Atherosclerosis & Coronary Artery Disease (CAD)
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.
A heart attack can occur if a coronary artery suddenly becomes blocked. Call 9-1-1 right away if you have:
Chest pain or pressure that lasts more than a few minutes
Pain spreading to the arm, neck, or jaw
Shortness of breath
Nausea, sweating, or feeling faint
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 doesn't always require symptoms. Testing may be recommended if you have multiple risk factors.
Treatment
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.
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 With/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.
Take Action for Your Heart Health
If you have chest discomfort, shortness of breath, or risk factors such as high blood pressure or high cholesterol, talk with your healthcare professional.
If you experience possible heart attack symptoms, call 9-1-1 right away. Early care can save heart muscle and improve outcomes.
References
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
Centers for Disease Control and Prevention. Preventing heart disease. Published May 15, 2024.
Figtree GA, Vernon ST, Harmer JA, et al. Clinical pathway for coronary atherosclerosis in patients without conventional modifiable risk factors: JACC state-of-the-art review. J Am Coll Cardiol. 2023;82(13). https://www.jacc.org/doi/10.1016/j.jacc.2023.08.004
National Heart, Lung, and Blood Institute. Symptoms of atherosclerosis. Accessed December 22, 2025.
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