Atherosclerosis Symptoms in Men

Atherosclerosis, often referred to as the “silent killer”, is an insidious disease of civilization that develops in secret for years, without giving any warning signals. It is the basis of cardiovascular diseases, which remain the most common cause of death in Poland and in the world. The disease process can begin as early as youth, but its dramatic consequences, such as heart attack or stroke, usually manifest themselves after many decades. A special risk group are men, in whom symptoms statistically appear earlier than in women. The purpose of this comprehensive guide is to arm readers, especially men, with reliable knowledge about atherosclerosis.

Anatomy of an Enemy: What Is Atherosclerosis and How Does It Destroy Arteries From the Inside?

Understanding atherosclerosis requires moving away from the simplistic perception of it as a mechanical “clogging of pipes” by fat. In fact, it is a complex, chronic inflammatory process that affects the entire arterial system.

Definition of atherosclerosis (atherosclerosis)

Atherosclerosis, also known as atherosclerosis, is a chronic disease of the arteries of medium and large diameter, such as the aorta, coronary, carotid or iliac arteries. Its essence is progressive hardening and loss of elasticity of blood vessel walls, caused by the formation of specific lesions inside them, called atherosclerotic plaques. These plaques, as they grow, gradually narrow the lumen of the artery, which restricts blood flow and leads to hypoxia of the organs and tissues supplied by it.

The Process of Plaque Formation – Step by Step

The pathogenesis of atherosclerosis is a multi-stage process in which inflammation plays a key role. The development of atherosclerotic plaque, the structure of which is vividly compared to “hard candy with liquid filling”, can be divided into several key phases.

Phase 1: Endothelial damage

It all starts with damage to the vascular endothelium – the delicate, single-layered lining of the inner wall of the artery. Damaging factors can be: increased blood pressure, toxins contained in tobacco smoke, high concentration of low-density lipoprotein (LDL) in the blood, as well as some infections. A damaged endothelium becomes dysfunctional – it loses its protective properties and becomes more permeable.

Phase 2: LDL Infiltration and Modification

Through the damaged endothelial barrier, particles of “bad” cholesterol, i.e. LDL lipoprotein, begin to penetrate into the artery wall. In this environment, they undergo modifications, mainly oxidation (oxidation), which makes them a target for cells of the immune system.

Phase 3: Inflammatory Response and Foam Cells

Modified LDL particles trigger an immune response. Monocytes (a type of white blood cell) migrate to the artery wall, which transform into macrophages – scavenger cells. Their task is to “clean up” excess cholesterol. By absorbing it uncontrollably, macrophages overload themselves with lipids and transform into the so-called Atherosclerosis is a disease, foam cells are the histological hallmark of atherosclerosis. These cells are not indifferent – they produce and send numerous pro-inflammatory substances (cytokines) that attract more immune cells, driving a vicious circle of chronic inflammation in the vessel wall. This is why the concentration of inflammatory markers, such as highly sensitive C-reactive protein (hs-CRP), is an important indicator of cardiovascular risk.

Phase 4: Proliferation and “Cap” Formation

Inflammatory signals also stimulate smooth muscle cells, which migrate from the deeper layers of the artery wall and begin to multiply (proliferate). These cells produce collagen and elastin fibers, which form a hard, fibrous “cap” over the accumulated lipid core. Over time, calcium salts can also accumulate in the plaque, which leads to calcification, hardening and further narrowing of the arterial lumen.

Stable vs. Unstable Plaque – The Key to Understanding the Threat

Not all atherosclerotic plaques are equally dangerous. It is crucial to distinguish between stable and unstable plaque.

• A stable lamina is characterized by a thick, strong fibrous cap and a smaller lipid core. It grows slowly, gradually narrowing the artery. It can cause symptoms of ischaemia during exercise (e.g. chest pain), but the risk of its sudden rupture is lower.
• The unstable lamina has a large, liquid lipid core and a thin, inflamed fibrous cap. It is extremely susceptible to rupture or erosion. A sudden rupture of the plaque triggers a cascade of coagulation – a thrombus (thrombus) forms rapidly at this point, which can completely block the artery within a few minutes. It is this mechanism that underlies most heart attacks and ischemic strokes.

A man’s thing? Why Do Men Get Atherosclerosis Earlier and More Often?

Medical statistics are unequivocal: the male sex is an independent risk factor for the development of atherosclerosis and its complications, especially at a younger age. The causes of this disparity are complex and result from both biological and behavioral conditions.

Non-modifiable risk factors – Genetic and biological baggage

There are factors that are beyond our control and that determine our individual risk.

• Gender: On average, men develop cardiovascular disease 10 years earlier than women.
• Age: The risk of atherosclerosis increases with age. The aging process of arteries, consisting in the gradual loss of their elasticity, is a natural phenomenon, which, however, can be significantly accelerated by other factors.
• Genetics: Family burden plays a huge role. The occurrence of a heart attack or stroke in a first-degree relative (father, brother before the age of 55; mother, sister before the age of 65) is a strong warning signal. It is estimated that up to 60% of cases of atherosclerosis may have a genetic basis. Hereditary diseases that drastically increase the risk include familial hypercholesterolemia or high lipoprotein(a) levels.

Women’s Hormonal Shield and the “Hormonal Paradox” in Men

Hormones play a key role in gender differences, which can affect the risk of cardiovascular disease.

• Protective role of estrogens: Estrogens, female sex hormones, have been proven to have a protective effect on the cardiovascular system. They have a beneficial effect on the lipid profile (they lower LDL, increase HDL), maintain the elasticity of blood vessels and have anti-inflammatory properties. This natural hormonal shield makes premenopausal women sick much less often. After menopause, when estrogen levels drop sharply, cardiovascular risk in women increases, equaling the risk in men.
• The complex role of testosterone: Many myths have arisen around testosterone. Contrary to popular belief, it is not its excess, but its deficiency that is associated with an increased risk of atherosclerosis. Low testosterone levels in men often co-occur with abdominal obesity, insulin resistance and metabolic syndrome – factors that strongly promote the development of the disease. The physiological level of this hormone has a protective effect, m.in. it affects the dilation of blood vessels. Therefore, a decrease in testosterone, related to age, but also an unhealthy lifestyle, can be treated as an additional warning signal.

Modifiable Factors – Your Line of Defense

The most important information is that we have direct influence on most of the key risk factors. However, it should be remembered that their action is not a sum, but a product – they mutually intensify their destructive effect. Studies show that the presence of one factor (e.g. smoking) doubles the risk, two (smoking + hypertension) increases it fourfold, and three (smoking + hypertension + high cholesterol) – up to ten times.

The most important modifiable risk factors include:

• Smoking: An absolutely crucial and fully reversible factor. Toxins from tobacco smoke directly damage the endothelium, increase inflammation, disrupt the lipid profile and increase blood clotting. Passive smoking is also harmful.
• Incorrect diet: The menu is rich in saturated fats (fatty meats, cold cuts, lard, butter), trans fats (highly processed foods, fast food, confectionery), simple sugars and salt, and at the same time low in fiber, vegetables and fruit.
• Lipid disorders (dyslipidemia): Increased LDL (“bad”) cholesterol and triglycerides, and decreased HDL (“good”) cholesterol.
• Hypertension: It acts like a jackhammer, mechanically damaging the delicate lining of the arteries and making it easier to “push” LDL particles into their walls.
• Diabetes and Prediabetes: Chronically elevated blood glucose levels damage blood vessels on many levels, drastically accelerating the atherosclerotic process.
• Overweight and obesity: Abdominal (visceral) obesity is particularly dangerous, as it is strongly associated with the development of hypertension, dyslipidemia and insulin resistance.
• Physical inactivity: A sedentary lifestyle is one of the main pillars of the modern epidemic of heart disease.
• Chronic stress: It leads to a steady increase in stress hormones such as cortisol, which in turn raises blood pressure and can contribute to endothelial damage.

When does the Red Light Come On? The First Symptoms of Atherosclerosis in Men

One of the greatest dangers associated with atherosclerosis is its asymptomatic course for many years. The disease process can begin as early as childhood and adolescence, and the arteries may already be significantly narrowed before the patient feels any discomfort. There is a dangerous gap, a “silent decade” (or even two, between the ages of 20 and 40), when the disease progresses and the man feels perfectly healthy. This is a fundamental argument for early prevention and check-ups to prevent atherosclerosis, rather than waiting for symptoms.

Critical Age – Decade 40-50

Statistically, the first clinical symptoms of atherosclerosis, such as chest pain when exerting or leg pain when walking, appear most often in men between 40 and 50 years of age. This is the moment when the build-up of plaque narrows the lumen of the artery to a critical level, typically by more than 70%, which causes the blood supply to become insufficient to cover the oxygen needs of the organs, especially during exercise.

Subtle warning signs that cannot be ignored (especially at the age of 30-40)

Before the classic symptoms appear, the body can send more subtle signals that are often downplayed or attributed to stress and fatigue. Their early diagnosis can save health and life.

• Erectile dysfunction: For many men, this is a taboo subject, while erection problems can be one of the earliest alarm signs of atherosclerosis, preceding heart problems by up to 3 to 5 years. The mechanism is simple: the arteries supplying the penis are much narrower than the coronary or carotid arteries. Therefore, the atherosclerotic process leads more quickly to their significant narrowing and impaired blood supply, which makes it impossible to achieve or maintain an erection. This is not an “age problem”, but potentially the first symptom of vascular disease.
• Changes in mood and cognitive function: Chronic, benign cerebral hypoxia caused by carotid artery stenosis can manifest itself in an unusual way. A man may notice problems with concentration and short-term memory, slowed reactions, increased irritability, apathy and even depression.
• Cold hands and feet: A persistent feeling of cold in the limbs, even in a warm environment, may indicate impaired peripheral circulation, resulting from narrowing in the arteries supplying blood to the arms and legs.
• Early fatigue and shortness of breath: If going up to the second floor, which used to be not a problem, now causes shortness of breath and the need to rest, it may be an early sign of coronary artery disease. The heart needs more oxygen to cope with the effort, and narrowed arteries are unable to supply it.
• Yellow tufts (Xanthelasma): can be one of the symptoms of atherosclerotic lesions. These are yellowish, lumpy cholesterol deposits deposited under the skin, most often in the corners of the eyelids or on tendons (e.g. Achilles). They are a visible signal of very high, often genetically determined, blood cholesterol levels.

Symptom Map: How Does Atherosclerosis Manifest in Different Parts of the Body?

Atherosclerosis is a systemic disease, which means that the disease process affects the entire arterial system, although to varying degrees in different parts of it. Therefore, symptoms in one location (e.g. leg pain) should be treated as an alarm signal indicating a threat in other key areas, such as the heart and brain. Symptoms depend on which arteries have been most affected by the disease.

Coronary arteries (ischemic heart disease)

• Symptoms of atherosclerosis – symptoms can be subtle and develop over many years. A classic symptom is angina pectoris (angina). It is pain, pressure, crushing or burning located behind the breastbone, which typically occurs during physical exertion, emotional stress or exposure to cold air, and disappears after a few minutes of rest. The pain can radiate to the neck, jaw, left shoulder and arm, and even to the back. Other symptoms include shortness of breath due to exertion, excessive fatigue and palpitations.
• The consequences of atherosclerosis are serious health problems that can lead to cardiovascular disease. Unstable angina (pain at rest), myocardial infarction, heart failure, sudden cardiac death.

Carotid and Cerebral Arteries

• Symptoms of atherosclerosis can include chest pain, shortness of breath, and other symptoms associated with cardiovascular disease. They can include dizziness, balance disorders, tinnitus, unexplained headaches, as well as subtle memory and concentration problems, which can be symptoms of the psychological effects of atherosclerosis. Transient ischemic attacks (TIAs), called “mini-strokes”, are a very dangerous signal. These are short-term (lasting from a few minutes to 24 hours) neurological episodes, such as sudden weakness or numbness on one side of the body, difficulty speaking or understanding speech, temporary visual disturbances (e.g. blindness in one eye like a “curtain being lowered”). TIA is a serious warning that the risk of a full-blown stroke is very high.
• Consequences: Ischemic stroke with permanent sequelae (paresis, paralysis, aphasia) or death.

Lower arteries (peripheral arterial disease)

• Symptoms: The flagship symptom is intermittent claudication. It is a characteristic, cramping pain, numbness or a feeling of heaviness in the muscles (most often in the calves, less often in the thighs or buttocks), which occurs when walking after walking a certain, constant distance and forces you to stop. The pain subsides quickly after a short rest, allowing you to continue walking. Other symptoms include: freezing, pale feet, loss of hair on the skin of the legs, thickened and brittle nails, and in the advanced stage – hard-to-heal wounds and ulcers, especially on the feet and toes. In men with obstruction of the aorta and iliac arteries , Leriche syndrome may occur: it is one of the complications of atherosclerosis of the lower limbs, i.e. a triad of symptoms: claudication in the hips and buttocks, lack of pulse in the groin and erectile dysfunction.
• Consequences: Critical limb ischemia with pain at rest (especially at night), necrosis (gangrene) and the need for amputation.

Abdominal aorta

• Symptoms: Aortic atherosclerosis is often asymptomatic. Sometimes patients report non-specific pain in the abdomen or lumbar spine (they may resemble sciatica), and thin patients may feel unusual, excessive throbbing in the abdomen.
• Consequences: The most dangerous complication is the formation of an abdominal aortic aneurysm. It is a pathological widening of the aortic wall, which threatens to rupture. Aneurysm rupture leads to massive internal bleeding and is an immediate life-threatening condition with a very high mortality rate.

Renal arteries

• Symptoms: The most important and often the only symptom is hypertension, which is difficult to control with standard medications (so-called resistant hypertension), appears suddenly in a young person or deteriorates rapidly. During the examination, the doctor may listen to a characteristic vascular murmur in the upper abdomen.
• Consequences: Progressive, chronic renal failure, which may lead to the need for renal replacement therapy (dialysis).

Diagnosis of atherosclerosis: What is the patient’s path from suspicion to diagnosis?

Early detection of atherosclerosis is crucial for preventing its dangerous complications. Diagnostics is based on three pillars: clinical assessment, laboratory tests and imaging tests.

Step 1: Primary Care Physician (POZ) – the first line of diagnosis

The diagnostic path of a patient with suspected atherosclerosis usually begins in the family doctor’s office. It is crucial to collect a detailed history of reported symptoms, lifestyle, addictions and family history of cardiovascular diseases. The doctor then performs a physical examination, which includes:

• Blood pressure measurement on both arms.
• Auscultation of the heart and large arteries (e.g. carotid, abdominal aorta) in search of abnormal murmurs that may indicate turbulent blood flow through a narrowed vessel.
• Pulse examination on peripheral arteries (e.g. atherosclerosis of the lower limbs). on the feet), the weakness or absence of which may indicate an obstruction.

On the basis of this assessment, the primary care physician identifies patients from the risk group and orders basic laboratory tests.

Step 2: Blood Lab Tests – Metabolism Picture

Blood tests provide fundamental information about risk factors for atherosclerosis.

• Lipidogram (lipid profile): This is an absolutely basic test that assesses the concentration of total cholesterol, LDL (“bad”), HDL (“good”) fraction and triglycerides. It is essential for risk assessment and monitoring the effectiveness of treatment of cardiovascular disease.
• Other important markers:
  • Fasting glucose and glycated hemoglobin (HbA1c): They allow for the detection of diabetes or prediabetes, which are strong risk factors.
  • hs-CRP (highly sensitive C-reactive protein): It is a sensitive indicator of chronic inflammation in the vessels, which plays a key role in the development of atherosclerosis.
  • Creatinine and eGFR: They are used to assess kidney function, which may be impaired in the course of atherosclerosis of the renal arteries.
  • Apolipoprotein (ApoB) and Lipoprotein(a) [Lp(a)]: These are more advanced markers, ordered in special cases, e.g. in the case of a strong family burden or when a traditional lipidogram does not fully explain the high risk of the patient.

Step 3: Diagnostic Imaging – Looking Inside the Arteries

When basic tests indicate a high risk or the patient has symptoms, it is necessary to visualize the arteries by means of imaging tests.

• Doppler ultrasound: It is a basic, non-invasive, painless and widely available imaging test. Using the Doppler effect, it allows to assess the speed and direction of blood flow in the arteries (carotid, lower limbs, kidneys, aorta). It allows for direct visualization of atherosclerotic plaques, assessment of their structure and precise measurement of the degree of vessel stenosis.
• Knuckle Arm Indicator (ABI): This simple test consisting in measuring systolic pressure on the ankle and arm is important in the diagnosis of atherosclerosis of the legs. The correct value is between 1.0 and 1.4. A score below 0.9 clearly indicates ischemia of the lower limbs and is a strong predictor of generalized atherosclerosis.
• CT angiography: It is an advanced, but still non-invasive examination that requires intravenous administration of a contrast medium. It allows to obtain very detailed, three-dimensional images of entire sections of arteries. It is extremely useful in the precise assessment of vascular anatomy, the degree of stenosis or the structure of aneurysms, especially in planning invasive treatment. In the case of coronary arteries, this examination is often called “virtual coronary angiography”.
• Classical angiography (e.g. coronary angiography): Considered the “gold standard” in the assessment of coronary arteries, it is, however, an invasive test. It involves inserting a thin catheter through an artery in the hand or groin to the heart and administering contrast directly to the coronary arteries. The image is recorded using X-rays. It is usually performed when there is a high probability that therapeutic intervention, i.e. angioplasty, will be necessary immediately after diagnosis.

Atherosclerosis Battle Plan: Modern Treatments

Atherosclerosis treatment is a long-term process that requires commitment and discipline from the patient. Surgical interventions, such as stent implantation or bypass surgery, are often seen as the ultimate “cure” for atherosclerosis, a chronic disease. However, this is a dangerous thought trap. These treatments only remove the effects of the disease in one specific place, but do not treat its cause – the systemic inflammatory process. Therefore, invasive treatment is not the end of therapy, but the beginning of a new stage of life with a chronic disease, which requires constant control, regular medication and a fundamental change in lifestyle.

The foundation of therapy: lifestyle change

This is absolutely the most important and effective element of treatment, without which all other methods lose their importance. It includes comprehensive measures in the field of diet, physical activity, quitting addictions, weight control and stress management.

Pharmacological treatment – an arsenal against atherosclerosis

Pharmacotherapy is the second pillar of the fight against atherosclerosis and its aim is to control risk factors and slow down the progression of the disease.

• Statins: This is the basic and most important group of drugs in the treatment of atherosclerosis. Their main mechanism of action is to inhibit the enzyme in the liver responsible for the production of cholesterol, which leads to a significant reduction in the concentration of “bad” LDL cholesterol in the blood. However, their role is much broader. Statins have the so-called pleiotropic effect, i.e. additional benefits, independent of lowering cholesterol. They have anti-inflammatory effects, stabilize atherosclerotic plaques (making them less prone to rupture) and improve endothelial function. The most commonly used are atorvastatin and rosuvastatin.
• Antiplatelet drugs: Their job is to prevent platelets from aggregating (clumping together) and forming clots that can block an artery. The basic drug in this group is acetylsalicylic acid (ASA), commonly used in secondary prevention (after a heart attack, stroke), and can help prevent atherosclerosis. In some situations, e.g. in the case of atherosclerosis of the legs, it is necessary to implement appropriate treatments. after stent implantation, dual antiplatelet therapy (e.g. ASA with clopidogrel) is used.
• Antihypertensive drugs: can prevent coronary atherosclerosis. Effective control of blood pressure is crucial for slowing the progression of atherosclerosis, as high pressure damages the arteries. Different groups of drugs are used, selected individually for the patient.
• Modern lipid therapies: In cases where the maximum doses of statins do not achieve the therapeutic goal, or are poorly tolerated, the doctor may add other medications. These include ezetimibe (inhibits the absorption of cholesterol from the intestines) and PCSK9 inhibitors (modern biological drugs administered in the form of injections, which strongly lower LDL cholesterol levels).

Invasive Treatment – When Plumbing Intervention Is Needed

When plaque narrows the artery significantly, causing significant ischemic symptoms or posing a high risk of an acute incident, invasive treatment may be necessary.

• Percutaneous coronary angioplasty (PTCA): Popularly known as “ballooning”. The procedure involves inserting a thin catheter with a balloon at the end through an artery (usually in the wrist or groin). After placing it in the narrowing site, the balloon is filled under high pressure, which causes the atherosclerotic plaque to “crush” and widen the lumen of the vessel.
• Stents: Almost always during angioplasty, a stent is implanted at the site of dilation. It is a small, metal “spring” or “scaffold” that supports the artery wall, preventing it from narrowing again (restenosis). Currently, drug-eluting stents (DES), which are coated with a substance that inhibits the stent overgrowth process, are the standard.
• Coronary artery bypass grafting (CABG) It is a cardiac surgery, usually performed on an open heart. It involves creating a “bypass” bypassing the blocked fragment of the coronary artery. A fragment of another blood vessel of the patient is used as a bypass – most often a vein taken from the leg or internal thoracic artery. This surgery is considered in the case of advanced, multivessel coronary artery disease, when the lesions are too extensive for angioplasty, or in patients with diabetes.

Prevention – The Best Investment in Health: How to Effectively Reduce Risk?

Preventive recommendations for atherosclerosis are simple in theory, but often difficult to implement in practice. Knowing what to do is one thing, but actually changing deep-rooted habits is a completely different challenge. Studies show that even patients diagnosed with the disease have great difficulty changing their lifestyle. Therefore, it is crucial not only to list recommendations, but also to approach difficulties empathetically and propose strategies for small, achievable steps.

Diet for the Heart – Fuel for Your Arteries

• Policy: The key is to limit the consumption of saturated fats (found in fatty red meat, cold cuts, bacon, lard, butter, full-fat dairy products) and completely eliminate trans fats (present in hydrogenated margarines, confectionery, fast food, powdered soups). They should be replaced with unsaturated fats, which have a beneficial effect on the lipid profile and can prevent atherosclerosis. Their sources are: olive oil, rapeseed oil, avocado, nuts, seeds and oily sea fish (salmon, mackerel, herring), rich in omega-3 acids.
• The Mediterranean Diet model can help prevent atherosclerosis. It is considered one of the healthiest models of nutrition in the prevention of heart disease. It is based on a high intake of vegetables, fruits, whole grain cereal products, legumes and nuts. The main sources of protein are fish and poultry, and red meat is eaten occasionally.
• Practical tips: Limit your salt intake to less than 5 g per day (one level teaspoon), avoid sugary drinks, choose steaming, stewing and baking instead of deep-frying.

Movement is health – cardiological recommendations

Regular physical activity is essential. According to the guidelines of the European and Polish Society of Cardiology (ESC/PTK), it is recommended to prevent atherosclerosis.

• At least 150-300 minutes per week of moderate-intensity aerobic (aerobic) exercise (e.g., brisk walking, cycling, swimming) OR 75-150 minutes per week of physical activity is recommended for the prevention of atherosclerosis.
• Activity should be spread over most days of the week, preferably 4-5 times a week or every day, to support the prevention of atherosclerosis.

Quitting – A Practical Plan for Quitting Smoking

Quitting smoking is the most beneficial single thing you can do for your heart.

• Preparation: Set a specific date for quitting smoking. Inform your family and friends of your decision to get their support. Identify the situations that trigger the desire to reach for a cigarette (e.g. morning coffee, stress, alcohol) and plan what you will replace them with.
• Methods: In moments of nicotine craving (which usually lasts a few minutes), reach for healthy substitutes: drink a glass of water, eat a carrot, chew sugar-free gum. Increase physical activity – even a short walk can help. In the first few weeks, avoid situations and places that are strongly associated with smoking.
• Support: Don’t hesitate to seek help. Consult your doctor, who can prescribe medication to help you quit smoking. Use the Telephone Smoking Assistance Clinic (tel. 801 108 108). Over-the-counter nicotine replacement therapy preparations (patches, gums, sprays) are also available.

Control is Key – Your Therapeutic Goals

Regular monitoring of key parameters and striving to achieve the therapeutic goals agreed with the doctor is the foundation of effective prevention.

• Blood pressure: The target value in most patients is below 140/90 mmHg. If treatment is well tolerated, aim for values below 130/80 mmHg.
• LDL cholesterol: The target LDL cholesterol level depends on the individual’s total cardiovascular risk, which is assessed by the doctor. According to the current guidelines:
  • Very high risk (e.g. patients with known cardiovascular disease, after myocardial infarction, diabetes mellitus and complications): the target is <1.4 mmol/L (<55 mg/dl).
  • High risk (e.g. patients with a severe single risk factor such as very high blood pressure or cholesterol): the target is <1.8 mmol/L (<70 mg/dL).
  • Moderate risk: target is <2.6 mmol/L (<100 mg/dL)

Summary

Atherosclerosis is a chronic, progressive inflammatory disease that is the foundation of most cardiovascular diseases. It begins quietly, decades before the first, often dramatic symptoms appear. Men, due to biological conditions and often the accumulation of lifestyle risk factors, are at particular risk, and the first symptoms may appear in them as early as after the age of 40. Be aware of early, subtle warning signs such as erectile dysfunction, deterioration of exercise tolerance or mood swings, which should never be ignored.

The key to a long and healthy life is to take responsibility for your health. You should not wait for symptoms to appear. Regular check-ups – blood pressure measurement, lipid profile and glucose concentration – should become a standard for every man over 30. Talking to your doctor and consciously implementing lifestyle changes is the most powerful weapon in the fight against atherosclerosis and the best investment to avoid heart attack and stroke.