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Atherosclerosis & Coronary Artery Disease

Atherosclerosis is plaque building up inside artery walls, and when it affects the arteries feeding the heart it is called coronary artery disease.

Atherosclerosis is a condition where plaque builds up inside your arteries. Plaque is made of cholesterol, fats, and other substances found in the blood. As plaque collects, arteries become narrower and stiffer. That can reduce blood flow.

Coronary artery disease, or CAD, is a type of atherosclerosis that affects the arteries that supply blood to your heart. When blood flow to the heart muscle decreases, chest discomfort or a heart attack can occur. Atherosclerosis can also affect arteries in other parts of the body.

Symptoms

Atherosclerosis may not cause symptoms at first. Symptoms usually occur when an artery becomes significantly narrowed or blocked.

When the coronary arteries are affected, common symptoms include:

  • Chest discomfort, pressure, tightness, or pain
  • Shortness of breath, especially with activity
  • Pain that spreads to the neck, jaw, shoulder, arm, back, or upper abdomen
  • Unusual fatigue
  • Light-headedness or feeling faint

Some people notice symptoms during physical activity or emotional stress. Others may have symptoms at rest if a blockage becomes severe.

Older adults and women may be more likely to report shortness of breath, nausea, or unusual fatigue instead of chest pain.

Causes & Risk Factors

Atherosclerosis and CAD develop when artery walls become damaged and plaque builds up inside them.

Causes

The inner lining of an artery can become injured by factors such as high blood pressure, high cholesterol, or smoking. After injury, cholesterol and other substances enter the artery wall and form plaque.

As plaque grows, the artery narrows. Blood flow decreases. Plaque can also rupture, which may lead to a blood clot that suddenly blocks blood flow to the heart.

Risk Factors

Some risk factors can be changed. Others cannot.

Modifiable risk factors
  • High LDL cholesterol
  • High blood pressure
  • Smoking
  • Diabetes
  • Excess body weight, especially around the abdomen
  • Physical inactivity
  • Unhealthy eating patterns
Non-modifiable risk factors
  • Older age
  • Family history of early heart disease
  • Male sex at younger ages; risk increases for women after menopause

CAD is more common in certain racial and ethnic groups, often due to differences in access to care, higher rates of high blood pressure, diabetes, and other health conditions.

Having more than one risk factor increases the chance of developing more severe disease.

Diagnosis

Clinicians diagnose atherosclerosis and CAD based on your symptoms, medical history, physical exam, and testing.

Common tests include:

  • Blood tests to check cholesterol and blood sugar
  • Electrocardiogram (ECG) to measure the heart’s electrical activity
  • Stress testing to see how your heart works during activity
  • Imaging tests, such as a coronary CT scan or cardiac catheterization, to look for narrowed arteries

Some people learn they have CAD after evaluation for chest pain. Others are diagnosed after a heart attack.

Diagnosis does not always require symptoms. Testing may be recommended if you have multiple risk factors.

Treatments

Treatment focuses on improving blood flow to the heart, reducing symptoms, and lowering the risk of heart attack. Your care plan depends on your symptoms, test results, and overall health. Not every person needs the same treatment.

Lifestyle Changes

Healthy habits are the foundation of treatment.

  • Stop smoking
  • Choose a heart-healthy eating pattern
  • Be physically active most days of the week
  • Reach and maintain a healthy weight
  • Manage stress and get enough sleep

These steps help protect your arteries and support heart health.

Medications

Medications can lower risk and reduce symptoms.

  • Cholesterol-lowering medications, such as statins, reduce LDL cholesterol and help stabilize plaque
  • Antiplatelet medicines reduce the chance of blood clots forming in narrowed arteries
  • Blood pressure medications lower strain on artery walls
  • Medications for chest discomfort, such as nitrates or beta blockers, improve blood flow or reduce the heart’s workload

Your clinician will review benefits and possible side effects. Treatment is individualized.

Medications and lifestyle changes are the foundation of treatment for coronary artery disease. Many people do well without a procedure.

Procedures

A procedure may be recommended if:

  • Chest symptoms continue despite medical therapy
  • Testing shows reduced blood flow to the heart
  • Certain high-risk blockages are found that may affect long-term outcomes

Two main procedures are used to restore blood flow:

Percutaneous coronary intervention (PCI) uses a small balloon and often a stent, which is a tiny mesh tube, to open a narrowed artery from the inside.

Coronary artery bypass grafting (CABG) is surgery that creates a new path for blood to flow around blocked arteries using healthy blood vessels from another part of the body.

The decision to perform a procedure depends on:

  • Which arteries are involved
  • How complex the blockages are
  • Heart muscle function
  • Whether conditions such as diabetes are present
  • Your overall health
  • Your goals and preferences

For more complex cases, heart specialists may review your case together to recommend the safest and most effective approach.

Living Well & Prevention

Atherosclerosis and CAD are long-term conditions. Ongoing care can reduce the risk of complications.

Regular follow-up visits help monitor:

  • Blood pressure
  • Cholesterol levels
  • Blood sugar, if you have diabetes
  • Symptoms and medication response

Taking medications as prescribed and maintaining healthy habits can lower the chance of heart attack and other complications.

Prevention uses many of the same strategies:

  • Avoid smoking
  • Stay physically active
  • Choose balanced meals with fruits, vegetables, whole grains, and lean proteins
  • Manage blood pressure, cholesterol, and diabetes

Small, steady changes can improve heart health. Working closely with your healthcare team can help you stay informed and supported.

vln.org/learn/topics/atherosclerosis