What is atherosclerosis, the disease that kills half of Americans?

Actor Ray Liotta and cricketer Shane Warne both died from atherosclerosis

Ray Liotta was filming on location in the Dominican Republic at the time of his death last year. Reuters

Atherosclerosis - also known as the silent killer that affects half of US population - has been revealed a contributory cause in the death of actor Ray Liotta.

Documents obtained by TMZ show that Liotta, 67, died on May 26 last year from respiratory insufficiency, pulmonary oedema (a build-up of fluid in his lungs) and acute heart failure during his sleep.

Doctors said he also suffered from atherosclerosis, a build-up of fats and cholesterol into hard plaques that block the coronary arteries.

Liotta, who is best known for his portrayal of real-life mobster Henry Hill in Goodfellas, died while shooting a film in the Dominican Republic.

Atherosclerosis was also revealed as the cause of cricket legend Shane Warne’s death, who died aged 52 while holidaying in Thailand in March 2022.

Documents released in February by the Victorian Supreme Court show the former leg-spinner, who featured in Australia’s 1999 World Cup triumph and won six Ashes series, died of “coronary artery atherosclerosis”.

The sports star had reportedly being experiencing chest pain - one of the symptoms of atherosclerosis - before leaving for Thailand.

Silent killer

Atherosclerosis, which is one of the biggest causes of cardiovascular disease, is known as “the silent killer” because plaque on the artery walls can build up over many years without any symptoms.

But eventually, the opening (lumen) of the artery narrows, leaving less room for blood to flow. Plaque can restrict blood flow to the heart by clogging the artery or by causing damage to the arteries.

The US National Institutes of Health says about half of Americans have atherosclerosis and don't know it.

Physicians recommend more than 150 minutes of exercise a week to help prevent heart disease.

High cholesterol, high blood pressure, smoking, stress and high levels of alcohol consumption are also contributory factors for atherosclerosis.

Around half of Americans aged from 45 to 85 are said to have the condition yet be unaware of it.

Professor Peter Whincup, who researches issues linked to cardiovascular disease at St George’s University of London, said, however, that in some western nations it was less often affecting people in middle age than used to be the case.

"In western countries a generation ago people would develop atherosclerotic disease in their forties or fifties. Now it’s something that occurs later in life," he said.

In some countries screening is available for vascular health, which can identify whether a person is at risk of atherosclerosis.

Risk factors include having a high level of cholesterol in the blood, often as a result of a diet rich in saturated fats. Other risk factors include high blood pressure and cigarette smoking.

Having diabetes, either type 1 or type 2, or being at risk of developing diabetes, is also associated with atherosclerosis, Prof Whincup said.

"And people who are overweight [are at risk of atherosclerosis], particularly because of the effects that has on their blood pressure and their cholesterol," he added.

Prof Whincup said the chances of developing the condition could be reduced by having a Mediterranean diet, often described as being rich in whole grains, legumes, vegetables, fruits, nuts and olive oil.

"Not too much refined carbohydrates, plenty of fruit and vegetables, fish, and low in meat, particularly red meat. That’s good for people and the planet," he said.

Exercising regularly, maintaining a healthy weight, not smoking and limiting alcohol intake are also recommended to reduce the likelihood of developing atherosclerosis.

Cardiovascular disease is the leading cause of death in the UAE and globally, with an estimated 35 to 40 per cent of deaths in the Emirates linked to the condition.

More than half of the UAE population has a relative or friend with a heart condition, a Cleveland Clinic Abu Dhabi survey found last year.

Fifty-three per cent of the participants said they have a close friend or relative with the condition, while 12 per cent have received a personal diagnosis of heart disease.