Cholesterol buildup in the arteries can lead to conditions like coronary artery disease (CAD) and peripheral arterial disease (PAD). These arterial diseases are common, affecting over 5% of the adult population.(1,2) In this article, we’ll explain how cholesterol can lead to calcified plaque that limits artery function and leads to CAD and PAD.

The Buildup of Cholesterol Over Time Leads to Artery Calcification

Diseases like CAD and PAD are ultimately caused by the buildup of cholesterol in the arteries. Cholesterol is a waxy, fat-like substance that travels in the blood. Cholesterol is produced naturally by the liver, and people also take in cholesterol from dietary sources. It’s not inherently bad, but excess cholesterol can join with other substances in the blood to form a hard, thick layer of plaque inside the arteries.(3)

Plaque buildup leads to the calcification of arteries, a process also known as atherosclerosis or the “hardening” or “thickening” of the arteries. This leads to higher blood pressure and inflammation. Artery calcification can also lead to blood clots that increase the risk of heart attacks and strokes.(4)

Calcified Plaque Limits Blood Flow, Leads to Arterial Stenosis, and Can Cause CAD and PAD

Plaque builds over time, narrowing the arteries and making it more difficult for the heart and vessels to transport blood. This gradual narrowing of the artery is a process called stenosis.(4)

CAD and PAD are related conditions caused by arterial plaque obstructing blood flow. They are defined by the location of the blockage – either in the coronary arteries of the heart, or the peripheral arteries of the legs and feet. CAD develops when plaque buildup in the coronary arteries blocks the flow of blood to the heart. PAD develops when plaque in the peripheral arteries blocks blood flow to tissues in the legs and feet.

Risk Factors for CAD and PAD Include Lifestyle Factors like Smoking and Activity Level

Plaque accumulation in both peripheral and coronary arteries is a gradual process that is strongly influenced by a person’s lifestyle. Risk factors for CAD and PAD include:

• Prolonged sedentary behavior

• Unhealthy diet with excessive cholesterol

• Smoking

• High blood pressure

• Diabetes

• Obesity

• Aging (4)

Coronary Artery Disease Occurs When Plaque Blocks Blood Flow to the Heart

Coronary artery disease affects the coronary arteries that supply blood to the heart. With CAD, calcified plaque buildup narrows or blocks one or more coronary arteries.(5) When these arteries become narrowed or blocked, the heart muscle can't get as much oxygen as it needs, leading to chest pain (angina), fatigue, or shortness of breath. A significant portion of people with CAD will experience a heart attack, also called an acute myocardial infarction (AMI). CAD can also lead to other complications like arrhythmia or heart failure.(5)

CAD is a chronic condition, and people may not experience CAD symptoms for many years as plaque gradually builds in the arteries. As the arteries narrow, mild symptoms begin to arise.(6) Many people with CAD may not notice symptoms until the buildup of plaque creates a blood clot. When blood can’t reach the heart because of a clot, a heart attack may happen.(6) CAD is also known as coronary heart disease (CHD) and ischemic heart disease.

Symptoms of CAD:

• Temporary chest pain or discomfort that comes and goes (stable angina)

• More persistent chest pain (angina) that may spread to limbs, neck, and back

• Shortness of breath (dyspnea) or trouble breathing

• Feeling dizzy or lightheaded

• Heart palpitations

• Tiredness 

• Reduced exercise capacity (5,6)

• Women may have additional symptoms like racing heart, or feeling hot or flushed.(5,6)

Peripheral Arterial Disease Occurs When Plaque Blocks Blood Flow to Tissues in the Legs and Feet

Peripheral artery disease is closely related to CAD and has a significant correlation. PAD affects the arteries outside the heart, especially the ones that supply blood to the legs and feet. With PAD, calcified plaque buildup narrows or blocks one or more peripheral arteries. This makes it more difficult for the blood to carry oxygen and nutrients to tissues in the limbs. This can cause pain, aching, and cramping with walking (known as claudication). Notably, women are more susceptible to PAD than men.(7)

Symptoms of PAD:

• Claudication (pain, cramping, and discomfort in the legs and buttocks)

• Burning or aching in the feet and toes while resting at night

• Redness or other color changes

• Skin and soft tissue infections in the feet or legs

• Persistent toe and foot sores(8)

PAD can build up over many decades, and roughly half of people with PAD may not experience active symptoms until later in life. However, the presence of PAD is still an indicator of systemic arterial calcification and an increased risk of heart disease.

Artery Diseases like CAD and PAD are Common, Affecting Hundreds of Millions People

CAD and PAD are common diseases experienced by over 5% of the adult population.(1) CAD is the most common type of heart disease, experienced by over 18 million American adults.(6) Approximately 8-12 million American adults are estimated to have PAD.(8) A recent systematic review estimates that the global prevalence of PAD was 5.6% in 2015, indicating roughly 236 million adults were living with PAD worldwide.(9) 

A Healthy Lifestyle is the Best Way to Prevent Artery Calcification and Diseases like CAD and PAD

No one can change their age or genetic disposition to arterial diseases, but making healthy lifestyle choices can limit risk factors for CAD and PAD. The best ways to prevent artery calcification are to live an active lifestyle, maintain a balanced diet, and avoid smoking. It’s also important to schedule regular health check-ups and communicate with a trusted medical provider.

People experiencing diabetes, obesity, and high blood pressure are at an increased risk of developing CAD and PAD. For people with these conditions, monitoring symptoms and scheduling regular medical checkups is especially important.

Treatments for CAD and PAD Include Medications and Interventions like Angioplasty and Intravascular Lithotripsy

People who develop an arterial disease like PAD or CAD have options ranging from lifestyle changes, to medications, to interventions like angioplasty and intravascular lithotripsy (IVL). Anyone experiencing these conditions should communicate with a trusted health provider who can develop a personalized treatment plan. Learn more about the treatment landscape for CAD and PAD in this article.

Traditional treatments for arterial diseases involve angioplasty, where a balloon catheter clears the blocked arteries for the deployment of drug-coated balloons or stents. However, calcified plaques can resist these methods, leading to possible acute failure or damage. This has led to the development of newer technologies like specialized cutting balloons, drug-eluting stents, and plaque modification tools. 

In recent years, the emergence of intravascular lithotripsy technologies has begun to change the CAD and PAD treatment landscape because of its unique ability to disrupt calcium with sonic shock waves. Learn more about IVL in this article, and see how it can help combat the plaque that builds in arteries and leads to CAD and PAD.