Atherosclerosis (plaque build-up): symptoms, causes, treatment

Atherosclerosis is a cardiovascular condition that occurs when a buildup of plaque causes your arteries to thicken or harden, potentially reducing blood flow. 

It is a common medical problem, especially among middle-aged and older adults in the United States, and can lead to serious complications like a heart attack or stroke. It is the underlying cause of half of all deaths in westernized society—and the leading cause of death in the United States, causing one in every four deaths (CDC, 2022; Pahwa, 2021). 

Fortunately, it’s both preventable and treatable. Read on to learn more about atherosclerosis, what causes it, how to know if you have it, and how to treat it.

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Atherosclerosis occurs when a person’s arteries become narrower and stiffer due to a buildup of plaques (small clumps made mostly of fats) on the artery walls. 

Plaques can form in blood vessels throughout the body but tend to cause the most problems when they’re in or near the heart, leading to cardiovascular disease. When plaques build up enough, they can block blood flow completely and cause things like a heart attack. Or a plaque can break off and travel through the bloodstream to organs like the brain or lungs, causing a stroke or pulmonary embolism. 

Sometimes the terms surrounding heart health can seem confusing and overlapping. “Cardiovascular disease” is the big umbrella term encompassing all the health problems affecting the heart and blood vessels. “Heart disease” is a type of cardiovascular disease, and “coronary heart disease” is a common kind of heart disease.

Atherosclerosis plays a role in virtually every condition that falls under cardiovascular disease (NHLBI-a, 2021).

Atherosclerosis is a slow accumulation of changes in the blood vessels that may start as early as childhood and worsen as you age.

Scientists believe it begins when an artery’s inner linings, the endothelium, get damaged (more on that below). 

When that happens, a type of cholesterol called low-density lipoprotein (LDL cholesterol, aka “bad cholesterol”) is able to sneak into the wall of the artery. Your immune system sees the LDL intruding and sends a swarm of white blood cells to attack it.  

This results in a cascade of events in which the LDL, white blood cells, platelets, and other cellular participants clump together and harden to the damaged spot on the endothelium. This calcified, hardened spot is a plaque, and once it’s there, it becomes easier for more passing cholesterol to catch on it and make the plaque bigger (Bentzon, 2014).

Damage to your endothelium happens due to a lot of lifestyle and health factors. And most of these factors are the same as the traditional things that put you at risk of atherosclerosis, including (Davignon, 2004; Pahwa, 2021):

• Smoking

• Diabetes

• Drinking alcohol

• High cholesterol

• High blood pressure (hypertension)

• Obesity

• Sedentary lifestyle

• Diet high in saturated fat and trans-fats

• Aging

• Family history

Atherosclerosis doesn’t tend to have a lot of symptoms. There aren’t usually early signs, and advanced signs tend to only be noticeable once the condition causes serious health issues.

Early signs

It may surprise you that one of the few early signs of atherosclerosis is erectile dysfunction. 

When plaques form in your arms and legs, your blood can’t circulate well, and your arteries can’t relax and dilate as they should—which are key ingredients for having an erection (Zemaitis, 2022). 

While this could sound disheartening, it’s actually good news; not only is erectile dysfunction treatable, but identifying atherosclerosis early on is a huge benefit for reducing your chance of having a serious health problem later on.   

Late signs

Late signs of atherosclerosis signify that plaque buildup is restricting blood flow. They include (Hermiz, 2021; NHLBI-b, 2022):

• Angina (chest pain or pressure)

• Shortness of breath

• Pain and numbness in extremities (especially the legs)

• Fatigue and muscle weakness

• Heart arrhythmias

• Heart attack

• Stroke

While atherosclerosis can be mild, it can also be very dangerous. It can lead to life-threatening complications like coronary artery disease (affecting blood vessels in your heart), cerebrovascular disease (affecting blood vessels in your brain), and peripheral artery disease (affecting blood vessels in your legs).

The plaques caused by atherosclerosis can create problems in two ways:

First, plaques can grow too big and reduce blood flow to parts of your body. This can cause symptoms like pain in the parts of your body that aren’t getting enough blood.

Second, plaques can rupture or break open, causing a blood clot. When that happens, the flow of blood is obstructed—this means that your tissues past the clot aren’t getting any blood (or the oxygen it carries). This is what happens during a stroke or heart attack.

Coronary artery disease

Coronary artery disease happens when atherosclerosis causes a buildup of plaques in the arteries that bring blood to the heart (the coronary arteries). It can restrict blood flow to the heart—even cause a blocked artery—and is a major cause of death in the United States (Shahjehan, 2021). 

Coronary artery disease can cause:

• Heart attack (when blood flow is completely blocked, leading to heart muscle death)

• Congestive heart failure (when the heart isn’t able to effectively pump blood)

• Heart arrhythmias (irregular heartbeat)

Cerebrovascular disease

A person has cerebrovascular disease when plaque buildup starts to affect blood flow to the brain. This can cause serious complications that include:

• Blood clots 

• Stroke (when a plaque ruptures and the broken piece blocks blood flow to the brain)

• Transient ischemic attack (TIA) (a sort of a mini-stroke that often is a precursor to a bigger stroke)

• Blood vessel rupture (hemorrhage or excessive bleeding that can cause a stroke)

Peripheral artery disease

Atherosclerosis doesn’t just affect arteries near the heart or brain—it can cause plaque buildup and poor circulation in your arms and legs as well. 

Most often, it causes circulation problems in the legs, causing pain in the thigh or calf during physical exertion. It can also cause bigger medical problems, including:

• Blood clots (which can break off to cause a heart attack or stroke)

• Ischemia (inadequate blood supply, which can lead to gangrene and amputation of a limb)

• Ulcers (due to poor circulation leading to poor healing)

• Erectile dysfunction

Several tests can help diagnose atherosclerosis and determine how advanced it is (NHLBI-b, 2022):

• Stress test: an exercise test that includes before-and-after pictures of your heart to assess symptoms of narrowed arteries and any changes in blood flow to your heart

• Blood tests: tests to check the levels of blood cholesterol, certain lipids (fats), blood sugar, and protein

• EKG or echocardiogram: a non-invasive test that looks at your heart’s electrical activity

• Imaging (CT, MRA, PET): shows images of your heart and any hardening of the arteries

• Angiography: a scan that involves using dye to show blocked arteries

• Ankle-brachial index: a comparison of blood pressure in your arm and ankle to see if there are blockages causing problems with your circulation

There are many ways to both slow and prevent the formation of plaques in your blood vessels—sometimes even shrink them. Once the plaques are there, you generally can only slow down the progression and further complications, and you can’t remove plaques without surgery.

It’s important to remember the goals of atherosclerosis treatment: 

• To relieve your symptoms

• To prevent further buildup of plaques

• To reduce your risk of blood clots from forming

• To prevent the more serious consequences of atherosclerosis 

You can use a few tools to achieve these goals, and combining several of them is most effective (Bergheanu, 2017; Mozaffarian, 2016).

Lifestyle changes

Adopting a healthier lifestyle is the first-line treatment for people with atherosclerosis. This may sound hard or overwhelming, but a lot of these changes are pretty simple—and you can build up to them over time, starting with the step that makes sense for you. 

These changes can include (Bergheanu, 2017; Pahwa, 2021; Yubero-Serrano, 2020):

• Quitting smoking

• Losing weight

• Eating a healthy diet (especially a Mediterranean diet)

• Building up your physical activity

Taking all—or even just a few—of these steps can greatly improve your cardiovascular health and prevent your atherosclerosis from snowballing into a worse problem. 

Talking to your healthcare provider can help you identify the steps most important for your body and which are most realistic for you to work on.

Medication

While medications can’t reverse the plaques already in your arteries, several medications can help reduce your chance of having a serious side effect of atherosclerosis (especially if combined with dietary and lifestyle changes). 

These medications include aspirin and other blood thinners that prevent blood clots, as well as medications that help reduce cholesterol, better known as statins (Bergheanu, 2017; Ittaman, 2014)

Your healthcare provider may also prescribe you a blood pressure medication. It won’t reverse your atherosclerosis, but it can help treat or prevent complications related to atherosclerosis, like ruptured plaques (and potentially heart attack or stroke).

Surgery

Once you’ve had a serious consequence of atherosclerosis (like a heart attack) or if one seems imminent, surgery may be necessary. 

The basic goal of all surgical options is to widen the blood vessel to prevent blood flow to the heart, brain, or lungs from being completely blocked. Your particular situation will determine the most appropriate choice for you. Some surgical options include (Ahmad, 2021; Bachar, 2021; Zemaitis, 2022):

• Angioplasty (also known as percutaneous coronary intervention, or PCI): A non-invasive procedure that involves inserting a small catheter into a blood vessel so that surgeons can pop open the blockage and insert a stent to keep it open.

• Bypass surgery: The blood vessels of the heart are re-routed to go around the blocked artery.

• Surgical removal of plaques (endarterectomy): A surgeon opens the blocked artery and physically removes the plaque.

Although it carries some heavy risks, atherosclerosis is a manageable condition that many people live with daily. By taking it seriously and treating it early, you can reduce your risk of complications and enjoy a healthier lifestyle.  

If you have atherosclerosis or are experiencing symptoms that concern you, talk to your healthcare provider about what steps could be right for you and your body.

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Current version

April 04, 2022

Written by

Nancy LaChance, BSN, RN

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.