What Is Atherosclerosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Atherosclerosis is the buildup of plaque — a combination of cholesterol, fat, calcium, and blood elements — on and inside the walls of your arteries. (1)

Your arteries are the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. When they narrow and stiffen due to plaque buildup, blood flow to various organs and tissues can be restricted, potentially causing symptoms and even tissue damage.

The terms “atherosclerosis” and “arteriosclerosis” are often used interchangeably, but atherosclerosis is actually a form of arteriosclerosis (commonly known as hardening of the arteries) specifically caused by plaque buildup.

Atherosclerosis can affect any of the body’s arteries. When the arteries that lead to your heart are affected, the condition is known as coronary artery disease (CAD). (2,3)

Many people with atherosclerosis don’t experience any symptoms, especially if their disease is mild.

But when the narrowing and stiffening of the arteries prevents enough blood from reaching certain areas of the body, symptoms in those areas can occur.

The most common symptoms of atherosclerosis happen when blood flow is restricted to your heart, brain, limbs, or kidneys.

Depending on the area(s) affected, signs and symptoms of atherosclerosis may include:

• Chest pain (angina)
• Numbness or weakness in your arms or legs
• Leg pain while walking (claudication)
• High blood pressure (hypertension) or signs of kidney failure (3)

Learn More About Signs and Symptoms of Atherosclerosis

The exact causes of atherosclerosis aren’t known.

There’s evidence that it may be caused by damage to the inner lining of your arteries (known as the endothelium), where plaque typically accumulates.

This damage may be caused by the following factors:

• Smoking and other tobacco use
• High levels of fat or cholesterol in your blood
• High blood pressure (hypertension)
• Elevated blood sugar
• Inflammation from arthritis, lupus, infection, or other diseases (3)

Risk factors for atherosclerosis include the following health conditions:

• High levels of LDL (“bad”) cholesterol
• Low levels of HDL (“good”) cholesterol
• High blood pressure
• Tobacco use
• Diabetes or prediabetes
• Being overweight or obese
• Lack of physical activity
• An unhealthy diet
• A family history of heart disease
• Older age (3,4)

In men, the risk for atherosclerosis increases after age 45. In women, the risk increases after age 55.

Your risk for atherosclerosis is higher if your father or a brother was diagnosed with heart disease before age 55, or if your mother or a sister was diagnosed with heart disease before age 65.

In addition, recent research suggests that high levels of a protein called C-reactive protein (CRP) in your blood may increase your risk for atherosclerosis. CRP is a marker of inflammation in your body. (4)

To diagnose atherosclerosis, your doctor will consider your symptoms and medical history, as well as perform a physical exam and possibly order certain tests.

Commonly used tests to help diagnose atherosclerosis include:

Blood Tests Your doctor may check your blood cholesterol and triglyceride levels, as well as blood glucose (sugar) if diabetes or prediabetes is known or suspected.

Blood Pressure Measurements Your doctor may take your blood pressure at various points on your arms or legs, which can help measure blood flow and detect blockages. A special ultrasound device (Doppler ultrasound) may be used for this.

Coronary Angiogram This test involves inserting a long, narrow tube (catheter) through an artery and extending it to your heart, then injecting a dye that’s visible on X-ray images to reveal blockages in your coronary arteries.

Electrocardiogram (ECG or EKG) This test measures the electrical activity in your heart, and may reveal a heart rhythm disorder or a prior heart attack. (3)

Learn More About Diagnosing Atherosclerosis

Prognosis of Atherosclerosis

Atherosclerosis is a serious health condition that may lead to major problems like heart failure, heart attack, or stroke. But it develops at a different pace in different people.

If your atherosclerosis progresses very slowly over decades and stays mild, you may never develop any symptoms or health problems as a result.

But if your atherosclerosis progresses more quickly and becomes moderate or severe, you may experience disabling complications or premature death.

How quickly your atherosclerosis develops or progresses depends on several risk factors, including many related to your lifestyle. (1,3)

How long it takes for atherosclerosis to develop varies from person to person.

In some people, atherosclerosis develops quickly in their thirties. In others, it doesn’t develop to any significant degree until people are in their fifties or sixties, or older. (1)

Once you have atherosclerosis, it tends to get worse as time goes on. You can avoid that by changing the risk factors that contribute to it.

You may be able to halt or reverse atherosclerosis through management with medications, exercise, weight loss, a heart-healthy diet, and other lifestyle measures. (1,2)

The course of treatment that your doctor recommends for atherosclerosis will depend on how severe it is and which arteries are affected.

Treatment for the condition may be especially critical if blood flow to the heart or brain is substantially restricted.

Proven treatments for atherosclerosis include lifestyle measures, prescription drugs, and surgical procedures.

Lifestyle changes are often the first recommended treatment and are likely to help even if you need other treatments.

Drug treatments for atherosclerosis can lower your blood pressure, improve unhealthy cholesterol levels, and reduce your risk of developing dangerous blood clots.

Surgery is usually recommended only if your condition is especially severe or if you don’t respond well to drug treatments. (2,3)

Medication Options

Your doctor may prescribe drugs to treat different causes or effects of your atherosclerosis:

Cholesterol Medications These drugs, which include statins and fibrates, are designed to lower your levels of total and LDL (“bad”) cholesterol.

Antiplatelet Medications These drugs, including aspirin, reduce your risk of developing a dangerous blood clot that could block an artery.

Blood Pressure Medications These drugs, some of which may also relieve chest pain, include beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and diuretics.

Pain Medications If you experience leg pain with activity, your doctor may advise you to take an over-the-counter pain reliever or prescribe something stronger. (3)

Alternative and Complementary Therapies

Changing your lifestyle is an important part of addressing atherosclerosis. Important changes may include:

• Getting more aerobic exercise
• Following a heart-healthy diet
• Losing extra weight
• Managing stress
• Not smoking (1,3)

A number of different foods and dietary supplements may also help lower your cholesterol or blood pressure, including the following (talk to your doctor before taking any supplement):

• Alpha-linolenic acid (ALA)
• Barley
• Black or green tea
• Calcium
• Cocoa
• Cod liver oil
• Coenzyme Q10
• Fish oil
• Folic acid
• Garlic
• Oat bran
• Psyllium (3)

Surgical Procedures

If lifestyle measures and medication aren’t enough to improve your symptoms, or if your atherosclerosis is advanced, your doctor may recommend one or more of the following procedures:

Angioplasty and Stent Placement This procedure involves opening up a blocked section of an artery by inflating a tiny balloon and inserting a stent, a mesh tube that’s left in place to hold the artery open.

Endarterectomy This procedure involves surgically removing plaque deposits from the artery wall. This may be done in the carotid arteries of your neck.

Fibrinolytic Therapy Your doctor may use a clot-dissolving drug at the site of an acute blood clot to break it up.

Bypass Surgery In this surgical procedure, doctors graft a section of blood vessel from another area of your body around a blocked or narrowed artery. (2,3)

Learn More About Treatment for Atherosclerosis

Prevention of Atherosclerosis

If your atherosclerosis is still at an early stage or if you haven’t been diagnosed with the condition yet, lifestyle measures can go a long way toward preventing plaque from forming in your arteries. These include:

• Not smoking
• Following a heart-healthy diet
• Getting enough aerobic exercise
• Maintaining a healthy weight (3)

Not smoking is probably the most important factor in limiting your risk, followed by diet and physical activity.

A heart-healthy diet is based on fruits and vegetables, whole grains, lean protein sources, and healthy fats. It’s important to limit sodium, refined carbohydrates, and saturated and trans fats.

Getting enough exercise generally means 30 minutes of moderate aerobic activity most days of the week. But more exercise yields more benefits, and some is better than none at all.

Losing excess weight can help improve your cholesterol levels. If you’re overweight, losing just 10 percent of your body weight can make a substantial difference. (1,3)

Learn More About Preventing Atherosclerosis

The potential complications of atherosclerosis depend on which arteries are affected. They may include:

• Coronary artery disease (CAD)
• Carotid artery disease
• Chronic kidney disease
• Peripheral artery disease
• Aneurysm

When atherosclerosis narrows the arteries leading to your heart, you may develop coronary artery disease (CAD), which can cause chest pain (angina), heart failure, or a heart attack.

When atherosclerosis narrows the arteries leading to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or a stroke.

Narrowing of the renal (kidney) arteries can cause chronic kidney disease, in which your kidneys can no longer sufficiently filter waste in your body.

When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems that make the affected limbs lose sensation, or hurt with movement. This is known as peripheral artery disease.

Atherosclerosis can also cause a bulge in the wall of your artery, known as an aneurysm. This serious complication can occur anywhere in your body and may cause throbbing pain or internal bleeding, both of which are medical emergencies. (3)

Subclinical atherosclerosis — the kind that doesn’t have any symptoms — appears to be common, with one study in the central Appalachian region of the United States showing that 56 percent of adults had a coronary artery calcium score (a measure of atherosclerosis) greater than zero. (5)

Heart disease, which commonly results from atherosclerosis, killed about 697,000 people in the United States in 2020. That’s 1 out of 5 total deaths, making heart disease the leading cause of death among women, men, and most racial and ethnic groups. (6)

More than 382,000 people in the United States died in 2020 as a result of CAD, making it the deadliest form of heart disease. (6) Other leading cardiovascular causes of death are also connected to atherosclerosis, including stroke, heart failure, and high blood pressure. (5)

There isn’t much data on early-stage atherosclerosis (subclinical atherosclerosis), but when it comes to diseases caused by atherosclerosis, there are notable differences among racial and ethnic groups in the United States.

After adjusting for the overall age distribution of different groups, 11.5 percent of non-Hispanic white adults in the United States had heart disease in 2017, according to the CDC. That number was 9.5 percent for non-Hispanic Black adults, 7.4 percent for Hispanic adults, and 6.0 percent for Asian adults.

But Black Americans were more likely than any other group to die from heart disease, with 208 deaths per 100,000 people. The equivalent number of heart disease deaths was 169 for white Americans, 114 for Hispanic Americans, and 86 for Asian Americans.

It’s unlikely that these disparities in deaths, though, are caused by differences in atherosclerosis alone, since rates of high cholesterol — a major contributor to atherosclerosis — are nearly identical among racial and ethnic groups in the United States. (7)

Atherosclerosis increases the risk of developing several health problems, including the following:

• Coronary artery disease (CAD)
• Carotid artery disease
• Chronic kidney disease
• Peripheral artery disease
• Aneurysm (3)

Atherosclerosis may be caused or made worse by certain health conditions, including these:

• High cholesterol
• High blood pressure
• Diabetes and prediabetes
• Overweightness and obesity (3,4)

The following organizations and websites offer information about atherosclerosis, along with ways to access care and connect with other people.

American Heart Association (AHA)

The leading advocacy and research group for heart health in the United States, the AHA provides information on different types of heart disease, ideas to inspire healthy living, and guidance on how to deal with a heart-related event or emergency.

National Heart, Lung, and Blood Institute (NHLBI)

This research arm of the U.S. National Institutes of Health provides an overview of topics connected to atherosclerosis and associated health conditions. It also has information and links about participating in atherosclerosis-related clinical trials.

Centers for Disease Control and Prevention (CDC)

This page from the main U.S. public health agency gives facts and statistics on heart disease, including charts and maps that show the racial and ethnic and geographic distribution of heart-related outcomes.

Mayo Clinic

This page provides information on all aspects of atherosclerosis, from how to limit your risk to finding the right health professionals when you need care.

Additional reporting by Quinn Phillips.