What Is Arteriosclerosis?

Atherosclerosis is a disease in which plaque builds up in your arteries. Technically, atherosclerosis is a subtype of arteriosclerosis although the two terms are often used interchangeably.

No matter which term you use, the disease process is the same. Plaque is made up of cholesterol and other fatty substances that harden and narrow your arteries, decreasing blood flow and increasing the likelihood of a complete blockage. Complete blockages occur when a piece of plaque breaks off from the artery wall and lodges into a narrow artery. Blockages can be transient, lasting for a very short period of time, or for much longer. The surrounding tissues are deprived of oxygen, causing pain. Some of the cell tissues may even begin to die.

While blockages in your arms or legs can be excruciating, a complete blockage in the heart or brain can be fatal without immediate medical attention.

Arteriosclerosis, hardening of the arteries


CHRISTOPH BURGSTEDT/SCIENCE PHOTO LIBRARY

Types of Arteriosclerosis

Arteriosclerosis occurs when arteries grow stiff and restrict blood flow. Another term commonly used to describe this chronic condition is the hardening of the arteries. There are three types of arteriosclerosis: atherosclerosis, arteriolosclerosis, and Mönckeberg medial calcific sclerosis. 

Atherosclerosis

Arteries are made up of three layers: the adventitia, media, and intima—the outer layer, middle layer, and an inner layer of epithelial cells, respectively. When plaque builds up along the innermost wall of an artery we call this atherosclerosis. Atherosclerosis is a chronic condition that can start early in life and show no symptoms. Injury to the innermost wall occurs due to high levels of cholesterol and triglycerides in the diet, high blood sugar levels, high blood pressure, and cigarette smoke. The injured area attracts platelets, fat, and other debris, which causes a narrowing of arteries lumen. Connective tissue goes on top of this injured area, worsening the problem. If a plaque ruptures, the fragment can clog a severely narrowed artery, which can obstruct blood flow. If this occurs in the heart or brain, it can cause a heart attack (myocardial infarction) or stroke. If arteries in the limbs become blocked we call this peripheral artery disease. Peripheral artery disease is characterized by pain when walking or doing strenuous activity and can be accompanied by chest pain, blurry vision, or headaches. 

Oftentimes, symptoms of atherosclerosis are felt only after the artery’s lumen has become 70 to 80% occluded. At this point, people often report angina pectoris, or chest pain, brought on by exertion because their heart cannot support increases in blood flow. In fact, most people are symptom-free at rest but notice symptoms during mild or moderate-intensity activities. Angina pectoris can occur even if there isn’t transient, complete, or sudden blockage of the artery because pro-clotting factors—the most important being tissue factor—create a clot in situ or a slow-growing clot on top of the fatty plaque, leading to poor oxygenation and chest pain.

Arteriosclerosis

Arteriosclerosis is similar to atherosclerosis except small vessels are impacted. If you have uncontrolled diabetes you may be at high risk of developing arteriosclerosis because high blood sugars and high blood pressure preferentially damage smaller blood vessels. It’s important to note that while arteriosclerosis can limit blood flow and therefore damage organs, some level of arteriosclerosis is expected with aging. Rarely does arteriosclerosis with aging cause symptoms. 

Mönckeberg Medial Calcific Sclerosis

Mönckeberg medial calcific sclerosis is a rare condition in which there is evidence of a ringlike calcification of the middle muscular layer of an artery. The benign condition is often found incidentally during X-ray imaging for other conditions. Small to medium vessels are often affected. Rarely are symptoms of atherosclerosis or arteriosclerosis experienced because the innermost layer of the artery, the intima, is not affected. The cause behind this rare condition is unknown.

Symptoms of Arteriosclerosis

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

Coronary (Heart) Arteries

Symptoms of coronary artery disease can 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

Arteries To the Brain

Symptoms of carotid artery disease 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

Arteries To the Legs

Leg pain, difficulty walking, and shortness of breath are the three most common symptoms of peripheral artery disease (PAD). Those with PAD may also notice:

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

Arteries To the Kidneys

Acute arterial occlusion is the term used when kidney arteries are blocked. The kidney is very sensitive to reduces in blood flow so even small changes can hurt kidney function. A complete blockage can result in kidney failure.

Symptoms of acute arterial occlusion of the kidney 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

If you or a loved one experiences any of these symptoms seek medical attention immediately.

Causes of Arteriosclerosis

Cardiovascular disease is one of the leading causes of death in the world. It is characterized by chronic inflammation of the arterial inner wall. As previously mentioned, an artery is composed of three layers: the outer wall or adventitia, the media or the middle muscular layer, and the intima or inner wall. The early stages of arteriosclerosis begin at the intima.

At normal levels, LDL cholesterol can pass through the endothelial cell layer that makes up the intima. At higher levels, some of the LDL cholesterol can get stuck in the intima’s subendothelial layer. The trapped LDL undergoes a chemical reaction called oxidation, which is toxic to the cell wall causing an inflammatory response. Monocytes—or white blood cells—that normally serve to attack foreign molecules in the body engulf the oxidized LDL particles creating a foam cell. Cytokines and other inflammatory markers form a fibrous cap around the injured area forming a plaque. If the plaque rupture tissue factors are released, it may result in the formation of a thrombus or blood clot. If blood flow is reduced by stenosis or a thrombotic occlusion, this may precipitate a cardiovascular event such as a heart attack or stroke.

Genetic conditions such as familial hypercholesterolemia, which render the body unable to remove LDL or bad cholesterol from the blood, can increase your risk of developing arteriosclerosis. While the genetic factors that contribute to arteriosclerosis are not well known, there are alterable risk factors that you should be aware of.

Major risk factors for arteriosclerosis 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 labs or imaging alone. Doctors take your complete medical history, family history, and a physical exam into account when making a diagnosis. If a diagnosis of arteriosclerosis is made, your family doctor may put you on a cholesterol-lowering medication called a statin, recommend a heart-healthy, low-sodium, low-cholesterol diet, gauge your interest in beginning a smoking cessation plan, and refer you to a cardiologist even if you are not experiencing symptoms. Seeing a neurologist or nephrologist is also recommended if you have had or are at high risk of having a stroke or kidney disease.

Some tests used to diagnose arteriosclerosis-related diseases include:

  • Electrocardiogram (EKG)
  • Chest X-Ray
  • Echocardiogram
  • Blood tests, such as cholesterol levels, a complete blood count, troponin level, and blood sugar.
  • Stress testing
  • Angiography, which uses a special dye and X-ray. This helps doctors assess the severity of the blockage in an artery. The coronary arteries of the heart and the carotid arteries are the most common blood vessels that are assessed using this method.
  • Ankle-Brachial Index
  • Computed Tomography Scan (CT Scan), which is usually done in the heart, brain, and carotid arteries.

Locating Arteriosclerosis

Your pain symptoms usually dictate where a doctor will begin to look for arteriosclerosis plaques in the body. Cardiac catheterization is a surgical procedure performed by a doctor who specializes in endovascular cardiology, in which dye is injected into an artery to locate narrowing, blockages, and other abnormalities associated with arteriosclerosis. Sometimes a Doppler sonography is also performed. During this procedure, a special probe is placed near the area of interest, and sound waves are used to evaluate blood flow. The goal of this technique is to further identify where the narrowing of blood vessels is located. Doppler sonography is most commonly used when the problem area is located in the abdomen, neck (the carotid arteries), or the legs as is the case in transient ischemic attacks and peripheral artery disease.

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:

  • Lovastatin (Mevacor)
  • Simvastatin (Zocor)
  • Pravastatin (Pravachol)
  • Fluvastatin (Lescol)
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)

Statins can be mild, moderate, or high intensity. The intensity of the statin prescribed by your doctors is based on your 10-year risk of having a heart attack or stroke. Cardiologists calculate your risk based on age, sex, race, total cholesterol, "good" HDL cholesterol, blood pressure, diabetes, and smoking history using a calculator called an ASCVD risk calculator.

If you meet any of the following criteria your doctor 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. Tissue plasminogen activator or tPA (Alteplase), is the gold standard treatment for acute strokes.

One or more antiplatelet medications such as aspirin, dipyridamole, and clopidogrel (Plavix) can be used to prevent strokes or transient ischemic attacks (TIA) also known as mini-strokes.

Surgery/Procedures

Surgeries are used in cases of severe arteriosclerosis to alleviate painful symptoms and promote revascularization—or the return of blood flow—to areas of the body that have otherwise been deprived of oxygen and nutrients. The most widely used surgeries and procedures for arteriosclerosis are angioplasty also known as percutaneous coronary intervention (PCI) and bypass surgery.

Angioplasty

There are four types of PCI:

  • Balloon angioplasty: A small balloon is guided into the flood vessel via a catheter and inflated so that the blocked area is now open.
  • Atherectomy: This procedure requires that doctors 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.

Most doctors only require a few minutes to complete these painless procedures, but more severe cases may take longer. Prior to surgery, people are asked to stop all blood-thinning medications, quit smoking to promote healing, and eat a healthy diet low in saturated fat to avoid complications.

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—the most commonly known being the triple bypass surgery.

Complications of Arteriosclerosis

Complications of arteriosclerosis manifest via cardiovascular events. This includes stroke, heart attack, and painful symptoms in the legs and arms especially while walking if you have peripheral artery disease. The use of statins, quitting smoking, implementing a regular walking routine, maintaining a healthy weight, and eating a diet low in sodium and saturated fat are ways to help promote blood flow, lower blood pressure, and maintain blood sugars within a healthy range. The key to feeling happy and healthy is to be knowledgeable about all the preventable aspects of your disease and to tackle each of them one at a time.

Can Arteriosclerosis Be Stopped or Reversed?

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. Recent study findings from researchers at the NYU Langone Medical Center found that regular use of a cholesterol-lowering drug called a statin may reverse arteriosclerosis although the results are preliminary. Statins stop the liver from making cholesterol by blocking HMG-CoA reductase. Once arteriosclerosis is identified, the goal is to prevent further narrowing of the arteries by lowering cholesterol levels so that symptoms never develop and vital organs are never damaged.

When Should I Call a Healthcare Provider?

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 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 as some medical interventions, such as the use of recombinant tissue plasminogen activator or tPA (Activase) in stroke is only effective if given within 4.5 hours of stroke symptoms.

You may have heard doctors use the phrase: time is tissue, underscoring the importance of early intervention following a cardiovascular event.

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 sugars, high blood pressure, and poor diet can all trigger a flare-up of your disease.

A Word From Verywell

Modern medicine has made it possible for people to live happy and healthy lives, even those who are at high risk of developing arteriosclerosis due to genetic conditions. While implementing early healthy eating habits and never smoking are ways to limit your risk of developing arteriosclerosis disease, it is never too late to make healthy lifestyle changes. Taking a holistic approach to your health—whether you have an arteriosclerosis-related disease or not— is key to living a stress-free life.

With that said, some people who are extremely healthy may experience a cardiovascular event as a result of arteriosclerosis. This is often life-changing and requires the support of family and friends. If you experience symptoms of an arteriosclerosis-related medical condition or are feeling anxiety or depression from your diagnosis, contact your doctor immediately so you can begin crafting a plan towards a happy and healthy life.

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Article Sources
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