What Is Arteriosclerosis?

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Arteriosclerosis is a group of vascular diseases that involve the thickening and loss of elasticity of the walls of arteries. Once popularly described as the "hardening of arteries." the condition causes the progressive restriction of blood flow to organs and tissues.

Arteriosclerosis (arterio- meaning artery and -sclerosis meaning hardening) occurs when abnormalities known as lesions form in the innermost layer of the arterial wall, called the intima. Over time, the lesions start to fill with cellular waste, causing the walls to harden, thicken, and stiffen.

There are several different forms of arteriosclerosis, which can vary by the types of vessels affected and/or differences in the disease process. Atherosclerosis is by far the most common of these.

Arteriosclerosis, hardening of the arteries

Christop Burgstedt / Science Photo Library / Getty Images

Types

There are three major types of arteriosclerosis known as atherosclerosis, arteriolosclerosis, and Mönckeberg medial calcific sclerosis.

Atherosclerosis

Atherosclerosis is a form of arteriosclerosis in which deposits of fats, cholesterol, calcium, and other substances form on the walls of an artery. The accumulation of these deposits, called plaque, causes the blood vessel to narrow. High cholesterol, obesity, smoking, diabetes, and hypertension (high blood pressure) are all contributing risk factors.

When severe, atherosclerosis can cause coronary artery disease (CAD), a major cause of heart attack and stroke. Atherosclerosis occurring in the blood vessels of the kidneys can lead to a condition known as renal artery stenosis. Atherosclerosis in the vessels that carry blood from the heart (particularly those of the lower limbs) is referred to as peripheral artery disease (PAD).

Arteriolosclerosis

Arteriolosclerosis is similar to atherosclerosis except that it occurs in smaller arteries and arterioles (tiny blood vessels that branch off into capillaries). These are the blood vessels that are tasked with delivering nutrients to cells.

The risk of arteriolosclerosis is higher in people with uncontrolled diabetes and hypertension, both of which can inflict significant damage on smaller blood vessels. Aging is also a contributing factor, as is the use of certain drugs (like calcineurin inhibitors).

Mönckeberg Medial Calcific Sclerosis

Mönckeberg medial calcific sclerosis is a rare condition in which calcium accumulates in the middle muscular layer of an artery, called the tunica media. Older age is the major contributing factor given that most people over 65 will experience some level of calcification (calcium buildup) in blood vessels.

The exact cause of Mönckeberg medial calcific sclerosis remains unknown. What scientists do know is that the incidence is higher in people with diabetes, chronic kidney disease (CKD), lupus, and hypervitaminosis D (toxic levels of vitamin D)—all of which are associated with calcium imbalance.

There are some who question whether Mönckeberg medial calcific sclerosis is a distinct disease entity or simply an uncommon feature of atherosclerosis.

Symptoms

It is possible to have arteriosclerosis for many years without experiencing symptoms. Warning signs of a clogged artery are usually felt when arteries are severely narrowed. Symptoms of arteriosclerosis depend on which blood vessel is occluded (blocked). 

Coronary Arteries

Symptoms of coronary artery disease (CAD) include:

  • Squeezing pain or feeling of pressure in the chest, neck, back, arms, jaw, or shoulders
  • Angina or chest pain that worsens with activity and subsides with rest
  • Shortness of breath

Cerebral Arteries

Symptoms of an acute cerebral arterial occlusion to the brain include:

  • Facial drooping
  • Inability to move your arms or legs
  • Vision problems
  • Difficulty understanding others or sudden development of slurred speech
  • Sudden severe headache
  • Numbness or weakness of the limbs or face
  • Loss of balance or dizziness

Peripheral Arteries

Signs and symptoms of peripheral artery disease (PAD) include:

  • Leg pain
  • Difficulty walking
  • Change in leg color
  • Coldness in the lower leg or foot
  • Poor wound healing
  • Hair loss on the legs

Renal Arteries

Symptoms of acute renal arterial occlusion of the kidneys include:

  • Back pain
  • Decreased urine output
  • Blood in the urine
  • Flank or side pain
  • Symptoms of high blood pressure such as headache, changes in vision, and swelling

Causes

Risk factors for arteriosclerosis can vary by the disease type (atherosclerosis, arteriolosclerosis, Mönckeberg medial calcific sclerosis) and may include:

  • Unhealthy blood cholesterol levels: High LDL cholesterol or low HDL cholesterol.
  • High blood pressure: Sustained high blood pressure over 140/90 mmHg for those without preexisting conditions and over 130/80 mmHg or higher for those with diabetes or kidney disease.
  • Smoking: This can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't allow enough oxygen to reach the body's tissues.
  • Insulin resistance: This worsens all other arteriosclerosis risk factors including diabetes, high blood pressure, and unhealthy cholesterol levels.
  • Diabetes: With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly.
  • Obesity: The extra weight is related to other health conditions.
  • Sedentary lifestyle: A lack of physical activity or exercise puts you at higher risk of developing high blood pressure, diabetes, high blood cholesterol levels, and overweight or obesity thereby increasing your risk of arteriosclerosis.
  • Unhealthy diet: Foods that are high in saturated and trans fats, cholesterol, salt not only put you at risk of developing arteriosclerosis but can also precipitate exacerbations of cardiovascular disease. 
  • Older age: As you get older, your risk for arteriosclerosis increases. We all develop some arteriosclerosis as we age, but as you age lifestyle factors can worsen the condition. Quitting smoking, limiting alcohol, eating a balanced diet, and exercising can stop the impact of arteriosclerosis on our blood vessels.
  • Family history of early heart disease: Your genes can paint a picture of what your heart health will look like in the future. Although having a close family member experience a heart attack does not mean that you will, you may want to consider getting tested for genetic conditions if there is a pattern in your family.

Diagnosis

A diagnosis of arteriosclerosis is not usually made with lab tests or imaging alone. Healthcare providers take your complete medical history, family history, and the results of a physical exam into account when making a diagnosis.

Some tests used to diagnose arteriosclerosis-related diseases include:

Treatment

A combination of lifestyle changes and medications are used to forestall arteriosclerosis. If you experience symptoms, medical procedures can be used to unclog the problematic artery and alleviate your painful symptoms.

Lifestyle Changes

Eating a low sodium diet consisting of fruits and vegetables is key to limiting your risk of developing arteriosclerosis. Avoiding cigarette smoking (including secondhand smoke), maintaining a healthy weight, and exercising regularly are also important.

Some additional measures that you can take to mitigate your risk of arteriosclerosis are:

  • Limiting high blood pressure: Do this by avoiding stressful situations, healthy eating, managing diabetes, and taking blood pressure medications when needed.
  • Maintaining proper cholesterol levels: You can do this via diet and medication.
  • Frequently checking your blood sugar: Do this especially if you have diabetes and keep your blood sugars within a normal range (less than 140 mg/dL after eating).

Medications

HMG-CoA reductase inhibitors or statins are the primary medications to fight arteriosclerosis and have been shown to slash cardiovascular deaths by 20% when taken as recommended. By blocking the enzyme HMG-CoA reductase in the liver, the body lowers its cholesterol levels limiting the formation of more plaque in the body.

Some commonly prescribed statins are:

Statins can be mild, moderate, or high intensity. The intensity of the statin based on your 10-year risk of having a heart attack or stroke.

Cardiologists calculate your 10-year risk of heart disease based on age, sex, race, blood pressure, cholesterol, diabetes status, and smoking history using a tool known as an ASCVD risk calculator.

If you meet any of the following criteria your healthcare provider may recommend that you start on statin therapy:

  • History of cardiovascular disease including angina
  • High LDL levels (over 190 mg/DL)
  • Age 40 to 75 with diabetes
  • A risk of 7.5% or more based on your ASCVD score

Regular use of baby aspirin has been shown to reduce the incidence of heart attack and stroke. Nitrates, beta-blockers, and calcium channel blockers are used to treat coronary artery disease and manage symptoms of angina.

One or more antiplatelet medications such as aspirin, dipyridamole, and Plavix (clopidogrel) can be used to prevent strokes.

Angioplasty

Angioplasty is a minimally invasive procedure used to widen narrowed or obstructed arteries or veins, typically to treat atherosclerosis. It is performed as part of cardiac catheterization and can be performed in a number of ways:

  • Balloon angioplasty: A small balloon is guided into the blood vessel via a catheter and inflated so that the blocked area is now open.
  • Atherectomy: This procedure requires that healthcare providers shave the edges of atherosclerotic plaque along the intima or inner wall of the blood vessel.
  • Laser angioplasty: A laser is used to vaporize the atherosclerotic plaque.
  • Coronary artery stent placement: In this procedure, a tiny mesh wiring is guided into the coronary artery via a catheter. The mesh coil is expanded to open the blocked area. Most stents are also coated with anticoagulation drugs to prevent clotting. The stent is left in place to keep the artery open and allow blood flow.

Coronary Bypass Surgery

Coronary artery bypass surgery is the most commonly used procedure to alleviate symptoms of angina or chest pain as a result of coronary artery disease.

During this procedure, a healthy vein called a graft is taken from one area of the body and used to redirect blood flow in another. These veins that make it possible for blood to get around a blockage are usually taken from the leg or chest wall. Sometimes more than one artery needs to be bypassed (such as occurs with a triple bypass).

Prevention

The best way to decrease your risk of having a cardiovascular event is to prevent arteriosclerosis by eating a diet rich in fruits and vegetables, exercising regularly, never smoking, controlling your blood pressure, maintaining a healthy weight, and managing your cholesterol levels. 

There is no cure for arteriosclerosis, but treatment can slow or halt the worsening of the disease. As such, it is important to take medications as prescribed and not to alter or stop treatment if you feel better.

Although the results are preliminary, a recent study from researchers at the NYU Langone Medical Center suggests that the regular use of cholesterol-lowering statins may reverse arteriosclerosis.

When to Call a Doctor

If you begin to experience symptoms of arteriosclerosis such as chest pain, shortness of breath, sudden slurred speech, or difficulty with your vision, you may be having a heart attack or stroke. This is a medical emergency. If you or a loved one experiences any of these symptoms seek immediate medical attention.

Early diagnosis and treatment not only stops arteriosclerosis from worsening, but it may also be life-saving. Some medical interventions, such as the use of Activase (recombinant tissue plasminogen activator), is only effective if given within four and a half hours of stroke symptoms.

If your symptoms are not severe but appear different from symptoms you have experienced in the past, you may want to call your healthcare provider. Changes in medication, uncontrolled blood sugar, high blood pressure, and poor diet can all trigger a flare-up of symptoms.

A Word From Verywell

Arteriosclerosis is a condition that affects millions of people in the United States. Although there are some risk factors you can't control, like age and family history, there are many that you can.

If you have risk factors for arteriosclerosis, changes in lifestyle (such as quitting cigarettes, eating a healthy diet, losing weight, and exercising) can greatly reduce your risk of heart attack, stroke, and other vascular diseases.

If you have arteriosclerosis, work closely with your doctor to manage your condition. If needed, ask for a referral to a dietitian or personal trainer who can help you alter unhealthy lifestyle habits. Despite what some people may tell you, it's never too late to start.

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