Plaque in the arteries: what it is, symptoms and how it is managed

Arteries carry oxygen-rich blood from the heart to the rest of the body. Atherosclerosis happens when fatty deposits build up in the artery walls and cause the arteries to narrow. The NHS coronary heart disease page describes the process as the walls of the arteries becoming furred up with fatty deposits, a process known as atherosclerosis, with the fatty deposits called atheroma. People often call this plaque.

Where it occurs determines what it does. In the coronary arteries that supply the heart it is the root of coronary heart disease. In the arteries to the brain it can lead to stroke, and in the legs it causes peripheral arterial disease. The NHS describes the main complications as heart attacks, stroke, peripheral arterial disease and other types of cardiovascular disease.

A key feature is that you can have plaque for years without noticing. The NHS says you may not have any symptoms of atherosclerosis, but that symptoms can include the following.

• Chest pain.

• Pain in your arms and legs, especially when exercising.

• Feeling short of breath.

• Feeling tired all the time.

• Feeling weak.

• Feeling confused.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have chest pain that comes and goes, feel short of breath, have pain in your arms or legs when walking or exercising, or have any other symptoms you are worried about.

It says to call 999 for signs of a heart attack (pain like a tight band or heavy weight in the chest), signs of a stroke (face drooping on one side, being unable to hold both arms up, difficulty speaking), difficulty breathing such as gasping for breath or choking, or sudden confusion. It adds that you should not drive yourself to A&E; the person you speak to at 999 will advise what to do.

The NHS says atherosclerosis happens when fatty deposits build up in the arteries. It lists things that increase the chance of getting it.

• Being over 50 years of age.

• Smoking.

• High cholesterol, high blood pressure, diabetes or kidney disease.

• Living with overweight or obesity.

• Having close relatives who have cardiovascular disease.

• Being of Black African, African Caribbean or South Asian origin.

Because plaque is often silent, much of the UK approach is about estimating risk before symptoms appear. The NHS says that if you are aged 40 to 74 you can get a free NHS health check, which can spot early signs of heart disease and stroke as well as kidney disease, dementia and type 2 diabetes.

For people with symptoms, the NHS coronary heart disease page says a doctor will ask about medical and family history and lifestyle and take a blood test, and that further tests may be needed to confirm coronary heart disease, including an electrocardiogram (ECG), echocardiogram, chest X-ray and coronary angiogram. Which test you are offered depends on your symptoms and where the suspected narrowing is.

The NHS statins page notes that a health assessment called QRISK estimates your chance of developing cardiovascular disease in the next 10 years, usually based on factors such as age, sex, ethnicity and cholesterol levels, and that a higher score can lead to an offer of a statin.

The NHS is direct that there are currently no treatments to reverse atherosclerosis. What treatment does is lower the chance of a heart attack or stroke and stop the process getting worse. You may be offered medicines to lower your cholesterol (usually statins), lower your blood pressure, lower the risk of blood clots, and lower blood sugar if you have diabetes. You may also need surgery to improve blood flow through affected arteries.

On statins, the NHS says they lower the amount of cholesterol your body makes, which helps prevent cholesterol building up in blood vessels. They are usually taken long term, and you should talk to a doctor or pharmacist before stopping. Alternatives exist for people who cannot take them, including ezetimibe, fibrates, bempedoic acid and injections such as inclisiran, alirocumab and evolocumab.

For coronary disease specifically, the NHS says it cannot be cured but treatment can help manage symptoms and reduce the chance of problems such as heart attacks, and can include lifestyle changes, medicines, angioplasty with balloons and stents, or surgery.

The NHS lists steps that help stop atherosclerosis getting worse: eat healthily and eat less saturated fat and sugar, exercise regularly, maintain a healthy weight, attend your NHS health check when invited, take medicines prescribed for other conditions, and keep blood sugar under control if you have diabetes. It also advises not smoking and not drinking more than 14 units of alcohol a week.

None of this is a substitute for medical treatment where it is needed, but the lifestyle measures act on the same risk factors as the medicines do. If you have been told you have narrowed arteries, ask your GP or specialist which of your risk factors matter most for you and what targets they would like you to reach.

Most people have their cardiovascular risk assessed and managed through their GP and the NHS health check, with referral to a cardiologist or vascular specialist if symptoms or test results call for it. Statins and other preventive medicines are prescribed on the NHS.

Some people pay privately for additional imaging or a specialist review, for example to see a cardiologist sooner. These routes can offer quicker access, but the evidence base for treatment, and the importance of the risk factors above, is the same. Make sure any private findings are shared with your GP so that medicines and follow-up stay joined up.