Coronary Atherosclerosis

Symptoms | Treatments

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What is

Symptoms

How to prevent

Causes and Risk Factors

Diagnosis

Treatment

Other Information

What is - Coronary Atherosclerosis

What is coronary atherosclerosis?

stages of coronary atherosclerosis

Coronary atherosclerosis is an accumulation of fatty deposits in the coronary artery wall. As coronary atherosclerosis progresses, this leads to gradual narrowing of the coronary arteries that are responsible for supplying nutrient to the muscle of the heart. This is known as coronary artery disease and is often associated with heart attack, heart failure and other cardiac health issues.

What are the types of coronary atherosclerosis?

Coronary atherosclerosis can be categorised as:

Stable Atherosclerosis: Firm plaque with a thick fibrous cap. It causes gradual artery narrowing, leading to predictable chest pain during exertion.
Unstable Atherosclerosis: Plaque with a thin cap, prone to rupture. This can result in sudden blockages and heart attacks, often with severe chest pain.
Non-Obstructive Atherosclerosis: Less than 50% narrowing, often asymptomatic but can still lead to plaque rupture.
Obstructive Atherosclerosis: Over 50% narrowing, restricting blood flow and causing significant chest pain.
Calcified Atherosclerosis: Hardened plaque due to calcium deposits, leading to arterial stiffness.

What are the possible complications of coronary atherosclerosis?

Coronary artery disease: Coronary atherosclerosis can lead to coronary artery disease when the coronary arteries become significantly obstructed.
Heart attack: When atherosclerotic plaque breaks, it results in clot formation. The clot blocks the coronary artery and prevents oxygen and nutrients from reaching the heart. This causes irreversible damage and muscle death in certain areas of the heart, called a heart attack.
Heart failure: If the heart muscle is damaged, the heart becomes weak and stiff, thus losing its ability to effectively pump blood to other parts of the body which results in heart failure.

Symptoms of Coronary Atherosclerosis

What are the symptoms of coronary atherosclerosis?

Atherosclerosis often develops over time, with mild cases typically presenting no symptoms. However, as it progresses and the blockage in the arteries becomes more serious, individuals may experience symptoms such as chest pain or angina, shortness of breath, fatigue, weakness and palpitations.

Chest pain, especially upon exertion, may indicate a more severe condition, and if the pain lasts more than 10 to 20 minutes, it could be a heart attack.

When should you see a doctor?

If you experience any of these symptoms, it is crucial to visit your doctor promptly, as early detection and treatment of coronary atherosclerosis can prevent it from worsening and reduce the risk of serious conditions like heart attack or stroke.

Coronary Atherosclerosis - How to prevent

How is coronary atherosclerosis prevented?

There are many ways one can prevent coronary atherosclerosis:

Eat a healthy diet: Eat foods that are high in fibre and wholegrains. Avoid foods with excessive salt, sugar or saturated fats

Recommended servings of different food types for better heart health.

Regular exercise: Aerobic exercises such as jogging, brisk walking or cycling are the best types of exercises for heart health. One should ideally complete 150 minutes of moderate-intensity exercise each week. Please seek your doctor’s advice if you are unsure of the suitable level of intensity for yourself.
Achieving and maintaining a healthy body mass index (BMI): The healthy range for Asians is from 18.5 to 22.9 kg/m².
Get sufficient sleep: One should aim to get six to eight hours of sleep daily. Inadequate sleep (≤4 hours) or excess sleep (≥10 hours) has been associated with increased risk of coronary artery disease.
Stop smoking: Smoking contributes to atherosclerosis and increases the risk of a heart attack. Many smoking cessation aids can improve your chances of success in trying to quit smoking. Speak to your doctor for help with quitting smoking.
Reduce alcohol consumption: You should not take more than 2 glasses of wine or 1 can of beer a day.

Coronary Atherosclerosis - Causes and Risk Factors

What causes coronary atherosclerosis?

Though the exact cause of coronary atherosclerosis is unknown, a number of modifiable and non-modifiable risk factors increase a person’s possibility of having it.

What are the risk factors for coronary atherosclerosis?

Modifiable risk factors

High blood pressure (hypertension): High blood pressure can cause damage to the walls of blood vessels, allowing plaque to build up.
High cholesterol: Your total cholesterol levels should be kept as low as possible because any excess cholesterol may be deposited in the arteries. This build-up causes the arteries to harden and narrow, preventing or reducing blood flow to the heart.
Smoking: Nicotine, a chemical found in cigarettes, causes damage to blood vessels and also can cause constriction of vessels.
Diabetes mellitus: Diabetes results in damage of the inner layers of blood vessels, increasing the build-up of plaque.
Obesity: Being overweight can increase one’s risk of coronary atherosclerosis.
Unhealthy diet: Eating foods high in saturated fats can increase the level of cholesterol in the body which causes the build-up of plaque that clog the arteries.
Lack of exercise: An inactive lifestyle is associated with increased risk of coronary atherosclerosis.

Non-modifiable risk factors

Age: Those who are older have a higher risk of developing coronary atherosclerosis.
Genetics: Those with a family history of coronary atherosclerosis are more likely to suffer from this condition.

Video - Myths & Facts on Heart Attack and How to Reduce Risks

Diagnosis of Coronary Atherosclerosis

How is coronary atherosclerosis diagnosed?

Coronary atherosclerosis can be diagnosed with a physical exam or certain tests.

In a physical exam, your doctor might,

Listen to your heart with a stethoscope.
Ask about your medical and family history.
Ask about your lifestyle.
Check your symptoms.
Measure your blood pressure.

There are also some tests that can help doctors in your assessment. Some may have accompanying risks or radiation and will be ordered when there are good indications for the test. These tests include:

Blood tests: Blood tests can be conducted to identify risk factors of atherosclerosis such as high cholesterol and sugar levels.
Cardiac Catheterisation: A long thin tube (catheter) is inserted into the coronary arteries to determine the exact location and severity of any narrowed coronary arteries.
Cardiac Computed Tomography (CT) scan: A CT scan shows the location and severity of the plaque build-up in your arteries.
Cardiac Magnetic Resonance Imaging (CMR): The CMR can help detect damage in heart tissues or issues with blood flow.
Echocardiogram: An echocardiogram or heart ultrasound shows how well the heart is pumping.
Electrocardiogram (ECG): An ECG gives information on heart rhythm and electrical activity.
Exercise stress test: Patients will be asked to exercise while connected to an electrocardiogram (ECG) machine to detect changes in the ECG which might suggest blocked coronary arteries. In the event that patients are unable to exercise, medications can be given to induce the effects of exercise on the heart.

Treatment for Coronary Atherosclerosis

How is coronary atherosclerosis treated?

Coronary atherosclerosis can be treated by making lifestyle changes, taking medication or through various procedures.

Lifestyle changes

Exercise regularly
Adopt a healthy diet
Quit smoking (if you smoke)
Manage stress
Achieve and maintain a healthy weight
Keep your cholesterol, blood sugar and blood pressure levels in check

Medication

If a patient’s condition does not improve after making lifestyle changes, medications may be prescribed. These medications generally aim to:

Lower blood pressure
Lower cholesterol levels
Reuce blood-clotting

Procedures

1) Coronary angioplasty

A stent is inserted into the narrowed artery to keep it open and allow blood to flow through

A coronary angioplasty or percutaneous coronary intervention (PCI) is a minimally invasive procedure that treats severe blockages of the coronary arteries. In this procedure, a small balloon or stent is used to keep the blocked part of the artery open, allowing more oxygenated blood to flow through. The latest option within coronary angioplasty is to use stents covered with a drug (drug-eluting stents) which supposedly reduce the likelihood of re-narrowing of the arteries.

2) Coronary artery bypass grafting

Atherosclerosis | Coronary artery bypass grafting

A bypass graft vessel allows oxygenated blood to bypass the blocked arteries and restore blood flow to the heart

A coronary artery bypass grafting (CABG) is an operation where healthy veins and/or arteries are used to create new pathways for blood to flow, bypassing the narrowed arteries. It is usually recommended to patients with severe coronary atherosclerosis to relieve its symptoms. Typically, it is performed as an open-heart surgery which involves opening up the patient’s chest but recently, minimally invasive CABG methods have been introduced to reduce recovery time.

Coronary Atherosclerosis - Other Information

What foods should you avoid if you have atherosclerosis?

To manage atherosclerosis, it is important to avoid foods high in saturated fats, trans fats and cholesterol. These include fried foods, processed meats, full-fat dairy products and baked goods. It is also advisable to limit your intake of salt and sugar.

What is the best exercise for atherosclerosis?

The best exercise for atherosclerosis is aerobic exercise, such as walking, jogging, cycling or swimming. These activities help improve cardiovascular health, strengthen the heart muscle and increase circulation, which can help fight atherosclerosis. It is important to consult with our doctors before starting any exercise programme.

How does stress affect atherosclerosis?

Chronic stress can contribute to the progression of atherosclerosis by increasing blood pressure and inflammation. Managing stress through relaxation techniques, exercise or counselling can help reduce its negative impact on heart health.

View our Guide for Patients with Coronary Atherosclerosis, in English and Mandarin:

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References

U.S. Department of Health and Human Services. (n.d.). What is coronary heart disease?. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/coronary-heart-disease
Coronary artery disease (atherosclerosis). University of Ottawa Heart Institute. (2024, April 4). https://www.ottawaheart.ca/heart-condition/coronary-artery-disease-atherosclerosis
Centers for Disease Control and Prevention. (n.d.). About coronary artery disease (CAD). Centers for Disease Control and Prevention. https://www.cdc.gov/heart-disease/about/coronary-artery-disease.html
Elgohari, A. (2023). Assessment of atherosclerosis in patients with suspected coronary artery disease by carotid artery Doppler ultrasound and coronary calcium score. Atherosclerosis, 379. https://doi.org/10.1016/j.atherosclerosis.2023.06.608
Popov, M., & Ivanov, A. (2024). Effect of coronary artery bypass grafting on blood aminothiols in patients with coronary artery atherosclerosis. Atherosclerosis, 395, 118227. https://doi.org/10.1016/j.atherosclerosis.2024.118227