There are a number of diagnostic tests and procedures available to diagnose and confirm the presence of atherosclerosis. Similarly, there are conservative and surgical options to treat it, which your doctor will decide after seeing the results of your diagnostic tests.
The doctor has blood tests and imaging tests at his disposal to help in the early diagnosis of atherosclerosis.
The broad aims of diagnosing atherosclerosis are:
- To confirm the cause of the symptoms, if any
- Identifying the risk factors and weighing the prognosis with a particular need for revascularization.
Your doctor first takes your personal and family history to see where you stand vis-à-vis risk factors. He will perform a physical exam and auscultate your heart to see if there are any worrying factors about the heart sounds.
Your doctor may order one or more of the following tests and procedures including:
High levels of blood sugar and cholesterol raise your risk of atherosclerosis.
- For blood sugar. Your doctor will order diagnostic blood tests to screen for diabetes such as the blood sugar tests and the HBA1C test. This is done because diabetes and high cholesterol often coexist.
- Cholesterol levels. Your doctor will also order a lipid profile test to check your cholesterol and triglyceride levels
- A C-reactive protein (CRP) test. This protein rises in inflammation of the arteries, a marked sign of atherosclerosis.
Electrocardiogram (ECG or EKG)
This simple and painless test records the electrical activity of your heart. A heart attack is a complication of atherosclerosis. An ECG can reveal signs of a heart attack and any associated heart damage.
During an acute coronary artery blockage, the ECG will show typical changes to the ST segment. And the Q waves can indicate a sign of a previous heart attack.
Exercise stress test
Your doctor may order a stress test when your ECG is normal and if you harbor any risk factor for a heart condition or develop pain or unusual shortness of breath after physical activity.
A stress test also called the treadmill test (TMT) is nothing but the recording of the electrical activity of your heart during different levels of physical activity such as walking on a treadmill.
This test uses sound waves to show how well blood moves in the heart and the main arteries when the heart is beating. It measures the speed and direction of blood flow within the heart and vessels. It can detect blocked or leaking valves and check blood pressure in the heart arteries.
It provides information about the size and shape of your heart and how well your heart chambers and valves are working. Besides identifying areas of poor blood flow to the heart, it shows areas of the heart muscle that aren’t contracting normally and any previous injury to the heart muscle caused by inadequate blood flow.
A Doppler ultrasound measures the blood pressure at various points along your arm or leg. This way your doctor can determine the degree of any blockages in the arteries of the limbs.
Ankle-brachial index (ABI)
This test can tell if there is a difference in the blood pressure in the upper and lower limb, which should be about the same. Any drop in the blood pressure of a particular limb indicates an interruption in blood flow due to atherosclerosis.
During an ABI test, your doctor compares the blood pressure in your ankle with the blood pressure in your arm. An abnormal difference may be a sign of peripheral vascular disease, which is usually caused by atherosclerosis.
Cardiac catheterization and angiogram
During this procedure, a doctor inserts a thin, flexible tube (catheter) into a blood vessel of your groin and into your heart. A radiopaque dye is injected through a catheter into your coronary artery network. Your doctor can directly visualize any narrowing or blockage of the coronary arteries.
Coronary calcium scan
Also called a heart scan, this test uses computerized tomography (CT) imaging to take detailed pictures of the inside of your heart. It can show calcium deposits if any in the artery walls. The presence of calcium indicates a higher risk of heart disease.
Other imaging tests
Magnetic resonance angiography (MRA) or Positron emission tomography (PET) can show the narrowing or hardening of large arteries, as well as the presence of aneurysms.
Atherosclerosis cannot be cured and reversed completely. However, managing it in the early stages makes it easier to treat.
Once diagnosed, your doctor will decide on treatment options for your atherosclerosis to prevent it from getting worse and causing life-threatening complications such as a heart attack or stroke.
Before starting you on drugs for your atherosclerosis or prescribing a surgical option, your doctor will advise you on the first line of managing atherosclerosis.
That will be to adopt certain lifestyle changes, which can slow or even reverse the progression of atherosclerosis. In some cases, that’s all that may be needed to treat your atherosclerosis and keep it under control. These lifestyle incorporations include:
- Follow a heart-healthy diet. Avoid foods high in cholesterol
- Aim for a healthy weight
- Get enough exercise.
- Try to manage stress
- Stop smoking
- Limit alcohol intake
However, sometimes, medication or surgical procedures may be needed.
Medications for atherosclerosis
Many types of drugs are available to slow the progression or even reverse the progress of atherosclerosis.
- Statins and other cholesterol medications effectively lower your low-density lipoprotein LDL cholesterol, the bad cholesterol, which is mainly responsible for atherosclerotic plaque buildup in your arteries. Statins can slow, stop or even partially reverse atherosclerosis. Statins also improve artery health and prevent further atherosclerosis. Another common type of cholesterol medication is a cholesterol absorption inhibitor called ezetimibe (Zetia). Your doctor may put you on one or more than one such medication.
- Blood thinners. Blood-thinning medications, such as aspirin, lower your risk of platelets clumping together in narrowed arteries, forming a blood clot and causing further blockage.
- Blood pressure medications help to lower your risk of a heart attack. Beta-blockers lower your blood pressure and heart rate, get rid of chest pains, and lower the risk of heart attack and arrhythmias. Angiotensin-converting enzyme (ACE) inhibitors lower your high blood pressure and the risk of a heart attack. Calcium channel blockers and diuretics (water pills) can reduce blood pressure.
- Diabetes medications. Your doctor may prescribe other medications to control risk factors of atherosclerosis such as diabetes.
- Anti-inflammatory medications will help reduce inflammation and give relief from symptoms of atherosclerosis, such as leg pain during physical activity (claudication pain). Cilostazol and pentoxifylline (Pentoxil) are other drugs that your doctor may prescribe to increase blood flow to the limbs by keeping the blood thin and by vasodilatation (widening the blood vessels).
Surgery or medical procedures
If you have severe atherosclerosis, your doctor may recommend a more aggressive line of treatment that involves a medical procedure or surgery. Options include:
- Angioplasty and stent placement. This procedure, also called percutaneous coronary intervention (PCI), helps open a blocked artery. It is usually an emergency treatment for a heart attack and is also done prophylactically when the person has been diagnosed as high-risk with a significant amount of blockage in the artery.
Angioplasty can be done on the coronary arteries of the heart, in which case it is called coronary angioplasty. It helps to treat or prevent heart attack.
- Cerebral angioplasty is used to open narrowed or blocked vertebral and carotid arteries in the neck, as well as blood vessels within the brain (intracranial atherosclerosis). It is done to treat and prevent stroke. Cleveland Clinic gives a detailed note on this procedure.
- Endarterectomy involves the surgical removal of part of the inner lining of an artery, together with the obstructive plaque buildup. It is often carried out on the carotid artery (carotid endarterectomy), the coronary artery (coronary endarterectomy), or on vessels supplying the legs (femoral endarterectomy).
- Fibrinolytic therapy. If a blood clot is blocking your artery, your doctor may use a clot-dissolving drug such as tissue plasminogen activator (tPA), to break it apart. Fibrinolytic therapy also referred to as thrombolytic therapy, is used to dissolve blood clots by activating plasminogen giving rise to the formation of plasmin, which splits the fibrin causing thrombus breakdown.
- Coronary artery bypass surgery. This is an open-heart surgery to treat coronary heart disease caused by a blocked coronary artery. Your cardiac surgeon takes a healthy blood vessel from another part of the body (usually the chest, leg, or arm) to create a bypass around the blocked artery and redirect blood flow. Sometimes the bypass is a graft made of synthetic material.
The prognosis of atherosclerosis is good when the condition is treated early. It improves because of the advances in the management of risk factors such as LDL-cholesterol with statin therapy, Blood pressure, diabetes, and improvement in lifestyle with smoking cessation, exercising regularly, and adhering to a healthy diet.
The prognosis worsens with the setting in of complications such as heart failure, ischemic stroke, gangrene, and rupture of an abdominal aneurysm.