Atherosclerosis
Also known as: Hardening of the Arteries, Arterial Plaque Disease
Quick Facts
Overview
Atherosclerosis is a condition where fatty deposits — called plaques — gradually build up on the inner walls of your arteries. These plaques are made of cholesterol, fat, calcium, and other substances found in the blood. Over time, the plaques harden and narrow the arteries, reducing the flow of oxygen-rich blood to vital organs and tissues.
Atherosclerosis develops slowly over many years. It often begins in childhood or adolescence with small streaks of fat in artery walls, but symptoms typically don't appear until middle age or later, when an artery becomes significantly narrowed or a plaque ruptures. When a plaque breaks open, it can trigger a blood clot that suddenly blocks blood flow, leading to a heart attack or stroke.
The condition can affect arteries anywhere in the body. When it occurs in the coronary arteries, it leads to heart disease. In the carotid arteries, it increases stroke risk. In the peripheral arteries of the legs, it can cause pain while walking and slow-healing wounds. Atherosclerosis is the underlying cause of most cardiovascular deaths worldwide, but it is largely preventable with healthy lifestyle choices.
Symptoms
Recognizing the symptoms of atherosclerosis early can lead to faster diagnosis and better outcomes.
Early Symptoms
- Often no symptoms in early stages
- Mild chest discomfort during physical exertion
- Occasional leg cramps when walking (intermittent claudication)
- Slightly reduced exercise tolerance
Advanced Symptoms
- Angina — chest pain or pressure during activity or stress
- Shortness of breath with exertion
- Leg pain, numbness, or weakness during walking
- Erectile dysfunction in men
- Cool or pale skin on the legs or feet
- Slow-healing sores on the toes or feet
Emergency Warning Signs
- Sudden, crushing chest pain radiating to the arm, jaw, or back (heart attack)
- Sudden numbness or weakness on one side of the body (stroke)
- Sudden difficulty speaking or understanding speech
- Sudden severe headache with no known cause
- Loss of consciousness or fainting
When to See a Doctor
See a doctor if you experience chest pain during exertion, leg pain when walking, or unexplained shortness of breath. Seek emergency care immediately if you develop sudden chest pain, numbness or weakness on one side of your body, difficulty speaking, or sudden severe headache — these may be signs of a heart attack or stroke.
Causes & Risk Factors
Common Causes
- Damage to the inner lining of arteries (endothelium) from high blood pressure, smoking, or high blood sugar
- Accumulation of LDL ('bad') cholesterol in damaged artery walls
- Inflammatory response that attracts white blood cells to form fatty streaks
- Gradual buildup of calcium, cellular debris, and fibrous tissue within plaques
- Plaque rupture triggering blood clot formation
Risk Factors
- High LDL cholesterol and low HDL cholesterol
- High blood pressure
- Cigarette smoking or tobacco use
- Type 2 diabetes or insulin resistance
- Obesity, especially abdominal obesity
- Sedentary lifestyle
- Family history of early heart disease
- Chronic inflammation or autoimmune conditions
- Unhealthy diet high in saturated fats, trans fats, and processed foods
How It's Diagnosed
Doctors often suspect atherosclerosis based on your symptoms, risk factors, and a physical examination. They may hear an abnormal whooshing sound (bruit) when listening to your arteries with a stethoscope. Blood tests checking cholesterol levels, blood sugar, and markers of inflammation (like C-reactive protein) provide important clues.
To confirm the diagnosis and assess severity, imaging tests are used. Common tests include a coronary calcium scan (CT scan that measures calcium deposits in heart arteries), carotid ultrasound, stress testing (exercise or medication-induced), coronary angiography (using dye and X-rays to visualize artery blockages), and ankle-brachial index (comparing blood pressure in your ankle to your arm to check for peripheral artery disease). The choice of test depends on which arteries are affected and how severe your symptoms are.
Treatment Options
Lifestyle Changes
- Adopt a heart-healthy diet low in saturated fat, trans fat, and sodium
- Exercise regularly — aim for 150 minutes of moderate activity per week
- Quit smoking completely — this is the single most impactful change
- Achieve and maintain a healthy weight
- Manage stress through relaxation techniques, therapy, or regular physical activity
Medications
- Statins (e.g., atorvastatin, rosuvastatin) — lower LDL cholesterol and stabilize plaques
- Antiplatelet drugs (e.g., aspirin, clopidogrel) — reduce blood clot risk
- ACE inhibitors or ARBs — lower blood pressure and protect blood vessels
- Beta-blockers — reduce heart rate and blood pressure
- PCSK9 inhibitors — for very high cholesterol not controlled by statins
Medical Procedures
- Angioplasty and stenting — balloon opens narrowed artery, stent holds it open
- Coronary artery bypass grafting (CABG) — reroutes blood around blocked arteries
- Carotid endarterectomy — surgically removes plaque from carotid arteries
- Peripheral artery bypass surgery — creates alternate blood flow path in legs
Complementary Approaches
- Omega-3 fatty acid supplements (fish oil) — may modestly reduce triglycerides
- Plant stanols and sterols — can help lower cholesterol absorption
- Regular yoga or tai chi for stress reduction and blood pressure management
Living With Atherosclerosis
Living with atherosclerosis means committing to heart-healthy habits every day. This includes eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while limiting processed and fried foods. Regular physical activity — even daily walking — helps keep arteries flexible and improves blood flow. Taking prescribed medications consistently and attending follow-up appointments are essential for monitoring progression and adjusting treatment.
Many people with atherosclerosis lead full, active lives with proper management. It helps to work closely with your healthcare team to set realistic goals, understand your lab results, and know the warning signs of complications. Joining a cardiac rehabilitation program can provide structured exercise, education, and emotional support. Staying connected with family and friends also plays an important role in maintaining motivation and mental well-being.
Potential Complications
- Heart attack (myocardial infarction)
- Stroke or transient ischemic attack (TIA)
- Peripheral artery disease causing leg pain and poor wound healing
- Chronic kidney disease from reduced blood flow to the kidneys
- Aortic aneurysm or aortic dissection
- Sudden cardiac death
Prevention
- Maintain healthy cholesterol levels through diet and medication if needed
- Control blood pressure and blood sugar
- Do not smoke — if you smoke, seek help to quit
- Stay physically active throughout life
- Maintain a healthy weight
- Get regular health screenings including cholesterol and blood pressure checks
Frequently Asked Questions
Sources
- Atherosclerosis. National Heart, Lung, and Blood Institute. View source
- Arteriosclerosis / Atherosclerosis. Mayo Clinic. View source
- Atherosclerosis. American Heart Association. View source
- How Is Atherosclerosis Diagnosed?. National Heart, Lung, and Blood Institute. View source
Medical Disclaimer
This content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Medically Reviewed By
Dr. James Carter, MD, Cardiology, Board Certified
Last reviewed: March 12, 2025
Our medical review process ensures accuracy and clinical relevance.
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