Atherosclerosis: Symptoms, Causes & Prevention Guide

What Is Atherosclerosis?

Atherosclerosis is a chronic disease where fatty deposits (plaque) gradually build up inside artery walls, causing them to narrow and harden. This restricts blood flow to vital organs and can lead to heart attack, stroke, or peripheral artery disease. The process typically develops over decades without symptoms until significant blockage occurs.

Atherosclerosis, also known as "hardening of the arteries" or arteriosclerosis, is one of the most common and serious cardiovascular conditions affecting people worldwide. The disease process begins when the inner lining of arteries (called the endothelium) becomes damaged. This damage allows cholesterol, inflammatory cells, calcium, and other substances to accumulate within the artery wall, forming what doctors call atherosclerotic plaque.

Understanding atherosclerosis requires knowing how healthy arteries function. Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. Healthy arteries are flexible and elastic, able to expand and contract with each heartbeat. They have smooth inner walls that allow blood to flow freely. When atherosclerosis develops, this smooth flow becomes compromised.

The plaque that forms in atherosclerosis is not simply a buildup of cholesterol, as many people believe. It is actually a complex structure containing lipids (fats), inflammatory cells, smooth muscle cells, connective tissue, and calcium deposits. Over time, these plaques can grow larger, progressively narrowing the artery and reducing blood flow. They can also become unstable and rupture, triggering blood clots that can completely block the artery.

What makes atherosclerosis particularly dangerous is that it typically develops silently over many years—often starting as early as childhood or adolescence—without causing any noticeable symptoms. Many people only discover they have atherosclerosis when they experience a serious cardiovascular event like a heart attack or stroke. This is why understanding risk factors and getting regular health screenings is so important for prevention.

Where Does Atherosclerosis Develop?

Atherosclerosis can affect arteries throughout the body, but it tends to develop more commonly in certain locations. The specific location determines what symptoms may eventually appear and what complications can occur. The coronary arteries that supply blood to the heart muscle are frequently affected, leading to coronary artery disease. When plaque builds up in these arteries, it can cause chest pain (angina) or lead to a heart attack.

The carotid arteries in the neck, which supply blood to the brain, are another common site. Atherosclerosis here can lead to strokes or transient ischemic attacks (TIAs, sometimes called "mini-strokes"). The peripheral arteries that supply blood to the legs and arms can also be affected, causing a condition called peripheral artery disease (PAD) that typically causes leg pain when walking.

Other commonly affected arteries include the renal arteries (supplying the kidneys), which can contribute to high blood pressure and kidney problems, and the aorta, the body's main artery. When atherosclerosis affects multiple arterial beds simultaneously, which is common, the overall cardiovascular risk increases substantially.

How Common Is Atherosclerosis?

Atherosclerosis is extremely common, particularly in developed countries where diets high in saturated fats and sedentary lifestyles are prevalent. Studies using advanced imaging techniques have found that some degree of atherosclerosis is present in the majority of adults over age 40, even in those without symptoms. The disease affects more than 200 million people globally and is the underlying cause of approximately 50% of all deaths in Western countries.

The prevalence of atherosclerosis increases significantly with age, but the process begins much earlier than most people realize. Autopsy studies of young adults who died from non-cardiovascular causes have found early atherosclerotic changes in a substantial proportion, demonstrating that the disease process can begin in the teens and twenties. This underscores the importance of establishing healthy habits early in life.

What Are the Symptoms of Atherosclerosis?

Atherosclerosis typically causes no symptoms until arteries become significantly narrowed (usually more than 50-70% blocked) or when a blood clot forms. Symptoms depend on which arteries are affected: chest pain or shortness of breath (heart), leg pain when walking (legs), or sudden weakness/speech problems (brain).

One of the most challenging aspects of atherosclerosis is that it usually develops silently over many years without producing any symptoms. This "silent" nature is why the disease is sometimes called a "silent killer." The artery can narrow progressively, with the body often compensating by developing collateral blood vessels or adapting to reduced blood flow. Symptoms typically only appear when the artery becomes severely narrowed (usually more than 50-70% blocked) or when a plaque ruptures and triggers a blood clot.

The specific symptoms that eventually develop depend entirely on which arteries are affected. Because atherosclerosis is a systemic disease, it often affects multiple arterial beds simultaneously, though one area may be more severely affected than others. Understanding the different symptom patterns helps in recognizing warning signs that warrant medical evaluation.

Coronary Artery Symptoms (Heart)

When atherosclerosis affects the coronary arteries that supply the heart muscle, it causes coronary artery disease (CAD). The most common symptom is angina—chest pain or discomfort that typically occurs during physical exertion or emotional stress when the heart needs more oxygen than the narrowed arteries can supply. Angina is often described as pressure, squeezing, heaviness, or tightness in the chest. It may also radiate to the arms (especially the left arm), jaw, neck, back, or stomach.

Other symptoms of coronary artery disease include shortness of breath during physical activity, fatigue, heart palpitations, and in some cases, dizziness. Women may experience atypical symptoms more frequently than men, including unusual fatigue, nausea, back pain, or shortness of breath without chest pain. These atypical presentations can lead to delayed diagnosis.

A heart attack (myocardial infarction) occurs when a coronary artery becomes completely blocked, usually when an atherosclerotic plaque ruptures and a blood clot forms. Heart attack symptoms include severe chest pain that doesn't go away with rest, shortness of breath, sweating, nausea, and a sense of impending doom. This is a medical emergency requiring immediate treatment.

Carotid Artery Symptoms (Brain)

Atherosclerosis in the carotid arteries, which supply blood to the brain, often produces no symptoms until a significant blockage or stroke occurs. Warning signs that may indicate carotid artery disease include a transient ischemic attack (TIA), sometimes called a "mini-stroke." TIA symptoms are similar to stroke but typically resolve within minutes to hours.

Symptoms of TIA or stroke include sudden weakness or numbness on one side of the face or body, difficulty speaking or understanding speech, sudden severe headache, vision problems in one or both eyes, dizziness, and loss of balance or coordination. Even if symptoms resolve quickly, a TIA is a serious warning sign that should prompt immediate medical evaluation, as it indicates high risk for a subsequent stroke.

Peripheral Artery Symptoms (Legs)

Peripheral artery disease (PAD) affects the arteries supplying the legs and, less commonly, the arms. The hallmark symptom is intermittent claudication—pain, cramping, or fatigue in the leg muscles (usually the calves, but sometimes the thighs or buttocks) that occurs during walking and is relieved by rest. This happens because the narrowed arteries cannot supply enough blood to meet the muscles' increased oxygen demands during exercise.

As PAD progresses, symptoms may include pain at rest (especially at night), numbness or weakness in the legs, coldness in the lower leg or foot, sores or wounds on the toes, feet, or legs that heal slowly or don't heal, color changes in the skin of the legs, and reduced hair growth on the legs. Severe PAD can lead to critical limb ischemia, which may require intervention to restore blood flow and prevent amputation.

What Causes Atherosclerosis?

Atherosclerosis is caused by damage to the inner lining of arteries, which triggers an inflammatory process that leads to plaque formation. Major causes include high cholesterol (especially LDL), high blood pressure, smoking, diabetes, and chronic inflammation. The process involves cholesterol deposition, immune cell infiltration, and gradual plaque growth over decades.

Atherosclerosis develops through a complex process that involves multiple factors working together over many years. While the exact mechanisms are still being studied, scientists have identified the key steps in how this disease develops. Understanding these causes helps explain why certain risk factors are so important and how treatment strategies work.

The process begins with damage to the endothelium—the thin layer of cells lining the inside of arteries. This endothelial damage can result from various factors including high blood pressure, which creates mechanical stress on artery walls; high levels of LDL cholesterol, which can penetrate and accumulate in the artery wall; smoking, which introduces toxins that directly damage blood vessels; high blood sugar levels in diabetes; and chronic inflammation throughout the body.

Once the endothelium is damaged, it becomes more permeable, allowing LDL cholesterol particles to enter the artery wall. Inside the wall, these cholesterol particles undergo oxidation—a chemical change that makes them more inflammatory and harmful. The body's immune system recognizes these oxidized particles as foreign and mounts an inflammatory response. White blood cells called monocytes migrate into the artery wall and transform into macrophages, which engulf the oxidized cholesterol and become "foam cells."

As more foam cells accumulate, they form the core of an atherosclerotic plaque. Smooth muscle cells from the artery wall also migrate into the developing plaque and produce collagen and other structural proteins that form a fibrous cap over the fatty core. Over time, calcium deposits may form within the plaque, contributing to the "hardening" of the arteries. This entire process typically takes decades to produce significant arterial narrowing.

The Role of Cholesterol

Cholesterol plays a central role in atherosclerosis development, but it's important to understand that not all cholesterol is harmful. LDL cholesterol (often called "bad cholesterol") is the primary culprit. When LDL levels are high, more cholesterol particles enter artery walls, accelerating plaque formation. HDL cholesterol ("good cholesterol"), on the other hand, helps remove cholesterol from artery walls and transport it back to the liver for elimination.

The ratio of different cholesterol types and the total amount are both important. People with high LDL, low HDL, and high triglycerides face the greatest risk. Certain genetic conditions can cause extremely high cholesterol levels (familial hypercholesterolemia), leading to accelerated atherosclerosis and heart disease at young ages. Even people with average cholesterol levels can develop atherosclerosis if other risk factors are present.

Inflammation and Atherosclerosis

Chronic inflammation is increasingly recognized as a crucial factor in atherosclerosis. The inflammatory process not only contributes to plaque development but also affects plaque stability. Plaques with more inflammation tend to have thinner fibrous caps and are more prone to rupture, which can trigger blood clots and acute cardiovascular events.

Systemic inflammation from various sources—including obesity, chronic infections, autoimmune diseases, and even poor dental health—can accelerate atherosclerosis. This explains why conditions like rheumatoid arthritis and psoriasis are associated with increased cardiovascular risk. Blood tests measuring inflammatory markers like C-reactive protein (CRP) can help assess inflammation-related cardiovascular risk.

What Are the Risk Factors for Atherosclerosis?

Major risk factors for atherosclerosis include high LDL cholesterol, high blood pressure, smoking, diabetes, obesity, physical inactivity, unhealthy diet, and family history of early heart disease. Having multiple risk factors significantly multiplies your overall cardiovascular risk. Most risk factors are modifiable through lifestyle changes and medical treatment.

Risk factors for atherosclerosis can be divided into those that can be modified (through lifestyle changes or treatment) and those that cannot. Understanding your personal risk factors is essential for prevention because having multiple risk factors dramatically increases overall cardiovascular risk—the effects are multiplicative rather than simply additive. This means that addressing even some risk factors can substantially reduce your overall risk.

Modifiable Risk Factors

High LDL Cholesterol: Elevated LDL cholesterol is one of the most important modifiable risk factors. LDL particles carry cholesterol into artery walls where it can accumulate and form plaques. The higher your LDL level, the greater your risk. Current guidelines recommend keeping LDL below 100 mg/dL (2.6 mmol/L) for most adults, and even lower for those at high cardiovascular risk.

High Blood Pressure (Hypertension): High blood pressure damages artery walls through chronic mechanical stress, making them more susceptible to atherosclerosis. It also accelerates the progression of existing plaques. Blood pressure should ideally be maintained below 120/80 mmHg. Even modest elevations in blood pressure over time significantly increase cardiovascular risk.

Smoking: Tobacco use is one of the most powerful accelerators of atherosclerosis. Smoking damages the endothelium, promotes inflammation, raises LDL cholesterol, lowers HDL cholesterol, makes blood more likely to clot, and causes blood vessels to constrict. Smoking roughly doubles the risk of cardiovascular disease. Quitting smoking at any age provides substantial benefits.

Diabetes and Prediabetes: High blood sugar levels damage blood vessels and accelerate atherosclerosis. People with diabetes have two to four times the cardiovascular disease risk of those without diabetes. Even prediabetes (blood sugar levels higher than normal but not yet in the diabetic range) increases cardiovascular risk. Good blood sugar control is essential for reducing this risk.

Obesity and Overweight: Excess body weight, particularly abdominal obesity, is associated with multiple cardiovascular risk factors including high blood pressure, high cholesterol, diabetes, and chronic inflammation. Even modest weight loss of 5-10% of body weight can significantly improve cardiovascular risk factors.

Physical Inactivity: A sedentary lifestyle contributes to obesity, diabetes, high blood pressure, and unfavorable cholesterol levels. Regular physical activity improves all of these risk factors and also has direct beneficial effects on blood vessel function. Guidelines recommend at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week.

Unhealthy Diet: Diets high in saturated fats, trans fats, sodium, and added sugars contribute to atherosclerosis through effects on cholesterol, blood pressure, blood sugar, and inflammation. In contrast, diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats (like the Mediterranean diet) are protective.

Excessive Alcohol: Heavy alcohol consumption raises blood pressure, increases triglycerides, and can contribute to obesity and heart rhythm problems. If you drink alcohol, moderate consumption is key—up to one drink daily for women and up to two for men.

Non-Modifiable Risk Factors

Age: The risk of atherosclerosis increases with age. The disease process typically begins in youth but takes decades to produce significant arterial narrowing. Most cardiovascular events occur in people over 65, though risk starts increasing after age 45 for men and 55 for women.

Sex: Men generally develop atherosclerosis earlier than women. However, after menopause, women's risk increases substantially and eventually equals that of men. Women may experience different symptoms and are sometimes underdiagnosed.

Family History: Having a first-degree relative (parent or sibling) who developed cardiovascular disease at an early age (before 55 for male relatives or 65 for female relatives) significantly increases your risk. This reflects both shared genetic factors and often shared lifestyle habits within families.

Genetics: Specific genetic variations can influence cholesterol levels, blood pressure, inflammation, and other factors affecting atherosclerosis risk. Familial hypercholesterolemia, a genetic condition causing very high LDL levels, dramatically accelerates atherosclerosis if untreated.

How Is Atherosclerosis Diagnosed?

Atherosclerosis is diagnosed through a combination of risk factor assessment, blood tests (cholesterol, blood sugar, inflammatory markers), blood pressure measurement, and imaging tests. Common diagnostic tests include ECG, stress tests, carotid ultrasound, ankle-brachial index, CT angiography, and coronary angiography depending on which arteries are suspected to be affected.

Diagnosing atherosclerosis often involves multiple approaches because the disease can affect different parts of the body and may be present without causing symptoms. The diagnostic process typically begins with a thorough medical history and physical examination, followed by laboratory tests to assess risk factors, and imaging studies when needed to directly visualize the arteries or assess their function.

During the medical history, your doctor will ask about any symptoms you may have, such as chest pain, shortness of breath, or leg pain with walking. They'll also inquire about your lifestyle habits (diet, exercise, smoking, alcohol use), family history of cardiovascular disease, and any existing medical conditions. The physical examination may include checking blood pressure in both arms, listening to your heart and the arteries in your neck (carotid arteries) with a stethoscope, checking pulses in your legs and feet, and examining your skin for signs of poor circulation.

Blood Tests

Several blood tests are important in evaluating atherosclerosis risk and progression. A lipid panel measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Elevated LDL and triglycerides, along with low HDL, indicate increased risk. Blood glucose and HbA1c (glycated hemoglobin) tests assess for diabetes or prediabetes. C-reactive protein (CRP) measures inflammation, which is associated with cardiovascular risk. Other tests may include kidney function tests, liver function tests, and sometimes more specialized markers like lipoprotein(a) or apolipoprotein B.

Imaging and Functional Tests

Electrocardiogram (ECG/EKG): This simple, non-invasive test records the heart's electrical activity and can show signs of current or previous heart damage, abnormal heart rhythms, or inadequate blood flow to the heart muscle.

Stress Testing: An exercise stress test monitors your heart's activity during physical exertion on a treadmill or stationary bike. It can reveal reduced blood flow to the heart that isn't apparent at rest. For people who can't exercise, medications can be used to simulate the effects of exercise on the heart. Stress tests are often combined with imaging (echocardiography or nuclear imaging) for greater accuracy.

Carotid Ultrasound: This non-invasive test uses sound waves to create images of the carotid arteries in the neck. It can detect plaque buildup, measure the degree of narrowing, and assess the thickness of the artery wall (carotid intima-media thickness, or CIMT), which is an early marker of atherosclerosis.

Ankle-Brachial Index (ABI): This simple test compares blood pressure measurements in the ankle and arm. A lower pressure in the ankle compared to the arm suggests peripheral artery disease. The ABI is a reliable and inexpensive screening tool for PAD.

CT Coronary Calcium Score: This specialized CT scan detects and measures calcium deposits in the coronary arteries. The amount of coronary calcium correlates with the overall amount of atherosclerotic plaque. A calcium score can help stratify cardiovascular risk, particularly in people at intermediate risk based on traditional factors.

CT Angiography: This imaging technique uses CT scanning combined with intravenous contrast dye to visualize the inside of arteries. Coronary CT angiography can show the location and severity of blockages in the heart's arteries without an invasive procedure.

Coronary Angiography (Cardiac Catheterization): This is the most definitive test for evaluating coronary artery disease. A thin tube (catheter) is inserted into an artery in the groin or wrist and guided to the heart. Contrast dye is injected, and X-ray images show any blockages. This procedure can also be combined with treatment (angioplasty and stenting) if significant blockages are found.

How Can I Prevent Atherosclerosis?

Atherosclerosis can be prevented primarily through lifestyle modifications: eating a heart-healthy diet rich in fruits, vegetables, and whole grains; exercising regularly (at least 150 minutes/week); not smoking; maintaining healthy weight; managing stress; limiting alcohol; and controlling conditions like high blood pressure, high cholesterol, and diabetes. Up to 80% of premature cardiovascular disease is preventable.

Prevention is the most effective approach to atherosclerosis because the disease is largely driven by modifiable lifestyle factors. Studies consistently show that adopting healthy habits can prevent up to 80% of premature cardiovascular disease. Prevention strategies work at every stage—they can prevent atherosclerosis from developing, slow its progression, stabilize existing plaques, and reduce the risk of cardiovascular events even in people who already have the disease.

The foundation of prevention is a healthy lifestyle, which addresses multiple risk factors simultaneously. Unlike medications that typically target one specific risk factor, lifestyle changes have broad benefits across cholesterol levels, blood pressure, blood sugar, inflammation, weight, and blood vessel function. These changes are beneficial at any age and should begin as early as possible.

Heart-Healthy Diet

Dietary choices have a profound impact on cardiovascular health. The Mediterranean diet, which emphasizes fruits, vegetables, whole grains, legumes, nuts, olive oil, fish, and moderate wine consumption, has been shown in large studies to significantly reduce cardiovascular events. The DASH (Dietary Approaches to Stop Hypertension) diet, which focuses on reducing sodium and emphasizing potassium-rich foods, is particularly effective for lowering blood pressure.

Key dietary recommendations include eating plenty of fruits and vegetables (aim for at least 5 servings daily), choosing whole grains over refined grains, including fish (especially fatty fish like salmon, mackerel, or sardines) at least twice weekly, using healthy oils like olive oil instead of butter or lard, limiting red meat and processed meats, reducing sodium intake to less than 2,300 mg daily (or 1,500 mg for those with high blood pressure), minimizing added sugars and sugary beverages, and avoiding trans fats (found in some processed foods).

Regular Physical Activity

Exercise provides multiple cardiovascular benefits including lowering blood pressure, improving cholesterol profile (raising HDL and lowering triglycerides), improving insulin sensitivity, helping with weight control, reducing inflammation, and improving blood vessel function. Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity (like brisk walking, swimming, or cycling) or 75 minutes of vigorous activity per week, spread across several days.

Strength training should be included at least twice weekly, working all major muscle groups. For those who have been sedentary, it's important to start gradually and increase activity levels over time. Even modest amounts of activity are beneficial—some exercise is always better than none. Breaking up prolonged sitting with short movement breaks is also helpful.

Smoking Cessation

Quitting smoking is perhaps the single most important step a smoker can take to reduce cardiovascular risk. Within just one year of quitting, the excess risk of coronary heart disease drops to about half that of a continuing smoker. Over time, the risk continues to decline and can eventually approach that of someone who never smoked.

Quitting is challenging but achievable with support. Effective strategies include nicotine replacement therapy (patches, gum, lozenges), prescription medications (varenicline, bupropion), counseling and behavioral support, and smartphone apps and quitlines. Combining multiple approaches increases success rates. Even people who have smoked for decades benefit substantially from quitting.

Weight Management

Maintaining a healthy weight reduces the burden on the heart and improves multiple risk factors. Body mass index (BMI) between 18.5 and 24.9 is considered healthy for most adults. However, where you carry weight also matters—abdominal obesity (measured by waist circumference) is particularly harmful. For men, a waist circumference above 40 inches (102 cm) indicates increased risk; for women, the threshold is 35 inches (88 cm).

Even modest weight loss of 5-10% of body weight can significantly improve blood pressure, cholesterol, and blood sugar levels. Sustainable weight loss comes from combining dietary changes with increased physical activity, rather than extreme or fad diets. For some people with obesity, medical or surgical weight loss interventions may be appropriate.

Stress Management

Chronic stress contributes to cardiovascular risk through multiple mechanisms including raising blood pressure, promoting unhealthy behaviors (overeating, smoking, drinking), disrupting sleep, and potentially affecting inflammation. While some stress is unavoidable, developing effective coping strategies is important.

Helpful approaches include regular physical activity (which is itself stress-reducing), relaxation techniques such as deep breathing, meditation, or yoga, maintaining social connections and support networks, getting adequate sleep (7-9 hours nightly for most adults), setting realistic goals and priorities, and seeking professional help for significant anxiety or depression.

Regular Health Screenings

Regular medical checkups allow for early detection of risk factors like high blood pressure, high cholesterol, and prediabetes, which often cause no symptoms. Recommendations for adults include blood pressure checks at least annually, cholesterol testing every 4-6 years for average-risk adults (more frequently if elevated or other risk factors present), blood glucose screening every 3 years starting at age 45 (earlier if overweight or other risk factors), and discussion of overall cardiovascular risk with your healthcare provider.

How Is Atherosclerosis Treated?

Treatment for atherosclerosis combines lifestyle modifications with medications and, when needed, procedures. Medications include statins (to lower cholesterol), blood pressure drugs, antiplatelet agents like aspirin, and diabetes medications. Procedures include angioplasty with stenting to open blocked arteries and bypass surgery to route blood around blockages.

Treatment for atherosclerosis aims to slow or stop disease progression, stabilize existing plaques to prevent rupture, reduce the risk of cardiovascular events like heart attacks and strokes, and relieve symptoms when present. The specific treatment approach depends on the severity of the disease, which arteries are affected, the presence of symptoms, and the overall cardiovascular risk profile.

Lifestyle modifications are the foundation of treatment for everyone with atherosclerosis, regardless of severity. These changes—including heart-healthy diet, regular exercise, smoking cessation, weight management, and stress reduction—provide benefits that medications cannot fully replicate. Even when medications or procedures are needed, lifestyle changes remain essential for optimal outcomes.

Medications for Atherosclerosis

Statins: These cholesterol-lowering drugs are the cornerstone of medical therapy for atherosclerosis. Statins reduce LDL cholesterol by blocking an enzyme needed for cholesterol production in the liver. Beyond lowering cholesterol, statins also stabilize plaques, reduce inflammation, and improve blood vessel function. Major studies have consistently shown that statins reduce heart attacks, strokes, and cardiovascular deaths. Common statins include atorvastatin, rosuvastatin, simvastatin, and pravastatin.

Other Cholesterol-Lowering Medications: For people who cannot tolerate statins or who need additional cholesterol reduction, other options include ezetimibe (which blocks cholesterol absorption in the intestine), PCSK9 inhibitors (injectable medications that dramatically lower LDL), bempedoic acid, and bile acid sequestrants. These may be used alone or in combination with statins.

Blood Pressure Medications: Controlling high blood pressure reduces the progression of atherosclerosis and lowers the risk of heart attack and stroke. Multiple classes of blood pressure medications are available, including ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, diuretics, and beta-blockers. The choice depends on individual factors, and many people need more than one medication to achieve blood pressure goals.

Antiplatelet Medications: These medications help prevent blood clots from forming on atherosclerotic plaques. Aspirin is the most commonly used antiplatelet agent. For people who have had a cardiovascular event or procedure, additional antiplatelet drugs like clopidogrel may be prescribed. The decision to use aspirin for primary prevention (in people without known cardiovascular disease) depends on individual risk assessment.

Diabetes Medications: For people with diabetes or prediabetes, controlling blood sugar is important for reducing cardiovascular risk. Some newer diabetes medications, particularly certain GLP-1 receptor agonists and SGLT2 inhibitors, have been shown to reduce cardiovascular events beyond their effects on blood sugar alone.

Procedures for Severe Blockages

Angioplasty and Stenting: In this minimally invasive procedure, a catheter with a small balloon is threaded through a blood vessel to the site of the blockage. The balloon is inflated to compress the plaque and widen the artery. Usually, a small mesh tube called a stent is then placed to keep the artery open. Modern stents are often coated with medication (drug-eluting stents) to prevent re-narrowing. Angioplasty can be performed on coronary, carotid, and peripheral arteries.

Coronary Artery Bypass Grafting (CABG): For people with severe coronary artery disease, especially those with multiple blocked arteries or blockages of the main coronary artery, bypass surgery may be recommended. This open-heart surgery uses blood vessels from elsewhere in the body (usually veins from the leg or arteries from the chest wall) to create new routes for blood to flow around the blocked areas.

Carotid Endarterectomy: For significant blockages in the carotid arteries, surgical removal of the plaque (endarterectomy) can reduce stroke risk. This procedure involves opening the artery, removing the plaque, and repairing the artery. Alternatively, carotid stenting may be performed in some cases.

Peripheral Artery Procedures: For peripheral artery disease, treatment options include angioplasty and stenting of leg arteries, atherectomy (removing plaque), or bypass surgery using grafts to route blood around the blocked segment.

What Happens in the Body with Atherosclerosis?

In atherosclerosis, damage to artery walls triggers an inflammatory response that leads to cholesterol deposition, immune cell infiltration, and plaque formation. Over time, plaques grow, narrowing arteries and restricting blood flow. Unstable plaques can rupture, triggering blood clots that may completely block the artery and cause heart attacks or strokes.

Understanding the biological process of atherosclerosis helps explain why certain risk factors are important and how treatments work. The disease develops through several stages over many years, beginning with subtle changes to artery walls and potentially progressing to life-threatening blockages or cardiovascular events.

Healthy arteries have smooth inner walls that allow blood to flow freely. The innermost layer, called the endothelium, is a single layer of cells that performs many important functions including regulating blood flow, preventing clot formation, and controlling the passage of substances into the artery wall. Various factors—including high blood pressure, elevated cholesterol, smoking, and high blood sugar—can damage this delicate endothelial layer.

Once the endothelium is damaged, LDL cholesterol particles can penetrate into the artery wall, where they undergo oxidation. These oxidized particles trigger an inflammatory response. White blood cells (monocytes) are attracted to the area and enter the artery wall, where they transform into macrophages. These macrophages engulf the oxidized cholesterol and become "foam cells"—so named because of their foamy appearance under a microscope.

The accumulation of foam cells forms a fatty streak, which is the earliest visible sign of atherosclerosis. Fatty streaks can be found in young people and are potentially reversible at this stage. However, with continued exposure to risk factors, the process continues. More immune cells and cholesterol accumulate, and smooth muscle cells from the artery wall migrate into the growing plaque. These smooth muscle cells produce collagen and other proteins that form a fibrous cap over the fatty, inflammatory core.

As plaques grow larger, they progressively narrow the artery and reduce blood flow. When blood flow becomes insufficient to meet the tissue's oxygen demands, symptoms develop—such as chest pain during exertion (angina) or leg pain when walking (claudication). The body may partially compensate by developing collateral blood vessels that bypass the blocked area, which is why some people with significant blockages have relatively few symptoms.

The greatest danger comes not from gradual narrowing but from sudden plaque rupture. When the fibrous cap covering a plaque breaks open, the plaque's contents are exposed to the bloodstream. This triggers the formation of a blood clot (thrombus) that can rapidly grow to completely block the artery. If this happens in a coronary artery, it causes a heart attack; in a brain artery, it causes a stroke. Plaques that are more likely to rupture—called "vulnerable plaques"—tend to have thin fibrous caps, large fatty cores, and significant inflammation.

Atherosclerosis Affecting Different Organs

Because atherosclerosis is a systemic disease, it often affects multiple arterial beds simultaneously. If you have atherosclerosis in one area, there's a high likelihood you have it elsewhere too, even without symptoms. This is why a diagnosis of coronary artery disease, for example, should prompt evaluation for carotid or peripheral artery disease, and vice versa.

When atherosclerosis affects the coronary arteries, it can lead to angina (chest pain with exertion), heart attacks, heart failure, and abnormal heart rhythms. In the carotid and cerebral arteries, it can cause strokes, transient ischemic attacks, and vascular dementia. In the peripheral arteries of the legs, it causes pain with walking, non-healing wounds, and in severe cases, tissue death requiring amputation. In the renal arteries, it can cause or worsen high blood pressure and contribute to kidney failure.

Atherosclerosis can also affect the aorta (the body's main artery), where it can contribute to the formation of aneurysms (abnormal bulging of the artery wall) that may eventually rupture. It can also affect the arteries supplying the intestines, potentially causing abdominal pain after eating or, in severe cases, intestinal ischemia. Additionally, atherosclerosis in the arteries supplying the penis is a common cause of erectile dysfunction in men.