By Jeni Baker

Better known as “hardening of the arteries,” atherosclerosis is a major cause of heart attack and stroke. Cardiologists Michael Blazing, MD,
and James Zidar, MD, of Duke Heart Center discuss what everyone should know about this common condition. Dr. Blazing (left) and Dr. Zidar

What Is Atherosclerosis?

Atherosclerosis is a condition in which fatty patches accumulate inside artery walls, causing them to become thick and rigid and impeding blood flow.

Blazing, director of cardiology wards at Duke University Hospital, likens a patch of atherosclerosis to a blister: soft on the inside, with a thin skin that can easily burst when it becomes inflamed or irritated. “Contrary to what many people think, most heart attacks and strokes occur because this ‘blister’ ruptures – sending debris into the bloodstream, where it can enter the heart or brain – not because it gets so thick that arteries become completely blocked,” he says.

Unchecked, atherosclerosis can lead to serious conditions such as:

• Coronary artery disease (CAD) -- The leading cause of death among Americans and the primary cause of heart attacks, CAD results from atherosclerosis in the arteries that feed the heart.
• Cerebral vascular disease -- A key factor in strokes and brain aging, this condition arises when atherosclerosis develops in arteries that supply the brain.
• Peripheral artery disease (PAD) -- PAD, which develops when atherosclerosis affects arteries in the pelvis and legs, can cause problems ranging from impotence to gangrene.

How Do I Know if I’m at Risk?

Risk factors for atherosclerosis include:

• Advancing age
• Cigarette smoking and secondhand smoke exposure
• High cholesterol and/or triglycerides
• Diabetes or insulin resistance
• High blood pressure
• Family history of early-onset heart disease
• Sedentary lifestyle
• Excess weight

Atherosclerosis is suspected to have a strong genetic component, as well -- a potentially critical link being examined by scientists at the Duke Clinical Research Institute and Duke Institute for Genome Sciences & Policy.

Symptoms and Diagnosis: What Are the Signs?

Unfortunately, most people are unaware that they have atherosclerosis until they suffer a heart attack or stroke, or experience pain -- often in the legs or chest -- resulting from severely restricted or blocked blood flow.

Those at risk for atherosclerosis might head off such events by visiting their physicians, who can diagnose the condition using methods such as:

• Angiography
• Blood tests
• CT scanning
• Echocardiogram
• Electrocardiogram
• Listening to the arteries via stethoscope
• Magnetic resonance imaging (MRI)
• PET scanning
• Checking for diminished peripheral pulses
• Stress testing

Cardiac MRI, although not yet widely available, is arguably the most sophisticated tool for diagnosing coronary artery and structural heart disease. Research at Duke Cardiovascular Magnetic Resonance Center seeks to uncover new clinical applications for this leading-edge procedure.

Treatment and Management: What Can Be Done?

The goal of atherosclerosis treatment and management, Blazing says, is to turn the “blisters” of soft, fatty buildup into hard, thin “calluses” that can’t rupture -- by aggressively targeting the disease and the factors that cause it. Options include:

• Lifestyle changes, such as improved diet, more exercise, smoking cessation
• Drugs, including antiplatelet compounds and lipid-lowering drugs
• Procedures such as angioplasty and bypass

What Should I Ask My Doctor?

If you think you’re at risk for atherosclerosis, talk with your doctor about your concerns – particularly if you smoke or are diabetic, says Zidar.

“The incidence of heart disease and PAD increases significantly in smokers and diabetics over 50,” says Zidar, medical director of cardiovascular services at Duke Raleigh Hospital, noting that about 30 percent of people in these groups suffer from PAD.

Prevention: The Best Medicine

Lifestyle management is the most effective way to reduce your chances of developing atherosclerosis. Recommendations include:

• Eat a diet low in fat and cholesterol
• Exercise regularly
• Maintain a healthy weight
• Quit smoking
• Maintain healthy blood pressure
• Manage diabetes and other insulin disorders
• Consume alcohol in moderation

“Try to exercise -- a brisk walk at a minimum -- for at least 30 minutes, four days a week,” says Zidar. “Regular exercise has been proven to lower the risk of stroke and coronary artery disease and to slow brain aging caused by atherosclerosis.”