What is Atherosclerosis?
Atherosclerosis is a long-term progressive vascular disorder in which plaque (fats, cholesterol, and other substances) hardens and clogs the arteries. This silent process cuts off blood flow to vital organs and, when the plaque bursts, may cause dangerous blood clots.
Types of Atherosclerosis
Arteries can become prone to atherosclerosis anywhere in the body. The name of the type is derived from the artery or organ system most involved.
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Coronary Artery Disease (CAD) When the coronary arteries that directly provide blood to the heart muscle accumulate plaque. The most frequent and common form. Left untreated, it can cause angina (chest pain), heart attack or heart failure.
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Carotid Artery Disease There is a pair of carotid arteries, one on each side of the neck that feed the brain. This is a significant risk factor for stroke and small, temporary interruptions in blood flow to the brain called transient ischaemic attacks.
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Peripheral Artery Disease (PAD) PAD affects the arteries in the legs and sometimes the arms. It leads to leg pain when walking, a failure of the wound to heal, and, in extreme cases, death of tissue.
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Renal Artery Atherosclerosis Renal artery atherosclerosis impacts the blood vessels that lead to the kidneys. A decrease in blood flow to the kidneys can cause chronic kidney disease and high blood pressure that is hard to control.
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Mesenteric Artery Atherosclerosis This means that the arteries that feed the intestines are affected, leading to abdominal pain after meals and, in extreme cases, intestinal ischaemia (death of intestinal tissue from a lack of blood supply).
How Common is Atherosclerosis in India?
Atherosclerosis and its consequences are a growing public health challenge in India. It occurs at a younger age, affects more people and advances quickly in absolute numbers compared to most of the developed countries.
India has less than 20% of the world's population, but bears the vast majority of all heart-related diseases in South Asian regional burden. It is estimated that 50% of all heart attacks in Indian men occur under 50 years of age, and 25% of all heart attacks in Indian men occur under 40 years of age.
What are the Symptoms of Atherosclerosis?
Atherosclerosis is not noticeable in the initial stages. Its symptoms usually do not occur until an artery is so narrowed or clogged that it cannot send enough blood to organs and tissues.
Symptoms depend on which arteries are affected.
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Symptoms Related to Heart Arteries (Coronary Artery Disease)
- Chest Pain or Pressure (Angina): A squeezing or heavy pain in the chest, especially with activity. The pain usually goes away with rest.
- Shortness of Breath: Even light exercise is tiring because the heart is not pumping enough oxygenated blood.
- Heart Palpitations: When blood does not flow normally through the heart muscle, resulting in an irregular or rapid heartbeat.
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Symptoms Related to Brain Arteries (Carotid Artery Disease)
- Sudden Numbness or Weakness: Usually on one side of the face, the arm, or the leg. This is an alarming sign of stroke.
- Sudden Speech Impairments or Mental Fog: Slurred speech or confusion, due to a disruption in blood flow to the brain.
- Sudden Vision Change: Sudden blurring or loss of vision in one eye.
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Symptoms Related to Leg Arteries (Peripheral Artery Disease)
- Claudication: Leg pain that occurs during walking but goes away during rest.
- Poor Circulation: Reduced circulation to the lower limbs leads to changes in temperature and loss of sensation (numbness) in the feet.
- Slow-Healing Wounds on Feet or Legs: These wounds may not heal properly because of poor blood supply, and this can lead to an infection.
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General Warning Signs
- Persistent tiredness: This can be a sign of poor tissue oxygenation.
- Difficult-to-Control High Blood Pressure: When major arteries narrow and lose their elasticity, the heart has to work harder to pump blood, leading to high blood pressure.
What are the Risks Associated with Atherosclerosis?
Atherosclerosis can cause a number of severe problems if it is not treated, such as affecting blood supply to the organs or causing rupture of the plaque and blood clots.
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Heart Attack and Heart Failure: If the coronary arteries become clogged with plaque, the heart muscle does not receive enough blood. This can lead to chest pain (angina), heart attack and eventually heart failure.
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Stroke and Transient Ischaemic Attack (TIA): Atherosclerosis in the carotid arteries can lead to a decrease in blood flow to the brain, or cause clots that can lead to stroke and/or to a temporary blood clot in the brain known as a "mini-stroke or TIA".
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Peripheral Artery Disease (PAD): Reduced blood supply to the leg may cause leg pain, slow healing, infections, and even tissue death (gangrene), which may occur and necessitate amputation.
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Chronic Kidney Disease: When the renal arteries become narrowed, the kidney's function can be affected and this can lead to uncontrolled high blood pressure.
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Mesenteric Ischaemia: Pain after eating, or in severe cases, damage to the tissue of the intestine, if the arteries that supply the intestines are blocked.
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Aneurysms Formation: Atherosclerosis can weaken artery walls, leading to aneurysms. When an aneurysm bursts, it may cause fatal bleeding. Cerebral aneurysms can cause fatal bleeding in the brain, while abdominal aortic aneurysms (AAA) can cause bleeding in the belly.
What Causes Atherosclerosis?
Damage of the walls of the arteries causes a complex biological response that leads to atherosclerosis. The main causes of this damage and the subsequent plaque are listed below:
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High LDL Cholesterol: Low-density lipoprotein (LDL) cholesterol is also known as 'bad cholesterol' that enters the artery wall and begins the process of plaque formation.
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Chronic Inflammation: Diseases that lead to chronic inflammation, like rheumatoid arthritis or infectious diseases, cause damage to the inner lining of the arteries and lead to increased plaque formation.
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Endothelial Injury: The lining of blood vessels, called the endothelium, is very thin. This layer can become injured due to high blood pressure, smoking, and toxins, and this injury initiates the atherosclerotic process.
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Oxidised LDL Accumulation: Once oxidised in the arterial wall, LDL cholesterol can stimulate an immune response and bring in white blood cells, which become trapped in the fatty layers of early plaque and are known as foam cells.
When Should I See a Doctor?
You should seek immediate medical help if you notice any of the following symptoms:
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Chest pain, tightness or pressure, especially with physical exertion or emotional stress.
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Sudden weakness, numbness or paralysis of one side of the face, arm or leg.
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Slurring speech, not hearing what is being said, or becoming suddenly confused.
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A pain or cramping of the leg that happens routinely while walking and goes away with rest.
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Fast loss of vision or blurring of one or both eyes.
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Wounds or ulcers that don't heal on the feet or legs after treatment.
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Shortness of breath with minimal exertion or at rest.
How is Atherosclerosis Diagnosed?
Atherosclerosis is diagnosed by physical exam, blood tests, and imaging tests.| Parameter | Desirable | Borderline High | High Risk |
| Total Cholesterol | Below 200 mg/dL | 200–239 mg/dL | 240 mg/dL and above |
| LDL Cholesterol | Below 100 mg/dL | 100–159 mg/dL | 160 mg/dL and above |
| HDL Cholesterol | Above 60 mg/dL | 40–59 mg/dL | Below 40 mg/dL |
| Triglycerides | Below 150 mg/dL | 150–199 mg/dL | 200 mg/dL and above |
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Lipid Profile (Blood Test) The lipid profile blood test includes measurements of total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. It is used to detect dyslipidaemia (abnormally high levels of fat in the blood), which is a main cause of plaque formation. This test is typically performed after a 9 to 12-hour fast.
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Electrocardiogram (ECG or EKG) An ECG is used to measure the electricity in the heart. It can identify irregularities in the heart's rhythms and decreased blood supply to the heart muscle, a sign of coronary artery atherosclerosis. There is no special preparation required.
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Echocardiogram An ultrasound of the heart will reveal the heart's function and normal wall motion. It helps identify damage caused by chronic coronary artery disease. No radiation is used.
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Ankle-Brachial Index (ABI) The ABI is the first test used to diagnose peripheral artery disease and compares ankle blood pressure with arm blood pressure. It is a non-invasive, painless test. A PAD is suggested by a measurement below 0.90; a measurement of 1.00 or above is considered healthy. A score between 0.91 and 0.99 is borderline, and below 0.90 is diagnostic.
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CT Coronary Angiogram / Coronary Artery Calcium (CAC) Score The CAC score measures the amount of calcium deposits in the walls of the coronary arteries, without a contrast. The higher the score, the more plaque. However, a computed tomography (CT) scan maps out the specific arterial blockages.
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Carotid Ultrasound The carotid ultrasound test can be used to measure the thickness of the wall of the carotid artery (called carotid intima-media thickness or cIMT). Thickening of cIMT is a sign of early atherosclerosis in arteries leading to the brain.
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Invasive Coronary Angiography The invasive coronary angiography procedure involves inserting a thin tube (catheter) into a blood vessel and injecting a contrast dye to visualise blockages in coronary arteries under X-ray.
How Is Atherosclerosis Treated or Managed?
Although it cannot be cured, atherosclerosis can be slowed and complications prevented by:
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Lifestyle Management The cornerstone of treatment is a healthy lifestyle. This entails eating a diet that minimises saturated and trans fats and salt intake and maximises fibre. For example, a Mediterranean diet modified for an Indian diet rich in millets (ragi, jowar) and lean plant proteins without deep-fried foods. Moderate-intensity aerobic activity, at least 150 minutes a week, helps manage cholesterol, blood pressure and insulin sensitivity. Important practices also involve weight control, especially of abdominal fat, which is one of the best practices, and periodic blood pressure and blood sugar checks to avoid arterial damage from these conditions.
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Medical Management Risk factors are treated with medications and complications are prevented. Statins are a class of medication often used to reduce levels of bad cholesterol (LDL cholesterol). Antiplatelet drugs help to prevent blood clots and keep heart attacks and strokes at bay. Artery-wall protection is offered by blood-pressure drugs, and tight glucose control is critical for diabetes patients to slow plaque buildup.
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Procedural and Surgical Interventions If it is a severe blockage, interventions might be necessary. Carotid Endarterectomy (CE) is a surgical procedure to remove plaque from the carotid artery, which helps prevent stroke.
What is the Prognosis? Can Atherosclerosis be Reversed?
Once atherosclerosis has developed, it is not possible to reverse it completely. It is a lifelong disease, but its development can be slowed down. While it can't be completely cured, a strict heart-healthy diet and aggressive treatment can shrink plaque volume, stabilise it and keep it from rupturing.
Adopting a healthy lifestyle could add more than a decade to life. Prognosis is largely dependent upon early detection of atherosclerosis, the arteries involved, and adherence to treatment. People with the ideal blood lipid profile, healthy blood pressure, no smoking ,and proper medical management tend to have much better health outcomes than those who don't.
How Can I Prevent Atherosclerosis?
Prevention is best done early before symptoms occur.
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Exercise Daily: Moderate physical activity for 30 minutes a day or more is a good goal. Brisk walking works as well.
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Avoid Smoking: Smoking is one of the most modifiable risk factors for atherosclerosis.
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Manage Blood Pressure: Take blood pressure regularly at all visits to the doctor. If hypertension is diagnosed, be sure to follow treatment recommendations.
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Control Blood Sugar: If you have pre-diabetes or diabetes, closely monitor your blood sugar levels with your doctor and keep them within the target level.
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Keep Body Weight in Check: Pay special attention to the abdomen's circumference, as it is a better predictor of cardiovascular risk than body weight in the Indian population.
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Check Lipid Profile: Adults over 30 years of age and younger with a familial history of heart disease should have a lipid profile at least once every 2-3 years.
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Reduce Alcohol Consumption: Drinking large amounts of alcohol increases triglyceride levels and blood pressure, which can lead to plaque formation.
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Manage Stress: High blood pressure increases with chronic psychological stress and inflammatory pathways that feed into artery walls. Yoga, meditation and good sleep are helpful.
Does Health Insurance Cover Atherosclerosis?
Yes. Cardiovascular diseases and atherosclerosis are covered under standard health insurance policies in India, subject to certain conditions. Most comprehensive plans include inpatient care for complications. They also include procedural costs for angioplasty and Coronary Artery Bypass Grafting (CABG). It is covered under standard health plans or may be included under critical illness health insurance.
When diagnosed prior to buying the policy, it is considered as a pre-existing condition, and involves a waiting period of up to 3 years.
How Much Health Insurance Coverage is Needed for Atherosclerosis?
The sum of insurance required will depend on the severity of the atherosclerosis and the possible expenses of treatment in India, which will range from a lifetime course of medicine to complicated cardiac surgical procedures. Medication and monitoring costs are relatively low, however, the costs are much higher if intervention is required. A coverage of up to ₹10 lakh is recommended for mild cases and for severe cases, you must opt for a higher coverage of up to ₹20-25 lakh is recommended.
Be sure to read the policy document thoroughly; coverage varies by policy and insurer.
FAQs
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Is atherosclerosis the same as a blocked artery?
Ans: Not exactly. Atherosclerosis is the buildup of plaque within the artery walls. When plaque grows large enough to significantly narrow or completely block an artery, it is referred to as a blocked artery. Atherosclerosis is the underlying disease, while blockage is one of its possible outcomes. -
What are the first signs of atherosclerosis?
Ans: Atherosclerosis often develops without any early symptoms. When symptoms occur, they depend on the artery affected, such as chest pain, leg pain while walking, or speech difficulties. Regular health screenings can help detect risk factors before symptoms appear. -
Can atherosclerosis be reversed with diet?
Ans: While atherosclerosis cannot usually be completely reversed, a heart-healthy diet can slow its progression. Reducing saturated fats, increasing fibre intake, and following a Mediterranean-style diet may help improve cardiovascular health.
