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Atherosclerosis - Symptoms and Diagnosis
Last reviewed: 04.07.2025
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Symptoms of atherosclerosis
Atherosclerosis initially develops asymptomatically, often over many decades. Signs of atherosclerosis appear when blood flow is obstructed. Transient ischemic symptoms (eg, stable angina, transient ischemic attacks, intermittent claudication) may develop when stable plaques enlarge and reduce the arterial lumen by more than 70%. Symptoms of unstable angina, MI, ischemic stroke, or resting leg pain may occur when unstable plaques rupture and suddenly obstruct a major artery, with the addition of thrombosis or embolism. Atherosclerosis may also cause sudden death without preceding stable or unstable angina.
Atherosclerotic lesions of the arterial wall can lead to aneurysms and arterial dissection, which manifests itself as pain, pulsating sensations, lack of pulse, or causes sudden death.
Diagnosis of atherosclerosis
The approach depends on the presence or absence of signs of the disease.
[ Symptomatic course of atherosclerosis
Patients with signs of ischemia are assessed for the extent and location of vascular occlusion using a variety of invasive and noninvasive tests depending on the organ involved (see other sections of the guide). Risk factors for atherosclerosis include a history, physical examination, lipid profile, blood glucose levels, and HbA1 and homocysteine levels.
Since atherosclerosis is a systemic disease, if damage is detected in one area (eg, peripheral arteries), other areas (eg, coronary and carotid arteries) must also be examined.
Because not all atherosclerotic plaques pose the same risk, imaging tests are used to identify those plaques that are particularly at risk of rupture. Most tests require catheterization of the vessel; they include intravascular ultrasound (uses an ultrasound probe placed at the tip of a catheter that can produce an image of the arterial lumen), angioscopy, plaque thermography (to detect elevated temperatures in plaques with active inflammation), optical cross-sectional imaging (uses an infrared laser to produce images), and elastography (to identify soft, lipid-rich plaques). Immunoscintigraphy is a noninvasive alternative that uses radioactive substances that accumulate in unstable plaque.
Some clinicians examine serum markers of inflammation. CRP levels > 0.03 g/L are important predictors of cardiovascular events. High lipoprotein-associated phospholipase A2 activity is thought to predict cardiovascular events in patients with normal or low LDL levels.
Asymptomatic atherosclerosis
In patients with risk factors for atherosclerosis without evidence of ischemia, the value of additional studies is unclear. Although imaging studies such as multi-site CT, MRI, and ultrasound may detect atherosclerotic plaque, they do not improve the accuracy of predicting ischemia compared with risk factor assessment (eg, Framingham risk index) or imaging findings and are not generally recommended.
Microalbuminuria (>30 mg albumin in 24 h) is a marker of kidney damage and its progression, as well as a powerful predictor of cardiovascular and vascular morbidity and mortality; however, a direct relationship between microalbuminuria and atherosclerosis has not been established.