What Are the Tests for Atherosclerosis?

Atherosclerosis develops slowly over time without obvious signs and symptoms. People who have the disease often don’t know they have it. That’s why it’s important to get regular exams and doctor-recommended screenings if you’re at risk.

Defining Atherosclerosis

When someone has high cholesterol, the excess fatty, waxy substance eventually begins to collect on the arterial walls. Atherosclerosis develops as more cholesterol is deposited and the body reacts to the buildup by sending white blood cells to attack it, much like they’d attack a bacterial infection. Eating the cholesterol kills the white blood cells. The dead cells also collect where the cholesterol was originally deposited. This results in inflammation. If the inflammation lasts for a long time, scarring eventually occurs. By this stage, the plaque formed in the arteries also contains calcium and has hardened.

Blood is unable to reach areas it needs to because the artery is now narrower. There’s also a higher risk that if a blood clot breaks away from another area in the body, it could get stuck in the narrow artery and cut off blood supply completely, causing a heart attack or stroke. Large plaque buildups are at risk of dislodging and quickly sending the formerly trapped blood supply to the heart. The sudden rush of blood can stop the heart, causing a life-threatening heart attack. 

Physical Exam

The risk factors for atherosclerosis include:

• obesity
• diabetes
• high cholesterol
• high blood pressure
• a family history of heart disease
• smoking cigarettes

Your doctors will take these into consideration at exam time. These factors will influence what type of testing is recommended.

According to Dr. Howard Weintraub, cardiologist at NYU Langone Medical Center, “in many cases you don’t need [imaging] tests. People who are intermediate in risk are the ones you do imaging tests for. If your patient has other health issues, you don’t need tests. You can check arteries in arms and feet with [an] ankle-brachial index (ABI) test, which is a good screening method and we know that that works.”

Tests

Your doctor may also use the following tests:

Blood Test

Your first line of defense against atherosclerosis is to make sure you keep your cholesterol numbers in check. To keep track of these numbers, your doctor will use a blood test called a lipid panel.

Usually at your annual physical, blood is drawn using a needle and then collected in a vial. You’ll likely be asked to fast before coming in for blood work to make sure you get an accurate reading. Drawing blood only takes a couple of minutes and is relatively painless. You may experience some soreness or bruising on your arm around the puncture site.

The blood is then sent to a lab where it’s analyzed for cholesterol levels. 

Ankle-Brachial Index (ABI)

An ankle-brachial index (ABI) compares the blood pressure in your ankle to the blood pressure in your arm. The test takes only a few minutes, and you don’t need to prepare for it ahead of time.

While you lie on an exam table, your doctor will use a blood pressure cuff and a handheld ultrasound to read the blood pressure in your ankle and your arm. After taking the numbers, your doctor will then compare them. If the blood pressure in your ankle is lower than the blood pressure in your arm, it’s a sign you have blockages. Your doctor may then recommend additional tests, like the ones listed below, to see the severity of your atherosclerosis.

Electrocardiogram (EKG)

An EKG measures your heart’s electrical activity. The test can find damage done to the heart by atherosclerosis. It’s a painless procedure that you don’t need to prepare for in advance.

The test can be done either in a doctor’s office or hospital. As you lie on an exam table, a healthcare provider will place about 12-15 sticky patches, called electrodes, on your chest. These are hooked to a device that measures your heartbeat.

Your doctor will look to see what your heart rate is. If it’s faster or slower than the normal range of 50-90 beats per minute, this could be a sign of an underlying issue like atherosclerosis.

Echocardiogram  

An echocardiogram lets your doctor see how well your heart is pumping blood. It uses sound waves to make pictures of the way your heart beats and pumps blood. The standard test doesn’t require any special prep and can be done at a doctor’s office or hospital.

You’ll be asked to take off your shirt so that sticky patches (electrodes) can be placed on your chest. The doctor will also put special gel on your chest before touching a small plastic device your skin. The device sends and receives sound waves to create images on a monitor. 

Depending on what’s found during this test, your doctor may also recommend a CT scan or angiography.

CT Scan

A CT scan takes pictures from different angles and creates 3-D computer-generated images of the heart. This test shows much finer detail than regular X-rays, so it can show hardening and narrowing of the arteries or where calcium has built up.

The test is done in a hospital or outpatient facility. You’ll be asked to remove jewelry and other metal objects that could interfere with the scan. In order to get a better picture of blood vessels and arteries, you may also be injected with a special dye.

You’ll be asked to lie on a table that will move you through the CT scanner, which is shaped like a large letter “O.” The technician may give you a pillow for comfort and place straps on you so you don’t move while the x-ray machine rotates around you taking pictures. The process takes about 30 minutes.

After the test, a radiologist will look at the results and report to your doctor. Your doctor will discuss treatment options with you based on these findings.

Angiography

An angiography uses a special liquid dye along with an X-ray to allow doctors to see the insides of your arteries. A small thin tube is threaded up one of your main arteries, usually through the thigh (femoral) area. The tube goes up to your coronary arteries where it can then deliver the special dye. While the dye is flowing through your arteries, X-rays are taken.

The procedure is done in a hospital’s cardiovascular lab. Your doctor will discuss preparations beforehand, which may include stopping a medication for a period before the test.

You’ll be awake during the process, but you’ll be given medicine to help you relax and the area where the tube will be inserted will be numbed first. Afterward, you’ll recover in the hospital while nurses monitor you. The doctor will then discuss your treatment plan based on what the X-rays showed.

Treatment Plan

The treatment goal for any level of atherosclerosis is to make sure it doesn’t progress any further. Your doctor will likely:

• prescribe cholesterol-lowering medications
• prescribe blood pressure medications
• recommend healthy dietary changes
• recommend increased exercise

You’ll then be monitored to see how your treatment plan is working.

If a life-threatening blockage is discovered through imaging and you haven’t responded to medication therapy, you may need surgery. A surgeon will either remove plaque from an artery or redirect blood flow around the blocked artery. Surgery is generally reserved for people who have severe cases and haven’t shown measurable progress with lifestyle changes and medication.