Atherosclerosis may be asymptomatic for decades, but eventually the plaques may cause a significant narrowing of the heart arteries – restricting blood supply to the heart muscle – resulting in angina (usually with exercise / physical activity), or if this occurs suddenly (i.e. vessel occlusion) it will cause a ‘heart attack’

Risk factors for atherosclerosis include: being overweight, diabetes, smoking, lack of physical exercise and a poor diet

If the atherosclerotic plaque has not narrowed the arteries to a significant degree (usually at least 70%) then there may be no symptoms at all

Angina can present differently depending on the person, especially in diabetic patients. Classically, angina is described as a central chest pressure / tightness that may radiate to the arm or jaw. It is triggered by exercise and relieved with rest (except in the case of a sudden heart attack)

Lifestyle modifications:

• Healthy eating (Mediterranean diet), especially in order to lose weight if your BMI is >25
• Salt restriction (less than 4g daily)
• Limitation of alcohol intake (no more than two standard drinks a day for men and one for women, with at least 2 alcohol-free days a week)
• At least 30 minutes of moderate intensity exercise daily
• Avoidance of smoking

Medications:

There are many classes of medications, but the most commonly prescribed medications include: 

• Anti-platelet medications (such as aspirin)
• Cholesterol-lowering medications (such as statins)
• Anti-anginal medications (such as beta-blockers, nitrates, calcium channel blockers or nicorandil)

Intervention:

For patients with significant symptoms despite medications or with very severe vessel narrowing, an intervention may be required:

• Stent
• Coronary Artery Bypass Grafting