Arteriosclerosis is a condition where the arteries, the blood vessels that carry oxygen-rich blood throughout the body, become thick, stiff, and less flexible over time—a process often called “hardening of the arteries.” This gradual change can silently develop over many years without causing any noticeable symptoms, making it particularly dangerous as it increases the risk of serious cardiovascular complications.

Understanding Arteriosclerosis and Its Types

The term arteriosclerosis refers to any hardening of the arteries from any cause. Healthy arteries are naturally flexible and elastic, allowing blood to flow smoothly. However, when the walls of these vessels become thick and rigid, blood flow can be disrupted, preventing organs and tissues from receiving the oxygen and nutrients they need to function properly.^[1]

Many people confuse arteriosclerosis with atherosclerosis, but these terms have slightly different meanings. Atherosclerosis is actually a specific type of arteriosclerosis. While arteriosclerosis describes hardening from any cause, atherosclerosis specifically refers to hardening caused by the buildup of plaque—a sticky substance made of fat, cholesterol, calcium, and other materials—inside the artery walls.^[2]

There are three main types of arteriosclerosis. The first and most common is atherosclerosis, which affects medium and large arteries like the coronary arteries in the heart, carotid arteries in the neck, and arteries in the legs. The second type is arteriolosclerosis, which involves thickening of the walls of small arteries called arterioles. These tiny vessels play an important role in controlling blood pressure. The third type is Mönckeberg medial calcific sclerosis, also called medial arterial calcification, which involves calcium deposits in the middle layer of artery walls. This type often occurs in people older than 50 but can happen earlier in those with certain medical conditions like chronic kidney disease.^[2]

How Common Is Arteriosclerosis?

Arteriosclerosis is extremely common worldwide. The complications that arise from plaque buildup, including heart attacks and strokes, are the leading cause of death globally. In the United States, diseases linked to atherosclerosis are also the top cause of death.^[3]

Studies from the United States National Institutes of Health reveal that about half of people between the ages of 45 and 84 have atherosclerosis but don’t know it because they haven’t experienced symptoms yet. This high prevalence among middle-aged and older adults highlights how silently this condition develops.^[5]

In the United States alone, approximately 610,000 people die of heart disease every year—that’s one in every four deaths. Coronary heart disease, which develops from atherosclerosis in the heart’s arteries, kills over 370,000 people annually. On average, about 735,000 Americans experience a heart attack each year. Of these, 525,000 are having their first heart attack, while 210,000 are experiencing a recurrent attack.^[7]

What Causes Arteriosclerosis?

Arteriosclerosis develops slowly as a result of damage to the artery walls. Although the exact cause isn’t completely understood, researchers believe the process begins when the inner lining of the arteries sustains injury or damage. This damage can happen for various reasons related to lifestyle, medical conditions, and genetic factors.^[4]

In the case of atherosclerosis, plaque often starts to build up during childhood and gradually worsens with age. When cholesterol and other substances in the blood accumulate in damaged areas of the artery walls, they form deposits. Over time, these deposits harden and narrow the opening inside the artery, reducing the space available for blood to flow. Additionally, plaque buildup increases the risk of blood clots forming on the plaque’s surface, which can completely block blood flow and trigger medical emergencies.^[3]

The development of atherosclerosis is fundamentally driven by apoB lipoproteins, particularly low-density lipoprotein cholesterol (LDL-C). As cholesterol, fat, blood cells, and other substances in the blood form plaque in artery walls, inflammation develops. The body responds by sending white blood cells to trap the cholesterol, but these cells turn into foamy cells that release more fat and trigger additional inflammation. This cycle causes muscle cells in the artery wall to multiply and form a cap over the growing plaque.^[3]

Risk Factors for Developing Arteriosclerosis

Certain groups of people and certain behaviors significantly increase the risk of developing arteriosclerosis. Understanding these risk factors is crucial because many of them can be controlled or modified through lifestyle changes and medical treatment.^[4]

Medical conditions that increase risk include high blood pressure, high blood cholesterol, diabetes, and metabolic syndrome. Inflammatory diseases such as rheumatoid arthritis and psoriasis also raise the likelihood of developing arteriosclerosis. When someone has multiple risk factors at the same time, the overall risk increases even more dramatically.^[4]

Lifestyle factors play a major role. Smoking or chewing tobacco damages artery walls and makes plaque buildup more likely. Eating a diet high in saturated fats contributes to high cholesterol levels, which in turn promotes plaque formation. Leading an inactive lifestyle and being overweight or obese are additional modifiable risk factors that significantly impact artery health.^[4]

Age and family history are risk factors that cannot be changed. The risk of arteriosclerosis increases significantly after age 45 in men and after age 55 in women. Having a family history of high cholesterol or early heart disease also puts someone at higher risk. Specifically, having a male relative who developed heart disease before age 55 or a female relative who developed it before age 65 indicates increased familial risk.^[7]

For men, erectile dysfunction can serve as an early warning sign of atherosclerosis. Studies show that men with erectile dysfunction are at higher risk for plaque buildup and its complications. This happens because the same vascular problems affecting blood flow to the heart and brain also affect blood flow to other parts of the body.^[4]

Symptoms of Arteriosclerosis

One of the most concerning aspects of arteriosclerosis is that it usually doesn’t cause symptoms until it leads to complications. In fact, mild atherosclerosis typically produces no symptoms at all. Many people don’t realize they have plaque buildup until they experience a medical emergency such as a heart attack or stroke.^[1]

Symptoms generally only appear when an artery becomes significantly narrowed—usually more than 70 percent blocked—or when a blood clot forms and completely stops blood flow. Sometimes a blood clot may break apart and travel to another part of the body, causing problems wherever it lodges.^[5]

The specific symptoms someone experiences depend on which arteries are affected by plaque buildup. When arteriosclerosis affects the coronary arteries that supply blood to the heart, symptoms may include chest pain or pressure called angina, shortness of breath during light physical activity, pain in the back, shoulders, neck, arms or belly, feeling dizzy or lightheaded, heart palpitations, fatigue, and nausea or vomiting that may feel like indigestion.^[5]

If the carotid arteries in the neck are affected, a doctor might hear a whooshing sound called a bruit when listening with a stethoscope. Patients could experience a transient ischemic attack, sometimes called a mini-stroke, which causes temporary symptoms like sudden weakness, confusion, difficulty understanding speech, or vision problems.^[4]

When peripheral arteries in the legs are affected, symptoms may include muscle pain when walking or climbing stairs, burning or aching pain in the feet and toes at rest (especially when lying flat), changes in skin color such as redness, cool skin on the feet, frequent skin and soft tissue infections in the legs or feet, and sores on the feet or toes that don’t heal. This condition is called peripheral artery disease.^[5]

Arteriosclerosis in the arteries supplying the kidneys, known as renal artery stenosis, can cause markedly elevated blood pressure that doesn’t respond to multiple medications, changes in how often someone needs to urinate, swelling in the body, feeling drowsy or tired, and skin that feels dry, itchy, or numb.^[5]

When arteriosclerosis affects arteries supplying the digestive system, a condition called mesenteric ischemia, symptoms can include severe pain or cramping in the abdomen after eating, bloating, nausea and vomiting, diarrhea, and unintentional weight loss due to “food fear”—when people become afraid to eat because it causes pain.^[5]

Preventing Arteriosclerosis

The good news is that many risk factors for arteriosclerosis can be controlled through lifestyle changes and preventive measures. Taking steps to maintain healthy arteries early in life is the most effective strategy for reducing the risk of complications later.^[1]

Quitting smoking is one of the most important steps anyone can take. Smoking damages artery walls and accelerates plaque buildup. It becomes even more dangerous when combined with other risk factors like high blood pressure or diabetes. It’s equally important to avoid exposure to secondhand smoke, as research shows that inhaling smoke from others can also increase the risk of arteriosclerosis. Additionally, e-cigarettes and vaping products can cause inflammation of the arteries, so avoiding these is also recommended.^[9]

Adopting a heart-healthy diet makes a significant difference. This means choosing foods low in saturated fat and cholesterol, as these substances contribute directly to plaque formation. A heart-healthy eating plan should include plenty of fruits, vegetables, and whole grains while limiting saturated fats, sodium (salt), and added sugars. Specific recommendations include choosing fat-free or low-fat dairy products, selecting unsaturated vegetable oils like canola oil instead of butter, eating foods naturally high in fiber such as oatmeal and beans, and including healthy fats from sources like avocados and nuts.^[9]

Regular physical activity is another powerful preventive measure. Exercise helps manage risk factors like unhealthy cholesterol levels, high blood pressure, and excess weight. Adults should aim for at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous activity. Before starting any new exercise program, it’s wise to consult with a healthcare provider to determine what level of activity is appropriate.^[9]

Maintaining a healthy weight reduces the risk of arteriosclerosis. Carrying extra weight raises LDL (bad) cholesterol levels and lowers HDL (good) cholesterol levels. However, losing even 10 percent of body weight can significantly improve cholesterol numbers and overall cardiovascular health.^[15]

Regular health monitoring is essential. Knowing your cholesterol and blood pressure numbers helps identify problems early. LDL cholesterol plays a major role in plaque formation, while HDL cholesterol helps clear LDL from the arteries. High blood pressure causes tears in artery walls where LDL cholesterol can settle more easily. Healthcare providers can perform blood tests and other screenings to assess cardiovascular risk and recommend appropriate interventions.^[15]

How Arteriosclerosis Affects the Body

Understanding the physical and biochemical changes that occur with arteriosclerosis helps explain why this condition is so serious. The process begins in the innermost layer of the blood vessel wall, called the tunica intima, where cellular wastes start to accumulate. As these deposits mature, they can take different forms depending on the type of arteriosclerosis developing.^[6]

In atherosclerosis, cholesterol lodges in the artery wall and triggers an inflammatory response. The body sends white blood cells to trap the cholesterol, but instead of removing it, these cells become engorged with fat and turn into “foam cells.” These foam cells release more fat and cause additional inflammation, creating a vicious cycle. This inflammatory process triggers muscle cells in the artery wall to multiply and form a fibrous cap over the fatty deposits.^[7]

The plaque that forms has two concerning characteristics. First, as it grows, it gradually narrows the artery’s opening, restricting blood flow. An artery with significant plaque buildup is like a highway reduced from multiple lanes to just one—the same amount of traffic (blood) must squeeze through a much smaller space. Second, the plaque itself can become unstable. The constant force of blood flowing past can cause the plaque to erode or rupture. When this happens, it’s like breaking open a blister inside the artery, exposing the fatty contents to the bloodstream.^[5]

When plaque ruptures, blood clots form rapidly at the site. A blood clot in an artery is like a barricade in the middle of a road—it completely blocks blood flow. The effects depend on where this blockage occurs. If it happens in a coronary artery feeding the heart muscle, that part of the heart is deprived of oxygen, causing a heart attack. If it occurs in an artery supplying the brain, it causes a stroke. Research shows that about 75 percent of acute heart attacks occur from plaque rupture.^[7]

In arteriolosclerosis, the thickening affects small arteries called arterioles. These vessels are connectors between larger arteries and tiny capillaries, and they play a crucial role in controlling blood pressure. When their walls become too thick, they cannot regulate blood flow properly, which can lead to organ damage, particularly in the kidneys and brain.^[2]

Mönckeberg medial calcific sclerosis involves calcium deposits in the middle layer of the artery wall. This calcium makes the artery stiff and rigid, like a pipe that has hardened. The loss of elasticity means the artery cannot expand and contract normally with each heartbeat, which disrupts normal blood flow patterns and raises the risk of complications.^[2]

The reduction in blood flow caused by arteriosclerosis affects organs throughout the body. When the heart doesn’t receive enough oxygen-rich blood, it can lead to coronary artery disease, angina, heart failure, or heart attack. When blood flow to the brain is reduced, it can cause transient ischemic attacks, stroke, or vascular dementia—a type of cognitive decline that goes beyond normal aging. Reduced blood flow to the kidneys can lead to chronic kidney disease. In the legs, poor circulation causes peripheral artery disease, which can eventually result in tissue damage so severe that amputation becomes necessary.^[14]

Plaque buildup can take away years of life, especially when complications develop. Research indicates that a heart attack takes away more than 16 years of life on average, while people with heart failure lose an average of nearly 10 years. However, studies also show that adopting a healthy lifestyle can add significant years: women with healthy habits could expect to live 14 years longer than those without them, while men could gain 12 more years of life.^[14]