Atherosclerotic Cardiovascular Disease (ASCVD)
What is Atherosclerotic Cardiovascular Disease (ASCVD)?
Atherosclerotic cardiovascular disease, also called ASCVD, happens when fatty deposits build up inside your arteries. These deposits, called plaques, form when cholesterol particles get trapped in artery walls. Over time, the plaques harden and narrow the arteries that carry blood to your heart, brain, and other organs.
When arteries narrow, your blood flow becomes restricted. This increases your risk of heart attack, stroke, and peripheral artery disease. ASCVD develops slowly over many years, often starting in your 20s or 30s. Most people have no symptoms until a plaque ruptures or blocks blood flow completely.
ASCVD is the leading cause of death in the United States. It causes about 1 in 3 deaths each year. The good news is that ASCVD is largely preventable through lifestyle changes and early detection with blood testing.
Symptoms
Many people with ASCVD have no symptoms in the early stages. Warning signs often appear only after significant artery blockage has occurred.
- Chest pain or pressure, especially during physical activity
- Shortness of breath with exertion or at rest
- Jaw, neck, or arm pain that comes and goes
- Numbness or weakness on one side of your body
- Trouble speaking or understanding speech
- Vision changes or sudden vision loss in one eye
- Leg pain or cramping when walking
- Cold feet or toes due to poor circulation
- Fatigue or reduced exercise tolerance
- Dizziness or fainting spells
Some people with advanced ASCVD remain symptom-free until they experience a heart attack or stroke. This is why regular screening with blood tests is critical for early detection.
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Causes and risk factors
ASCVD develops when LDL cholesterol particles infiltrate your artery walls. Small dense LDL particles are especially dangerous because they easily penetrate arterial walls and become oxidized. This triggers inflammation and attracts immune cells that form foam cells. These foam cells accumulate and create fatty plaques that narrow and stiffen your arteries.
Risk factors for ASCVD include high LDL cholesterol, elevated apolipoprotein B, high lipoprotein(a), smoking, diabetes, high blood pressure, obesity, physical inactivity, poor diet, family history of heart disease, and increasing age. Men over 45 and women over 55 face higher risk. Chronic inflammation and insulin resistance also accelerate plaque formation. Many risk factors are modifiable through lifestyle changes and medication.
How it's diagnosed
ASCVD is diagnosed through a combination of medical history, physical examination, and blood tests. Advanced lipid testing measures your LDL cholesterol, apolipoprotein B, LDL particle size, and lipoprotein(a) levels. These biomarkers identify your risk long before symptoms appear. Small dense LDL particles indicate higher risk because they penetrate artery walls more easily than large LDL particles.
Rite Aid's flagship panel measures over 200 biomarkers, including all major cholesterol markers that assess ASCVD risk. Testing twice per year helps you track changes and adjust your prevention strategy. Your doctor may also recommend imaging tests like coronary calcium scans or stress tests to evaluate existing artery blockages.
Treatment options
Treatment focuses on reducing LDL cholesterol, addressing inflammation, and preventing plaque rupture.
- Follow a Mediterranean or plant-focused diet rich in fiber, omega-3 fatty acids, and antioxidants
- Eliminate or reduce saturated fat, trans fat, and refined carbohydrates
- Exercise at least 150 minutes per week with a mix of cardio and strength training
- Quit smoking and avoid secondhand smoke exposure
- Manage stress through mindfulness, sleep hygiene, and relaxation techniques
- Maintain a healthy weight and waist circumference
- Control blood pressure and blood sugar levels
- Take statins or other cholesterol-lowering medications as prescribed
- Consider PCSK9 inhibitors if LDL remains high despite lifestyle changes
- Work with a functional medicine provider to address root causes
Regular monitoring through blood tests helps you and your doctor adjust treatment as needed. Early intervention can reverse mild plaque buildup and prevent progression to heart attack or stroke.
Concerned about Atherosclerotic Cardiovascular Disease (ASCVD)? Get tested at Rite Aid.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Coronary artery disease is one type of ASCVD that affects the arteries supplying your heart. ASCVD is a broader term that includes all conditions caused by plaque buildup in arteries. This includes coronary artery disease, carotid artery disease, and peripheral artery disease. All these conditions share the same underlying cause of cholesterol accumulation in artery walls.
Early-stage atherosclerosis can sometimes be reversed with aggressive lifestyle changes and medication. Studies show that very low LDL cholesterol levels, achieved through diet and statins, can shrink plaques. However, advanced calcified plaques are harder to reverse. The key is starting prevention early and maintaining healthy cholesterol levels throughout life.
If you have risk factors like family history, diabetes, or high blood pressure, check your cholesterol at least once per year. People with diagnosed ASCVD or very high cholesterol may need testing every 3 to 6 months. Regular testing helps you track whether your treatment plan is working. Rite Aid members get tested twice per year to monitor trends over time.
Small dense LDL particles are more dangerous than large fluffy LDL particles. Small particles penetrate artery walls more easily and are more prone to oxidation. This makes them highly atherogenic, meaning they promote plaque formation. Standard cholesterol tests miss this detail, which is why advanced lipid testing that measures particle size provides better risk assessment.
Apolipoprotein B, or Apo B, is a protein found on each atherogenic particle in your blood. This includes LDL, VLDL, and lipoprotein(a). Measuring Apo B gives you a direct count of these dangerous particles. Many experts consider Apo B a better predictor of heart disease risk than LDL cholesterol alone.
ASCVD results from a combination of genetic and lifestyle factors. Some people inherit genes that cause high cholesterol or elevated lipoprotein(a). However, lifestyle factors like diet, exercise, and smoking have enormous impact on whether you develop disease. Even people with genetic risk can dramatically reduce their ASCVD risk through healthy habits and early intervention.
Avoid foods high in saturated fat like red meat, butter, cheese, and fried foods. Eliminate trans fats found in processed baked goods and margarine. Reduce refined carbohydrates and added sugars, which raise triglycerides and small dense LDL. Focus instead on vegetables, fruits, whole grains, legumes, nuts, seeds, and fatty fish rich in omega-3s.
Yes, standard cholesterol tests can miss important risk factors. You might have normal LDL cholesterol but high levels of small dense LDL particles or elevated lipoprotein(a). You might also have inflammation or other metabolic issues that promote plaque formation. This is why comprehensive testing that includes particle size and Apo B is so valuable.
Yes, statins are proven to reduce heart attack and stroke risk in people with ASCVD. They lower LDL cholesterol and have anti-inflammatory effects that stabilize plaques. Studies show statins reduce cardiovascular events by 25 to 35 percent. However, they work best when combined with diet, exercise, and other lifestyle changes.
You can see improvements in cholesterol levels within 2 to 3 months of diet and exercise changes. However, reducing actual plaque buildup takes longer, often 1 to 2 years of sustained effort. The earlier you start, the better your outcomes. Tracking your biomarkers every 6 months helps you stay motivated and adjust your approach as needed.