Atherosclerosis & Coronary Artery Disease (CAD)
Atherosclerosis is a condition where plaque builds up inside the walls of arteries over time. Plaque is made up of fats, cholesterol, and other substances, and it can cause arteries to narrow and stiffen, making it harder for blood to flow.
Coronary artery disease (CAD) is a form of atherosclerosis that affects the arteries that supply blood to the heart. Reduced blood flow in these arteries can limit the amount of oxygen reaching the heart muscle and may lead to chest discomfort, heart attack, or other serious heart problems.
Symptoms
Atherosclerosis often develops slowly and may not cause symptoms for many years. Symptoms usually appear when plaque buildup significantly narrows an artery or suddenly interferes with blood flow.
When symptoms occur, they depend on which arteries are affected. When atherosclerosis affects the coronary arteries—known as coronary artery disease (CAD)—symptoms may include:
Chest discomfort, pressure, or tightness
Shortness of breath, especially with activity
Pain that may spread to the neck, jaw, arms, back, or upper abdomen
Unusual fatigue
Light-headedness or feeling faint
Some people experience symptoms mainly during physical activity or emotional stress, while others may have few or no noticeable symptoms.
More serious symptoms can occur when blood flow to the heart is suddenly reduced. These symptoms may be more intense, last longer, or feel different from typical chest discomfort. Older adults are more likely to experience symptoms such as shortness of breath, unusual fatigue, nausea, or dizziness rather than chest pain.
Causes & Risk Factors
Atherosclerosis develops over time when certain risk factors repeatedly strain the lining of the arteries. This strain makes it easier for plaque—made up of fats, cholesterol, and other substances—to build up inside artery walls and interfere with normal blood flow.
Several risk factors play a central role in the development of atherosclerosis and coronary artery disease. These include:
High cholesterol, especially elevated LDL (“bad”) cholesterol
High blood pressure, which places ongoing stress on artery walls
Smoking, which damages blood vessels and accelerates plaque buildup
Other health conditions and lifestyle factors can further increase risk, including:
Diabetes or problems with blood sugar control
Excess body weight, especially weight carried around the abdomen
Physical inactivity
A family history of early heart or vascular disease
Chronic kidney disease
Older age
Having multiple risk factors at the same time increases the likelihood of developing more severe disease.
Diagnosis
Treatment
Treatment for atherosclerosis and coronary artery disease (CAD) focuses on improving blood flow, lowering the risk of heart attack, and preventing further plaque buildup. Care usually includes a combination of healthy lifestyle changes and medications tailored to a person’s overall health and risk factors.
Healthy Lifestyle Changes
Lifestyle habits are the foundation of treatment. They help slow plaque buildup and support overall heart health.
These changes may include:
Quitting smoking
Eating a heart-healthy diet
Being physically active on a regular basis
Reaching and maintaining a healthy weight
These steps help reduce strain on the arteries and lower the risk of heart attack and stroke.
Medications
Several types of medications may be used to treat atherosclerosis or CAD. These work in different ways to protect the blood vessels and reduce the chance of complications:
Cholesterol-lowering medications help reduce plaque buildup and stabilize existing plaque.
Antiplatelet medicines make blood clots less likely to form inside narrowed arteries.
Blood pressure medications reduce stress on artery walls and help prevent further damage.
Medications for chest discomfort can improve blood flow to the heart and help manage symptoms.
Clinicians choose treatment combinations based on a person’s symptoms, risk factors, and overall cardiovascular health.
Procedures
When arteries become significantly narrowed or symptoms continue despite medical therapy, procedures may be considered to help improve blood flow. Options may include procedures that open blocked arteries or surgery to bypass narrowed areas. These decisions depend on the severity of disease, symptoms, and overall heart function.
Ongoing Care
Regular check-ins help healthcare teams monitor symptoms, track progress, and adjust treatment as needed. Long-term care focuses on preventing complications, reducing risk, and supporting heart and vascular health over time.
Living With/Prevention
There isn’t a cure for atherosclerosis or CAD, but it can often be managed with consistent care. Healthy lifestyle changes and medications can help reduce the chance that plaque will cause symptoms or complications. The goal of care is to limit how much the disease worsens and lower the risk of serious problems such as heart attack. Staying engaged in care and managing risk factors can help support heart and vascular health.
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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