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Atherosclerosis

Hardening of the arteries; Arteriosclerosis; Plaque buildup - arteries; Hyperlipidemia - atherosclerosis; Cholesterol - atherosclerosis

Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can narrow or completely block the arteries and cause problems throughout the body.

Atherosclerosis is a common disorder.

Causes

Atherosclerosis often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them.

Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them.

These blockages starve tissues of blood and oxygen. This can result in damage or tissue death. It is a common cause of heart attack and stroke.

High blood cholesterol levels can cause hardening of the arteries at a younger age.

For many people, high cholesterol levels are due to a diet that is too high in saturated fats and trans fats.

Other factors that can contribute to hardening of the arteries include:

Symptoms

Atherosclerosis does not cause symptoms until blood flow to part of the body becomes slowed or blocked.

If the arteries supplying the heart become narrow, blood flow can slow down or stop. This can cause chest pain (stable angina), shortness of breath, and other symptoms.

Narrowed or blocked arteries may also cause problems in the intestines, kidneys, legs, and brain.

Exams and Tests

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.

All people age 18 or older should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure.

Cholesterol testing is recommended in all adults. The major national guidelines differ on the suggested age to start testing.

  • Screening should begin between ages 20 to 35 for men and ages 20 to 45 for women.
  • Repeat testing is not needed for five years for most adults with normal cholesterol levels.
  • Repeat testing may be needed if lifestyle changes occur, such as large increase in weight or a change in diet.
  • More frequent testing is needed for adults with a history of high cholesterol, diabetes, kidney problems, heart disease, stroke, and other conditions

A number of imaging tests may be used to see how well blood moves through your arteries. Check with your provider to see if any of these are recommended for you.

  • Doppler tests that use ultrasound or sound waves
  • Magnetic resonance arteriography (MRA), a special type of MRI scan
  • Special CT scans called CT angiography
  • Arteriograms or angiography that use x-rays and contrast material (sometimes called "dye") to see the path of blood flow inside the arteries

Treatment

Lifestyle changes will reduce your risk for atherosclerosis. Things you can do include:

  • Quit smoking: This is the single most important change you can make to reduce your risk for heart disease and stroke.
  • Avoid fatty foods: Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
  • Limit how much alcohol you drink: Recommended limits are one drink a day for women, two a day for men.
  • Get regular physical activity: Exercise with moderate intensity (such as brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 to 90 minutes a day. Talk to your provider before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.

If your blood pressure is high, it is important for you to lower it and keep it under control.

The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.

  • Do not stop or change high blood pressure medicines without talking to your provider.

Your provider may want you to take medicine for abnormal cholesterol levels or for high blood pressure if lifestyle changes do not get you to your goals for these. This will depend on:

  • Your age
  • The medicines you take
  • Your risk of side effects from possible medicines
  • Whether you have heart disease or other blood flow problems
  • Whether you smoke or are overweight
  • Whether you have diabetes or other heart disease risk factors
  • Whether you have any other medical problems, such as kidney disease

Your provider may suggest taking aspirin or another medicine to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your provider.

Losing weight if you are overweight and reducing blood sugar if you have diabetes or pre-diabetes can help reduce the risk of developing atherosclerosis.

Outlook (Prognosis)

Atherosclerosis cannot be reversed once it has occurred. However, lifestyle changes and treating high cholesterol levels can prevent or slow the process from becoming worse. This can help reduce the chances of having a heart attack and stroke as a result of atherosclerosis.

Possible Complications

In some cases, the plaque is part of a process that causes a weakening of the wall of an artery. This can lead to a bulge in an artery called an aneurysm. Aneurysms can break open (rupture). This causes bleeding that can be life threatening.

Open References

References

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414. PMID: 30894319 pubmed.ncbi.nlm.nih.gov/30894319/.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Libby P. The vascular biology of atherosclerosis. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022: chap 24.

Marks AR. Cardiac and circulatory function. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 41.

US Preventive Services Task Force website. Final recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. Updated August 23, 2022. Accessed March 1, 2024. www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/statin-use-in-adults-preventive-medication.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):2199-2269. PMID: 2914653 pubmed.ncbi.nlm.nih.gov/29146533/.

  • Atherosclerosis causes

    Atherosclerosis causes

    Animation

    •  

    Atherosclerosis causes - Animation

    Atherosclerosis is a condition in which deposits of fatty material, called plaques, develop in the walls of arteries, leading to a reduction or blockage of blood flow. It can affect almost any artery in the body. Atherosclerosis is the most important and most common type of arteriosclerosis, a group of diseases in which the wall of an artery becomes thicker and less elastic. The development of atherosclerosis is complex, but the primary event appears to be injury to the arterial wall. Many different factors can injure the artery's wall, triggering the formation of plaque, for example, turbulent blood flow due to high blood pressure (BP), inflammatory immune responses, certain infections, and chemical abnormalities of the blood, such as diabetes and high cholesterol. Chemical signals that are generated as a result of injury cause white blood cells to attach to the arterial wall, where they collect cholesterol and other fatty material, eventually forming plaque. Over time, the build-up of plaque narrows the space within an artery. Certain risk factors, such as being a male, advanced age, and a family history of early atherosclerosis, cannot be changed. However, to help prevent atherosclerosis, individuals can refrain from tobacco use, decrease low density lipoprotein (LDL) cholesterol levels, lower blood pressure, lose weight, consume fresh fruits and vegetables daily, eat a diet that is low in saturated fats, and exercise regularly. Diabetic individuals need to maintain strict control of their blood sugar. People at high risk for developing atherosclerosis may also benefit from taking certain drugs, such as statins, aspirin, or other antiplatelet drugs.

  • Atherosclerosis

    Animation

    •  

    Atherosclerosis - Animation

    Atherosclerosis is a disease in which fatty material is deposited on the wall of an artery. Normally, the walls of an artery are smooth, allowing blood to flow unimpeded. However, if damage occurs to its inner lining, fat, cholesterol, platelets, and other substances may accumulate at a damaged section of the arterial wall. Eventually, the tissue builds up and a plaque is formed, narrowing the lumen of the artery. Where the narrowing is severe, there is a risk that the vessel can become blocked completely if a thrombus forms in the diseased segment.

  • Carotid stenosis - X-ray of the left artery

    Carotid stenosis - X-ray of the left artery - illustration

    A carotid arteriogram is an X-ray study designed to determine if there is narrowing or other abnormality in the carotid artery, a main artery to the brain. This is an angiogram of the left common carotid artery (both front-to-back and side views) showing a severe narrowing (stenosis) of the internal carotid artery just beyond the division of the common carotid artery into the internal and external branches.

    Carotid stenosis - X-ray of the left artery

    illustration

  • Carotid stenosis - X-ray of the right artery

    Carotid stenosis - X-ray of the right artery - illustration

    This is an angiogram of the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past the carotid fork. There is enlargement of the artery or ulceration in the area after the stenosis in this close-up film. Note the narrowed segment toward the bottom of the picture.

    Carotid stenosis - X-ray of the right artery

    illustration

  • Enlarged view of atherosclerosis

    Enlarged view of atherosclerosis - illustration

    Atherosclerosis is a disease of the arteries in which fatty material and plaque are deposited in the wall of an artery, resulting in narrowing of the arterial lumen and eventual impairment of blood flow.

    Enlarged view of atherosclerosis

    illustration

  • Prevention of heart disease

    Prevention of heart disease - illustration

    Heart disease may be prevented by recommended healthy diet, regular exercise and to stop smoking if you are a smoker. Follow your health care provider's recommendations for treatment and prevention of heart disease.

    Prevention of heart disease

    illustration

  • Developmental process of atherosclerosis

    Developmental process of atherosclerosis - illustration

    The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.

    Developmental process of atherosclerosis

    illustration

  • Atherosclerosis causes

    Animation

    •  

    Atherosclerosis causes - Animation

    Atherosclerosis is a condition in which deposits of fatty material, called plaques, develop in the walls of arteries, leading to a reduction or blockage of blood flow. It can affect almost any artery in the body. Atherosclerosis is the most important and most common type of arteriosclerosis, a group of diseases in which the wall of an artery becomes thicker and less elastic. The development of atherosclerosis is complex, but the primary event appears to be injury to the arterial wall. Many different factors can injure the artery's wall, triggering the formation of plaque, for example, turbulent blood flow due to high blood pressure (BP), inflammatory immune responses, certain infections, and chemical abnormalities of the blood, such as diabetes and high cholesterol. Chemical signals that are generated as a result of injury cause white blood cells to attach to the arterial wall, where they collect cholesterol and other fatty material, eventually forming plaque. Over time, the build-up of plaque narrows the space within an artery. Certain risk factors, such as being a male, advanced age, and a family history of early atherosclerosis, cannot be changed. However, to help prevent atherosclerosis, individuals can refrain from tobacco use, decrease low density lipoprotein (LDL) cholesterol levels, lower blood pressure, lose weight, consume fresh fruits and vegetables daily, eat a diet that is low in saturated fats, and exercise regularly. Diabetic individuals need to maintain strict control of their blood sugar. People at high risk for developing atherosclerosis may also benefit from taking certain drugs, such as statins, aspirin, or other antiplatelet drugs.

  • Atherosclerosis

    Animation

    •  

    Atherosclerosis - Animation

    Atherosclerosis is a disease in which fatty material is deposited on the wall of an artery. Normally, the walls of an artery are smooth, allowing blood to flow unimpeded. However, if damage occurs to its inner lining, fat, cholesterol, platelets, and other substances may accumulate at a damaged section of the arterial wall. Eventually, the tissue builds up and a plaque is formed, narrowing the lumen of the artery. Where the narrowing is severe, there is a risk that the vessel can become blocked completely if a thrombus forms in the diseased segment.

  • Carotid stenosis - X-ray of the left artery

    Carotid stenosis - X-ray of the left artery - illustration

    A carotid arteriogram is an X-ray study designed to determine if there is narrowing or other abnormality in the carotid artery, a main artery to the brain. This is an angiogram of the left common carotid artery (both front-to-back and side views) showing a severe narrowing (stenosis) of the internal carotid artery just beyond the division of the common carotid artery into the internal and external branches.

    Carotid stenosis - X-ray of the left artery

    illustration

  • Carotid stenosis - X-ray of the right artery

    Carotid stenosis - X-ray of the right artery - illustration

    This is an angiogram of the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past the carotid fork. There is enlargement of the artery or ulceration in the area after the stenosis in this close-up film. Note the narrowed segment toward the bottom of the picture.

    Carotid stenosis - X-ray of the right artery

    illustration

  • Enlarged view of atherosclerosis

    Enlarged view of atherosclerosis - illustration

    Atherosclerosis is a disease of the arteries in which fatty material and plaque are deposited in the wall of an artery, resulting in narrowing of the arterial lumen and eventual impairment of blood flow.

    Enlarged view of atherosclerosis

    illustration

  • Prevention of heart disease

    Prevention of heart disease - illustration

    Heart disease may be prevented by recommended healthy diet, regular exercise and to stop smoking if you are a smoker. Follow your health care provider's recommendations for treatment and prevention of heart disease.

    Prevention of heart disease

    illustration

  • Developmental process of atherosclerosis

    Developmental process of atherosclerosis - illustration

    The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.

    Developmental process of atherosclerosis

    illustration

A Closer Look

 
 

Review Date: 2/27/2024

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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