Atherosclerosis is a long-term disease in which cholesterol, fat, inflammation, and scar tissue gradually build up inside the arteries. Over many years, these deposits thicken and stiffen the vessel walls, reducing the amount of blood that can flow through them.
Because this process is slow and silent, most people do not realize it is happening until a major event—such as a heart attack, stroke, or sudden cardiac arrest—suddenly reveals the underlying artery disease. Even though many factors contribute to atherosclerosis, including genetics, diet, smoking, blood pressure, diabetes, and inflammation, early detection and treatment can slow or even stop its progression.
Overview
Atherosclerosis affects arteries throughout the body. Healthy arteries are flexible tubes that deliver oxygen-rich blood from the heart to organs and tissues. As plaque accumulates inside the artery wall, it narrows the vessel and makes it more rigid.
Blood flow gradually decreases, and the affected organ receives less oxygen. The most dangerous stage occurs when a plaque becomes unstable and ruptures, forming a clot that can suddenly block the artery completely. When this happens in a coronary artery, it causes a heart attack. When it happens in a brain artery, it causes a stroke.
Because these life-threatening outcomes can occur without warning, preventing plaque from forming or growing is essential for long-term cardiovascular health.
Causes
Atherosclerosis develops because the inner lining of the arteries becomes damaged and more vulnerable to plaque accumulation. High LDL cholesterol is one of the most important contributors because excess LDL particles enter the artery wall and trigger inflammation.
High blood pressure also accelerates the process by repeatedly stressing and injuring the vessel lining. Smoking plays a major role as well; tobacco chemicals cause direct damage to arteries and promote the formation of unstable plaques.
Diabetes further increases risk because high blood sugar alters how cholesterol behaves in the bloodstream and causes chronic inflammation within artery walls. Excess body weight, particularly abdominal fat, amplifies these effects by increasing insulin resistance and inflammation.
Family history also matters—a strong genetic tendency can make plaque form earlier and progress faster. Finally, aging alone contributes because arteries naturally become stiffer and more susceptible to injury over time. Most people develop atherosclerosis due to a combination of several of these factors rather than a single cause.
Symptoms
Atherosclerosis usually produces no symptoms until the narrowing of the artery becomes severe or a sudden blockage occurs. When coronary arteries supplying the heart are affected, people may experience chest discomfort, pressure, or shortness of breath during physical activity because the heart is not receiving enough blood.
If the carotid arteries that supply the brain are narrowed, the first symptom may be a transient episode of weakness, numbness, or difficulty speaking, which can be a warning sign of an impending stroke. When arteries in the legs are involved, walking may cause cramping or pain that improves with rest.
Some individuals develop cold or pale feet or wounds that heal slowly because circulation is impaired. However, many people never notice any symptoms at all until a major event like a heart attack or stroke occurs, making early detection crucial.
Diagnosis
Doctors diagnose atherosclerosis by evaluating risk factors, symptoms, and blood flow to different organs. Blood tests help identify high LDL cholesterol, diabetes, or inflammation that contribute to plaque formation.
Imaging tests such as coronary calcium scoring can detect early plaque long before symptoms appear. Ultrasound studies of the carotid arteries can reveal narrowing that increases stroke risk.
Stress tests show whether the heart receives enough blood during exercise. In more advanced cases, CT angiography or catheter-based angiography provides detailed images of artery narrowing or blockages. The goal of diagnosis is not just to identify existing plaque but also to determine how unstable it is and how likely it is to cause a sudden event.
Early recognition allows treatment before irreversible damage occurs.
Treatment
Treating atherosclerosis focuses on slowing plaque growth, stabilizing existing plaques so they are less likely to rupture, and improving blood flow when arteries are significantly narrowed. Lifestyle changes form the foundation of therapy.
Eating a heart-healthy diet, staying physically active, losing excess weight, avoiding smoking, and managing stress all reduce the progression of plaque over time. Medications often play a major role.
Statins are one of the most effective treatments because they lower LDL cholesterol and reduce inflammation within plaques, making them more stable. Blood pressure medications protect artery walls from further damage.
Antiplatelet drugs such as aspirin reduce the risk of clot formation within a narrowed artery. In people with diabetes, good glucose control is essential to reduce ongoing injury to arteries. When blood flow is severely limited and symptoms persist despite medical therapy, procedures may be necessary.
Angioplasty with stenting opens narrow arteries by inflating a small balloon and placing a metal scaffold to keep the artery open. In more complex blockages, bypass surgery creates a new pathway for blood to reach the affected organ.
These procedures do not cure atherosclerosis but improve blood flow and reduce symptoms, while long-term treatment continues to focus on preventing further plaque buildup.
What Happens If Left Untreated
If untreated, atherosclerosis continues to worsen silently. As plaques grow, blood flow becomes increasingly restricted, eventually causing organ damage.
In the heart, this can lead to angina, heart failure, or sudden heart attack. In the brain, it can cause a stroke, either through gradual narrowing or sudden plaque rupture. In the kidneys, atherosclerosis may lead to progressive kidney dysfunction.
In the legs, severe blockage can result in chronic pain, skin ulcers, and in extreme cases, tissue loss or gangrene. Atherosclerosis is also a major cause of life-threatening aortic aneurysms, which can rupture without warning.
Because the disease progresses slowly but relentlessly, untreated atherosclerosis significantly shortens life expectancy.
What to Watch For
People with atherosclerosis or risk factors should pay attention to warning signs that suggest limited blood flow to vital organs. Chest pressure, shortness of breath, sudden weakness, difficulty speaking, vision loss, dizziness, or pain in the legs during walking all deserve prompt medical evaluation.
Any sudden or severe symptom—especially chest pain or neurological changes—should be treated as an emergency.
Living with Atherosclerosis
Living with atherosclerosis requires long-term commitment, but many people lead full and active lives by managing their risk factors.
Taking medications consistently, following a heart-healthy diet, exercising regularly, and monitoring blood pressure, cholesterol, and blood sugar all help slow plaque progression. Avoiding smoking entirely is one of the most important steps.
Regular follow-up with a healthcare provider ensures that treatment stays effective and allows early detection of any complication. Many patients find that lasting lifestyle changes improve their cardiovascular health, energy levels, and overall well-being.
Key Points
- Atherosclerosis is a chronic disease in which plaques gradually build up inside the arteries, narrowing them and increasing the risk of heart attack and stroke.
- It develops due to a combination of factors—high LDL cholesterol, high blood pressure, diabetes, smoking, genetics—and often progresses silently for many years.
- Diagnosis relies on identifying risk factors and assessing blood flow, while treatment focuses on lifestyle changes, medications, and procedures to improve circulation when needed.
- Without treatment, atherosclerosis can lead to life-threatening complications, but with proper management, most people can live long, healthy, and active lives.
Reference: https://www.nature.com/articles/s41572-019-0106-z
