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Atherosclerosis

Atherosclerosis is the buildup of fatty plaque on arteries’ interior lining. While symptomless early on, it can lead to artery blockage and increased clot formation, which can cause a wide range of serious atherosclerotic cardiovascular diseases, most commonly coronary heart disease and stroke. Lifestyle factors such as poor diet, little exercise, and smoking play a huge role in the progression of atherosclerosis and its associated diseases.

Our evidence-based analysis on atherosclerosis features 8 unique references to scientific papers.

Research analysis led by and reviewed by the Examine team.
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Summary of Atherosclerosis

What is atherosclerosis?

Atherosclerosis refers to the buildup of fatty plaque on the interior lining of the arteries — the medium- and large-sized blood vessels that carry nutrients and oxygen to tissues throughout the body. The plaque is made up of fats, calcium, and more. The formation of these plaques damage the inside surface of the arteries and leads to more plaque buildup, inflammation, artery hardening and narrowing, and an increased risk of clotting.[1] Severe plaque buildup leads to a wide range of diseases, including coronary artery disease, carotid artery disease (blockage of the arteries feeding into the brain), and peripheral arterial disease (blockage of arteries in the arms, legs, or pelvis).[2]

Atherosclerosis should not be confused with arteriosclerosis, which refers to general thickening and stiffening of blood vessels of all sizes. [1] Atherosclerosis can be considered a type of arteriosclerosis since it can ultimately lead to stiffer and thicker blood vessels.[3]

What are the main signs and symptoms of atherosclerosis?

Signs (what can be measured objectively)

Atherosclerosis can be visualized using a process called angiography. While this is one of the better methods for assessing atherosclerosis, it’s not usually used for routine screening since it’s invasive.[4] Other less invasive methods can be used to assess atherosclerosis, including coronary calcium scans that measure calcium buildup inside heart arteries (less invasive, but involves radiation exposure) and the ankle-brachial test (noninvasive; mainly relates to atherosclerosis in the peripheral arteries, but atherosclerosis in the periphery is correlated with atherosclerosis elsewhere in the body[4]). [5] 

When atherosclerosis gets bad enough, it will share the same signs as the clinical diseases it’s causing, like coronary artery disease and peripheral artery disease.

Symptoms (what can be perceived subjectively)

Atherosclerosis is usually symptomless until it starts causing other atherosclerotic cardiovascular diseases like coronary artery disease.[6] 

How is atherosclerosis diagnosed?

Atherosclerosis isn’t usually diagnosed directly through imaging or the other measurements mentioned above. Instead, it’s either diagnosed through the criteria for the clinical diseases it leads to (e.g., peripheral artery disease) or assessed on the basis of risk factors such as biomarkers like high blood pressure or LDL-C, demographics like age, or behaviors like smoking.

What are some of the main medical treatments for atherosclerosis?

Medical treatment options depend on the type of clinical disease and how far it’s progressed.

If a person doesn’t have clinical disease yet, then the main medical treatments usually target the major risk factors of high cholesterol and high blood pressure using drugs like statins and antihypertensives as spelled out in major guidelines.[7] 

Medical treatment is often added on top of lifestyle changes, since lifestyle plays a large role in atherosclerosis. The major lifestyle recommendations are discussed more below.

Have any supplements been studied for atherosclerosis?

Yes, although exactly which supplements qualify depends on whether you count studies involving markers tightly related to atherosclerosis like LDL-C or only count studies that measure atherosclerosis more directly. A lot more studies have looked at biomarkers related to atherosclerosis than direct measurements. However, since a lot of studies have examined biomarkers like LDL-C and blood pressure that are firmly established to actually cause atherosclerosis, the evidence base isn’t too bad.

A very incomplete list of supplements examined for impact on atherosclerosis or its biomarkers include:[8]

  • Omega-3 and omega-6 polyunsaturated fatty acids

  • Garlic and allicin (one of garlic’s main bioactives)

  • Plant sterols

  • Flavanols

  • Fiber

  • Antioxidant vitamins such as vitamin C and vitamin E

What's the connection between diet and atherosclerosis?

Diet plays a huge role in atherosclerosis through impacting many of its associated risk factors, such as obesity, high cholesterol, high blood pressure, and diabetes. Recent guidelines cite strong evidence that weight loss in people with overweight or obesity can reduce atherosclerotic disease risk. There’s also strong evidence that a diet high in fruits, veggies, legumes, nuts, whole grains, and fish can reduce the risk for diseases caused by atherosclerosis. Weaker evidence suggests that swapping out saturated fat with mono- or polyunsaturated fats and minimizing processed meats and refined carbohydrates can also help.[7] 

Are there any other treatments for atherosclerosis?

Two of the biggest lifestyle changes beyond diet that can impact atherosclerosis are quitting smoking and getting aerobic exercise. To reduce atherosclerotic risk, people should ideally perform at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or a combination of the two each week.[7] A rule of thumb to measure intensity is the talk test: moderate aerobic activity makes it hard to sing but not to talk, whereas it’s hard to say more than a few words at a time during vigorous aerobic exercise.

What causes atherosclerosis?

Quite a few factors are needed to cause atherosclerosis, the main ones being damage to the artery lining, fats, and inflammation.

Atherosclerosis starts with damage to the interior lining of medium and large arteries, which often occurs in arteries that are under high pressure and tension, a process that can start in childhood. This damage leads to the fats — which are mostly in the form of low density lipoprotein (LDL) — being trapped in the interior arterial lining. The fats then get oxidized, which attracts white blood cells — mainly macrophages — to try to clean up the mess. However, when there’s a lot of fat to clean up, the macrophages overdo it and transform into foam cells, which is one of the main ingredients of atherosclerotic plaque formation.

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Human Effect Matrix

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The Human Effect Matrix looks at human studies to tell you what supplements affect Atherosclerosis.

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Grade Level of Evidence
Robust research conducted with repeated double-blind clinical trials
Multiple studies where at least two are double-blind and placebo controlled
Single double-blind study or multiple cohort studies
Uncontrolled or observational studies only
Level of Evidence
? The amount of high quality evidence. The more evidence, the more we can trust the results.
Supplement Magnitude of effect
? The direction and size of the supplement's impact on each outcome. Some supplements can have an increasing effect, others have a decreasing effect, and others have no effect.
Consistency of research results
? Scientific research does not always agree. HIGH or VERY HIGH means that most of the scientific research agrees.
Notes
grade-c Minor - See study
Stasis has been reported in the growth of arterial plaque over 48 months when people consume 900mg of garlic, but this effect may only be statistically significant for women.
grade-c Minor - See study
In high risk subjects, supplementation of ginkgo biloba appeared to reduce atherosclerotic buildup relative to control at the standard supplemental dose.
grade-d
Minor
- See 2 studies
On the one hand, one study found a reduction in carotid intima-medial thickness over the course of 12 weeks, and another found no effect on total plaque volume after 6 months, but did find a notable increase in stenosis when taking carnitine, though most of the study isn't available. Much more research is needed to discern what can be expected from long-term carnitine supplementation.

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grade-d  

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