Atherosclerosis is the slow buildup of cholesterol-rich plaque inside artery walls, and it is the main cause of cardiovascular disease. It can narrow arteries to the heart (coronary artery disease), brain (carotid disease and stroke) and legs (peripheral artery disease). It often causes no symptoms for years, but it can be slowed with cholesterol and blood pressure control, not smoking, exercise and medicines.
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Board-certified cardiologist · Katy & Sugar Land, TX
Fellowship-trained in cardiovascular disease, interventional cardiology, echocardiography and advanced heart failure and transplant cardiology. Former Assistant Professor of Cardiology at McGovern Medical School.
What is atherosclerosis?
Healthy arteries are flexible tubes with smooth inner linings. Atherosclerosis begins when the lining is injured by factors such as high LDL cholesterol, high blood pressure, smoking or high blood sugar. Cholesterol particles enter the wall, inflammatory cells gather, and a plaque forms. Over decades, plaques grow, harden with calcium and narrow the artery. According to the NHLBI, atherosclerosis can affect any artery in the body.
Plaques cause harm in two ways: by gradually narrowing the artery and limiting blood flow, and by suddenly rupturing, which triggers a clot that can block the artery and cause a heart attack or stroke.
Where atherosclerosis causes disease
Cardiovascular disease is an umbrella term for diseases of the heart and blood vessels, and atherosclerosis drives most of them:
| Arteries affected | Condition | Possible symptoms |
|---|---|---|
| Heart (coronary) | Coronary artery disease, angina, heart attack | Chest pressure with exertion, breathlessness, fatigue |
| Neck and brain (carotid, cerebral) | Carotid artery disease, TIA, stroke | Sudden weakness, numbness, speech or vision problems |
| Legs (peripheral) | Peripheral artery disease (PAD) | Leg cramping when walking, slow-healing sores, cold feet |
| Kidneys (renal) | Renal artery stenosis | Hard-to-control blood pressure, kidney decline |
| Aorta | Aortic aneurysm | Usually silent; sometimes back or abdominal pain |
Risk factors for atherosclerosis
- High LDL cholesterol and lipoprotein(a); see high cholesterol treatment.
- High blood pressure; see hypertension treatment.
- Diabetes and insulin resistance; see diabetes and heart disease.
- Smoking and vaping.
- Obesity, inactivity and an unhealthy diet.
- Chronic inflammation, reflected in markers such as hs-CRP.
- Family history of early heart disease; see family history screening.
- Older age, chronic kidney disease and autoimmune conditions.
Symptoms of atherosclerosis
Atherosclerosis is usually silent until an artery is significantly narrowed or suddenly blocked. Symptoms depend on which arteries are affected: angina and breathlessness for the heart, leg pain when walking for PAD, and sudden neurological symptoms for the brain. Learn the signs of blocked arteries in the heart and about peripheral artery disease treatment.
- Chest pressure or pain lasting more than a few minutes
- Shortness of breath, cold sweat or pain spreading to the arm or jaw
- Face drooping, arm weakness, speech difficulty or sudden vision loss
- Sudden severe headache or loss of balance
How atherosclerosis is diagnosed
- Blood tests: cholesterol panel, lipoprotein(a), blood sugar and A1c, kidney function and sometimes hs-CRP.
- Coronary calcium scan to measure calcified plaque in the heart arteries.
- Heart disease risk assessment combining your numbers into a 10-year risk estimate.
- Ankle-brachial index and vascular ultrasound for leg and neck arteries.
- Stress testing, CT angiography or cardiac catheterization when symptoms suggest coronary disease.
Can atherosclerosis be slowed or reversed?
Plaque that has formed is not easily removed, but its growth can be slowed, and intensive LDL lowering can stabilize plaque and modestly reduce its size. The cornerstones are:
- Lower LDL cholesterol with diet, statins and, when needed, other medicines such as ezetimibe or PCSK9 inhibitors. See how to lower cholesterol with diet.
- Control blood pressure and blood sugar.
- Stop smoking; the benefit starts quickly.
- Move every day: at least 150 minutes of moderate activity a week.
- Eat a heart-healthy diet rich in vegetables, fruit, whole grains, legumes, nuts and fish.
- Antiplatelet therapy such as aspirin for people with established disease, when recommended.
- Procedures such as angioplasty and stenting for arteries causing symptoms.
Preventive and interventional cardiology in Katy and Sugar Land
Dr. Adnan Khalid has a special interest in atherosclerosis and preventive cardiology. At our Katy and Sugar Land offices, we assess your risk, order the right tests and build a plan to slow plaque buildup, with catheter-based treatment at affiliated hospitals when needed. Learn about preventive cardiology and cardiovascular disease care.
Katy office: 410 W Grand Pkwy S, Suite 4D, Katy, TX 77494
Sugar Land office: 7102 Tarrington Ave, Suite 505, Sugar Land, TX 77479
Phone: (713) 258-6111
We also see patients from Fulshear, Richmond, Rosenberg, Stafford, Missouri City and west Houston.
Know your plaque risk before it causes symptoms
A preventive cardiology visit can estimate your risk and lower it. Request an appointment in Katy or Sugar Land.
Having symptoms right now? Call 911. Do not wait for an appointment.
Frequently asked questions
What is atherosclerosis?
A buildup of cholesterol-rich plaque inside artery walls that narrows arteries and can trigger clots, causing heart attacks, strokes and peripheral artery disease.
What is the difference between atherosclerosis and cardiovascular disease?
Cardiovascular disease is the broad term for heart and blood vessel diseases. Atherosclerosis is the underlying process that causes most of them.
What are the symptoms of atherosclerosis?
Often none until arteries are significantly narrowed. Then symptoms depend on location: angina for the heart, leg pain when walking for PAD and stroke symptoms for the brain.
Can atherosclerosis be reversed?
It cannot be fully reversed, but aggressive LDL lowering, blood pressure and blood sugar control, not smoking and exercise can stabilize plaque and slow or modestly reduce it.
How is atherosclerosis diagnosed?
With blood tests, a coronary calcium scan, risk assessment, vascular ultrasound and, when symptoms suggest it, stress testing, CT angiography or catheterization.
What causes atherosclerosis?
High LDL cholesterol, high blood pressure, smoking, diabetes, inflammation, inactivity, genetics and aging all contribute.
Trusted health resources
- Atherosclerosis, National Heart, Lung, and Blood Institute (NIH)
- Atherosclerosis, MedlinePlus, U.S. National Library of Medicine
- Blood Cholesterol, National Heart, Lung, and Blood Institute (NIH)
- Peripheral Arterial Disease, MedlinePlus, U.S. National Library of Medicine
- Carotid Artery Disease, MedlinePlus, U.S. National Library of Medicine
Medical disclaimer: This article is for general education and is not a diagnosis or a substitute for care from your own doctor. If you think you may be having a heart attack, stroke or another emergency, call 911 right away.
