Atherosclerosis - Signs and Symptoms

Signs and Symptoms

Atherosclerosis does not occur in children, but can begin as early as the teen years. Until progressing to an advanced stage, it is usually symptomless. Atheroma in arm, or more often in leg arteries, which produces decreased blood flow is called peripheral artery occlusive disease (PAOD). Typically, atherosclerosis begins as a thin layer of white streaks on the artery wall (usually due to white blood cells) and progresses from there.

According to United States data for the year 2004, for about 66% of men and 47% of women, the first symptom of atherosclerotic cardiovascular disease is heart attack or sudden cardiac death (death within one hour of onset of the symptom).

Most artery flow disrupting events occur at locations with less than 50% lumen narrowing (~20% stenosis is average). The illustration above, like most illustrations of arterial disease, overemphasizes lumen narrowing, as opposed to compensatory external diameter enlargement (at least within smaller arteries, e.g., heart arteries) typical of the atherosclerosis process as it progresses (see Glagov or the ASTEROID trial). The relative geometry error within the illustration is common to many older illustrations, an error slowly being more commonly recognized within the last decade.

Cardiac stress testing, traditionally the most commonly performed non-invasive testing method for blood flow limitations, in general, detects only lumen narrowing of ~75% or greater, although some physicians claim that nuclear stress methods can detect as little as 50%.

A famous case study involved autopsies of American soldiers killed in WWII and the Korean War. Although these were mostly young, healthy men in their 20s, many already had evidence of developing atherosclerosis. Other studies done on soldiers in the Vietnam War showed similar results, although often worse than the ones from the earlier wars. Theories include high rates of tobacco use and (in the case of the Vietnam soldiers), the advent of processed foods after WWII.