Central Atherosclerosis

What "central atherosclerosis" means

Atherosclerosis is the build-up of plaque, made of cholesterol, inflammatory cells, scar tissue and calcium, inside the walls of arteries. Plaque narrows the artery, stiffens it, and can crack, triggering a clot.

Doctors sometimes divide arterial disease by location:

• Central: the aorta, the coronary arteries to the heart, the carotid arteries to the brain, and the renal arteries to the kidneys
• Peripheral: the arteries to the legs and arms (peripheral artery disease)

"Central atherosclerosis" is not a formal diagnosis. You may see it, or terms such as "aortic atherosclerosis" or "atherosclerotic calcification of the aorta", on an imaging report. It tells you that plaque is present in these large central vessels. Atherosclerosis is a body-wide process, so finding it in one place means it is probably present elsewhere too, including in the coronary arteries.

Symptoms

Central atherosclerosis causes no symptoms until an artery is narrowed enough to limit blood flow, or a plaque ruptures. Symptoms depend on which artery is affected:

Causes and risk factors

Plaque begins when the inner lining of the artery is damaged and LDL cholesterol enters the wall. Risk factors that drive this include:

• Age: plaque builds over decades. Men are affected about 10 years earlier than women on average
• Smoking: one of the strongest risk factors for aortic disease and aneurysm
• High blood pressure
• High LDL cholesterol and raised lipoprotein(a)
• Diabetes and insulin resistance
• Family history of early heart disease (a father or brother before 55, a mother or sister before 65)
• Obesity, inactivity and unhealthy diet
• Chronic kidney disease and chronic inflammatory diseases such as rheumatoid arthritis

Diagnosis

Central atherosclerosis is often found by chance. Tests that show it include:

• Chest X-ray or CT: calcium in the wall of the aorta (aortic knob calcification)
• Coronary artery calcium (CAC) score: a quick CT scan that measures calcified plaque in the heart arteries and helps decide on preventive treatment
• Carotid ultrasound: plaque or narrowing in the neck arteries
• Abdominal ultrasound: screens for aortic aneurysm. In the US, a one-time screen is recommended for men aged 65 to 75 who have ever smoked
• Stress testing or CT coronary angiography: if you have chest symptoms
• Blood tests: cholesterol panel, lipoprotein(a), HbA1c (blood sugar) and kidney function

Doctors combine these results with your age and risk factors to estimate your 10-year risk of heart attack and stroke.

Treatment

There is no way to remove plaque completely, but treatment can stabilize it, slow its growth and sharply reduce the risk of heart attack and stroke.

Lifestyle changes

• Stop smoking: the single most effective step, and the risk falls within a year of quitting
• Exercise: at least 150 minutes a week of moderate activity such as brisk walking
• Eat a heart-healthy pattern: more vegetables, fruit, whole grains, legumes, nuts and fish; less processed meat, refined starch and salt
• Reach and keep a healthier weight, and limit alcohol

Medicines

• Statins lower LDL cholesterol and stabilize plaque. Most people with known atherosclerosis are advised to take one. Other cholesterol-lowering drugs (ezetimibe, PCSK9 inhibitors) are added if needed
• Blood pressure medicines to reach a target set by your doctor, often below 130/80 mm Hg
• Antiplatelet medicine such as low-dose aspirin for people with established disease. Do not start aspirin on your own, because it increases bleeding risk and is not advised for everyone
• Diabetes treatment, including medicines that also protect the heart

Procedures

• Stents or bypass surgery for severe coronary narrowing
• Carotid surgery or stenting for significant narrowing after a stroke or TIA
• Aneurysm repair when an aortic aneurysm reaches a size where rupture risk outweighs surgical risk, typically 5.5 cm in men

Complications

• Heart attack and heart failure
• Stroke and vascular dementia
• Aortic aneurysm and its rupture
• Kidney artery narrowing and chronic kidney disease
• Embolism: fragments breaking off from aortic plaque and blocking smaller arteries in the brain, kidneys, gut or toes

Outlook

Plaque found on a scan is a warning, not a sentence. People who stop smoking, take a statin and control blood pressure and blood sugar cut their risk of future heart attack and stroke substantially. Regular follow-up with your primary care doctor, and sometimes a cardiologist or vascular specialist, keeps risk factors on target.

Frequently asked questions

What does central atherosclerosis mean?

It means plaque build-up in the large central arteries: the aorta and its main branches to the heart, brain and kidneys. It is a description of where atherosclerosis is found, often on a scan, rather than a separate disease. It signals a higher risk of heart attack and stroke.

Is atherosclerosis of the aorta serious?

It is a marker of increased cardiovascular risk and can lead to aneurysm or small clots breaking off. Found early, it is very manageable. Treatment with a statin, blood pressure control and stopping smoking lowers the risk of complications.

Can central atherosclerosis be reversed?

Plaque cannot usually be removed, but intensive cholesterol lowering can shrink soft plaque slightly and make it more stable, so it is less likely to rupture. Calcified plaque stays, but the risk of events falls with treatment.

What are the symptoms of central atherosclerosis?

There are usually none until blood flow is reduced. Then symptoms depend on the artery: chest pain on exertion from the heart arteries, mini-strokes from the neck arteries, belly pain after meals from the gut arteries, or high blood pressure from the kidney arteries.