Atherosclerosis: Who Gets It?

It might be easier to ask, who doesn't get atherosclerosis?

Atherosclerosis starts early. In autopsies of young American soldiers killed in action in the Korean and Vietnam wars, half to three-quarters had early forms of atherosclerosis.

And what about today, with our salads and StairMasters? A 2001 study of 262 apparently healthy people's hearts may surprise you:

• 51.9% had some atherosclerosis
• Atherosclerosis was present in 85% of those older than 50
• 17% of teenagers had atherosclerosis

No one had symptoms, and very few had narrowings in any arteries. This was very early disease, detectable only by special tests.

If you are 40 and generally healthy, you have about a 50% chance of developing serious atherosclerosis in your lifetime. The risk goes up as you get older. The majority of adults older than 60 have some atherosclerosis but often do not have noticeable symptoms.

There is good news. Rates of death from atherosclerosis have fallen by 25% since 30 years ago. This is thanks to both improved treatments and better lifestyles.

Between heart attacks, strokes, and peripheral vascular disease, though, atherosclerosis still causes more than 900,000 deaths in the U.S. each year.  Diseases caused by atherosclerosis are the most common cause of death in the U.S.

Atherosclerosis: How to Prevent It

Atherosclerosis is progressive, but it's also preventable. For example, nine risk factors are to blame for up to 90% of all heart attacks:

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Abdominal obesity ("spare tire")
• Stress
• Not eating fruits and vegetables
• Excess alcohol intake (more than one drink for women, one or two drinks for men, per day)
• Not exercising regularly

You may notice all of these have something in common: You can do something about them! Experts agree that reducing your risk factors leads to a lower risk of cardiovascular disease.

For people at moderate or higher risk -- those who’ve had a heart attack or stroke, or who suffer angina -- taking a baby aspirin a day can be important. Aspirin helps prevent clots from forming. Ask your doctor before starting daily aspirin, as it can have side effects.

Atherosclerosis: Treatment

Once a blockage is there, it's generally there to stay. With medication and lifestyle changes, though, plaques may slow or stop growing. They may even shrink slightly with aggressive treatment.

• Lifestyle changes: Reducing the lifestyle risk factors that lead to atherosclerosis will slow or stop the process. That means a healthy diet, exercise, and no smoking. These lifestyle changes won't remove blockages, but they’re proven to lower the risk of heart attacks and strokes.
• Medicines:Taking medication for high cholesterol and high blood pressure will slow and perhaps even halt the progression of atherosclerosis, as well as lower your risk of heart attacks and stroke.  

Using invasive techniques, physicians can also open up blockages from atherosclerosis, or go around them:

• Angiography and stenting: Cardiac catheterization with angiography of the coronary arteries is the most common angiography procedure performed. Using a thin tube inserted into an artery in the leg or arm, doctors can access diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (catheters with balloon tips) and stenting can often open up a blocked artery. 
• Bypass surgery: Surgeons "harvest" a healthy blood vessel (often from the leg or chest). They use the healthy vessel to bypass a segment blocked by atherosclerosis.

These procedures involve a risk of complications. They are usually saved for people with significant symptoms or limitations caused by atherosclerosis.