Atherosclerosis: Symptoms, Causes, Diagnosis, and Prevention

Atherosclerosis is a chronic cardiovascular condition in which plaque builds up inside the arteries, causing them to narrow and harden. Over time, this reduces blood flow to vital organs and increases the risk of heart attack, stroke, and peripheral artery disease. Early detection and management are critical because atherosclerosis often develops silently for years before symptoms appear.

Medically reviewed by the HealthMatters clinical team
Last updated: February 10, 2026

What is Atherosclerosis?

Atherosclerosis is a progressive disease of the arteries characterized by the accumulation of plaque made up of cholesterol, fat, calcium, inflammatory cells, and other substances. This plaque can:

• Narrow arteries (arterial stenosis)

• Reduce oxygen delivery to tissues

• Trigger blood clots

• Lead to cardiovascular events such as heart attack or stroke

Atherosclerosis is the underlying cause of most cardiovascular disease (CVD) worldwide and is strongly linked to lipid imbalances, inflammation, and metabolic health.

Commonly affected arteries

• Coronary arteries (heart)

• Carotid arteries (brain)

• Peripheral arteries (legs and limbs)

• Renal arteries (kidneys)

Early Signs and Symptoms

Atherosclerosis may not cause symptoms until arteries are significantly narrowed. Symptoms depend on which arteries are affected.

Possible symptoms include

• Chest pain or angina

• Shortness of breath

• Fatigue or reduced exercise tolerance

• Leg pain when walking (claudication)

• Confusion or neurologic symptoms if brain blood flow is reduced

Advanced disease can lead to heart attack, stroke, or critical limb ischemia.

Causes and Risk Factors

Atherosclerosis develops gradually due to damage and inflammation in arterial walls. Multiple risk factors accelerate plaque formation.

Major risk factors

• High LDL cholesterol or ApoB

• Low HDL cholesterol

• High triglycerides

• High blood pressure

• Diabetes or insulin resistance

• Smoking or tobacco exposure

• Obesity and metabolic syndrome

• Sedentary lifestyle

• Chronic inflammation

• Family history of cardiovascular disease

Emerging risk markers

• Oxidized LDL

• Small dense LDL particles

• Elevated ApoB or LDL-P

• Elevated hs-CRP

• Elevated lipoprotein(a)

How Atherosclerosis is Diagnosed

Atherosclerosis is often detected through a combination of lab testing and imaging.

Blood tests

• Lipid panel (LDL-C, HDL-C, triglycerides)

• ApoB and LDL particle number

• Inflammatory markers (hs-CRP)

• Glucose, insulin, HbA1c

• Lipoprotein(a)

Imaging and functional tests

• Coronary artery calcium (CAC) scan

• Carotid ultrasound

• Stress test

• CT angiography

• Cardiac catheterization (angiography)

Early detection through biomarkers and imaging allows intervention before major cardiovascular events occur.

Prevention and Risk Reduction

Atherosclerosis is largely preventable and often reversible in early stages through lifestyle and medical management.

Lifestyle strategies

• Heart-healthy diet (Mediterranean-style)

• Regular physical activity

• Weight management

• Smoking cessation

• Blood pressure control

• Blood sugar control

• Sleep optimization

• Stress reduction

Medical management

• Statins or lipid-lowering therapy

• PCSK9 inhibitors (if high risk)

• Blood pressure medications

• Antiplatelet therapy when indicated

• Diabetes treatment

Key Biomarkers Linked to Atherosclerosis

Monitoring biomarkers helps assess risk, progression, and treatment response.

Core markers

• LDL-C

• HDL-C

• Triglycerides

• Total cholesterol

• Non-HDL cholesterol

Advanced cardiovascular markers

• ApoB

• LDL particle number (LDL-P)

• Small dense LDL

• Oxidized LDL

• Lipoprotein(a)

• hs-CRP

Tracking these markers over time provides a clearer picture of cardiovascular risk than cholesterol alone.

Why Atherosclerosis Matters

Atherosclerosis is the leading cause of:

• Heart attack

• Stroke

• Peripheral artery disease

• Vascular dementia

Because it develops silently, routine lab testing and cardiovascular risk assessment are essential—even in people without symptoms.

When to Get Tested

Consider screening if you:

• Have elevated cholesterol or triglycerides

• Have diabetes or insulin resistance

• Have a family history of heart disease

• Are over age 35–40

• Have high blood pressure

• Have metabolic syndrome

Early testing allows prevention long before serious complications occur.

Summary

Atherosclerosis is a chronic inflammatory disease of the arteries driven by lipid imbalances, metabolic dysfunction, and lifestyle factors. It can remain silent for decades but is the root cause of most cardiovascular events. Regular biomarker testing, imaging when appropriate, and proactive lifestyle and medical management can significantly reduce risk and improve long-term heart health.

Frequently Asked Questions about Atherosclerosis

What is atherosclerosis?
Atherosclerosis is a chronic condition where plaque (made of cholesterol, inflammatory cells, calcium, and other substances) builds up inside arteries. This can narrow arteries, reduce blood flow, and increase the risk of heart attack, stroke, and peripheral artery disease.

What causes atherosclerosis?
Atherosclerosis develops from injury and inflammation in the artery wall over time. Common drivers include elevated ApoB-containing lipoproteins (especially LDL), high blood pressure, smoking, insulin resistance/diabetes, chronic inflammation, and genetic risk factors such as high lipoprotein(a).

What are the symptoms of atherosclerosis?
Many people have no symptoms until arteries are significantly narrowed or a plaque ruptures. Symptoms depend on the affected arteries and may include chest pain (angina), shortness of breath, leg pain with walking (claudication), or stroke-like symptoms (sudden weakness, trouble speaking, vision changes).

How is atherosclerosis diagnosed?
Diagnosis can involve blood tests and imaging. Blood tests assess lipid and metabolic risk (LDL-C, ApoB, triglycerides, HbA1c, hs-CRP, Lp(a)). Imaging can detect plaque or narrowing (coronary artery calcium scan, carotid ultrasound, CT angiography). A stress test evaluates blood flow limitations under exertion.

Which blood tests matter most for atherosclerosis risk?
Core: LDL-C, non-HDL cholesterol, triglycerides, HDL-C.
More predictive in many cases: ApoB, LDL particle number (LDL-P), and lipoprotein(a).
Inflammation and metabolic health: hs-CRP, fasting glucose, insulin, HbA1c.

Can atherosclerosis be reversed?
Plaque regression is possible in some people, especially early disease, but results vary. The most consistent goal is to stop progression and lower event risk by improving ApoB/LDL levels, blood pressure, glucose control, and reducing inflammation and smoking exposure. Even when plaque remains, stabilizing plaque can meaningfully reduce heart attack and stroke risk.

What lifestyle changes help prevent or slow atherosclerosis?
A Mediterranean-style diet, regular aerobic and resistance exercise, weight management, smoking cessation, adequate sleep, and stress reduction are key. Reducing saturated fat and refined carbohydrates can help improve ApoB/LDL and triglycerides for many people, depending on their metabolic profile.

What medications treat atherosclerosis?
Treatment targets risk factors rather than “plaque” directly. Common options include statins, ezetimibe, and PCSK9 inhibitors to lower LDL/ApoB; blood pressure medications; diabetes medications when appropriate; and antiplatelet therapy in selected higher-risk patients.

Is atherosclerosis the same as high cholesterol?
No. High cholesterol (especially high ApoB/LDL) is a major risk factor, but atherosclerosis is the disease process occurring in the artery wall. Some people develop atherosclerosis despite “normal” LDL-C due to factors like elevated ApoB, Lp(a), insulin resistance, inflammation, or genetics.

Who should be screened for atherosclerosis?
Screening is often considered for adults with risk factors (family history, hypertension, diabetes, smoking, obesity, high LDL/ApoB, high triglycerides), and for people with uncertain risk where imaging like a coronary artery calcium scan could guide prevention decisions.