intake of fruits and vegetables and also a balanced ratio of omega-3 and omega-6 fatty acids.

Read the magazine article: The Mediterranean diet and its impact on human health.

The intake of unsaturated fatty acids is also important. The French diet also focuses on increased intake of vegetables, fruits and milk fats, the Mediterranean diet contains more cereals, legumes, olive oil and seafood.

These are mainly marine fish and fish products dominated by EPA and DHA, which have antisclerotic and antiarrhythmic effects. Seafood mainly consumes tuna, mackerel, salmon, sardines, seaweed and fish oils.

Conversely, people with atherosclerosis should avoid protein foods such as meat, cheese, yogurt, cottage cheese, and sugar and confectionery should be limited. If you already eat meat, choose poor, avoid fried foods and do not eat sausages or entrails.

How it is treated: Atherosclerosis

Atherosclerosis: treatment with lifestyle changes health measures

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How atherosclerosis occurs - video

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Interesting resources

  • "What Are the Signs and Symptoms of Atherosclerosis? - NHLBI, NIH".
  • "What Causes Atherosclerosis? - NHLBI, NIH".
  • "New Concept of Heart Disease Posits Vitamin C Deficiency as Culprit". DAIC (Diagnostic and Interventional Cardiology)
  • "Who Is at Risk for Atherosclerosis?".
  • "How Can Atherosclerosis Be Prevented or Delayed? - NHLBI, NIH".
  • "How Is Atherosclerosis Treated? - NHLBI, NIH".
  • Aronow WS, Fleg JL, Rich MW (2013). Tresch and Aronow's Cardiovascular Disease in the Elderly, Fifth Edition. CRC Press. p. 171. ISBN 9781842145449.
  • "Arteriosclerosis / atherosclerosis - Symptoms and causes". Mayo Clinic
  • "What Is Atherosclerosis? - NHLBI, NIH".
  • Lind, L (August 2003). "Circulating markers of inflammation and atherosclerosis". Atherosclerosis169 (2): 203–214. 
  • "How Is Atherosclerosis Diagnosed? - NHLBI, NIH".
  • Topol EJ, Califf RM (2007). Textbook of Cardiovascular Medicine. Lippincott Williams & Wilkins. p. 2. ISBN 9780781770125.
  • Shor A (2008). Chlamydia Atherosclerosis Lesion: Discovery, Diagnosis and Treatment. Springer Science & Business Media. p. 8. ISBN 9781846288104.
  • Ross R (April 1993). "The pathogenesis of atherosclerosis: a perspective for the 1990s". Nature362 (6423): 801–9. B
  • Atherosclerosis. Harvard Health Publications Harvard Health Publications. Health Topics A – Z, (2011)