Atherosclerotic cardiovascular disease, or ASCVD, is a condition where a sticky substance called plaque builds up inside the arteries. This accumulation narrows the arteries, restricting the flow of oxygen-rich blood to the body’s organs. The process of plaque buildup, known as atherosclerosis, develops slowly and can affect arteries throughout the body. The diseases linked to ASCVD are a primary cause of death globally.
The Formation of Arterial Plaque
The development of arterial plaque is a multi-step process that begins with damage to the endothelium, the thin layer of cells lining an artery. This initial injury can be caused by factors like high cholesterol and high blood pressure. Once the endothelium is damaged, an inflammatory response is triggered.
Low-density lipoprotein (LDL) cholesterol, often called “bad” cholesterol, accumulates in the artery wall at the site of the injury. The body’s immune system sends white blood cells called macrophages to the area to clean up the LDL cholesterol. The macrophages engulf the cholesterol, becoming engorged and transforming into “foam cells.”
These foam cells are a component of early plaque. They accumulate with other cellular debris and fats, forming a “fatty streak,” the first visible sign of atherosclerosis. Over time, this streak can grow, and a fibrous cap of smooth muscle cells forms over it, creating a more complex plaque structure called an atheroma.
Key Risk Factors
Several factors can increase the likelihood of developing ASCVD. Non-modifiable risk factors include advancing age, being male, and having a family history of the disease. Modifiable risk factors are primarily related to lifestyle and other health conditions that can be managed.
Managing these modifiable factors can significantly impact the development and progression of the disease. These include:
- High blood pressure, which can accelerate damage to the artery’s inner lining.
- High levels of LDL cholesterol and triglycerides in the blood.
- Tobacco use, which is a major cause of endothelial damage.
- Diabetes, which can increase inflammation and affect cholesterol levels.
- Obesity, which is often linked to high blood pressure, high cholesterol, and diabetes.
- A sedentary lifestyle and an unhealthy diet, particularly one high in saturated and trans fats.
Recognizing and Diagnosing the Condition
ASCVD often progresses silently for decades, with many individuals showing no symptoms until an artery is severely narrowed or a plaque ruptures. When symptoms do appear, they depend on which arteries are affected. The first sign may be a major medical event like a heart attack or stroke.
Specific symptoms can include:
- Chest pain (angina), shortness of breath, or fatigue if the coronary arteries supplying the heart are narrowed.
- Sudden numbness or weakness in the face or limbs, confusion, or trouble speaking if plaque is in the carotid arteries supplying the brain.
- Leg pain during walking (claudication) if atherosclerosis affects the arteries in the legs, a condition known as peripheral artery disease (PAD).
Diagnosing the condition involves a thorough evaluation by a healthcare provider, starting with a review of medical history and a physical exam. Diagnostic tests may include blood tests to check cholesterol and blood sugar levels and blood pressure measurements. An electrocardiogram (ECG or EKG) can detect heart rhythm problems, while a stress test assesses heart function during exercise. Imaging tests like a coronary calcium scan or a CT angiogram can visualize plaque buildup.
Medical Treatments and Interventions
For individuals diagnosed with ASCVD, medical treatments focus on slowing plaque progression and preventing complications. Medications are a primary part of this management. Statins are commonly prescribed to lower LDL cholesterol levels, while other drugs like ACE inhibitors or beta-blockers may be used to control high blood pressure.
To address the risk of blood clots forming on plaques, doctors often recommend antiplatelet agents. Low-dose aspirin is a common choice, as it helps prevent platelets from clumping together. For patients who cannot take aspirin, other medications like clopidogrel may be prescribed.
In cases where arteries are significantly narrowed, more invasive procedures may be necessary. Angioplasty involves inserting a thin tube with a balloon into the blocked artery. The balloon is inflated to compress the plaque and widen the artery, and a small mesh tube called a stent is often left in place to keep it open. For extensive blockages, coronary artery bypass surgery may be performed, using a healthy blood vessel to create a new path for blood flow.
Lifestyle Approaches for Prevention and Management
Lifestyle modifications are important for both preventing ASCVD and managing it after a diagnosis. A comprehensive approach involves several key changes.
Making these adjustments a consistent part of one’s routine is a primary goal for long-term health.
- Adopt a heart-healthy diet, such as the Mediterranean or DASH diet, which emphasizes fruits, vegetables, whole grains, and lean proteins.
- Engage in at least 150 minutes of moderate-intensity exercise, like brisk walking, per week to help manage weight, blood pressure, and cholesterol.
- Quit smoking, as it is one of the most impactful changes for cardiovascular health.
- Maintain a healthy weight and manage stress through techniques like mindfulness or regular physical activity.