By Natasha Persaud

Smooth and supple, healthy arteries expand and contract to move blood, oxygen and nutrients along towards your organs and tissues. Problems arise when your arteries become damaged, due to injury or disease. One of the culprits is atherosclerosis, or hardening of the arteries, which may start around the time you're born and may progress through adulthood.

"Ultimately, atherosclerosis is responsible for virtually all heart attacks and the vast majority of strokes," says Prediman K. Shah, M.D., director of cardiology at Cedars Sinai Medical Center-Heart Institute. "It may contribute to as many as a million deaths a year in the United States—and 300,000 of those are sudden unexpected deaths, meaning people at risk possibly did not know it."

Hardening of the arteries is a thickening of artery walls due to deposits of fat, cholesterol, calcium and other substances, collectively known as plaque. As plaque increases in size, it narrows arteries, impeding delivery of blood, and thus, nutrients and oxygen to the body’s organs and tissues.

If a plaque ruptures, it produces a blood clot that may completely block a blood vessel. When lodged in a coronary artery, that clot can trigger a heart attack; in an artery feeding the brain, a stroke; in a leg artery, it can, in severe cases, lead to gangrene and the need for amputation.

Researchers don’t know exactly what starts atherosclerosis, but certain aspects of lifestyle or genetics can speed it up. Major risk factors for atherosclerosis include

  • Abnormal cholesterol levels
  • Prediabetes or diabetes
  • High blood pressure
  • Family history of early heart disease
  • History of smoking

Other risk factors include

  • Obesity
  • Inactivity
  • Depression
  • Menopause

Reducing Your Risks of Atherosclerosis

When atherosclerosis becomes advanced, it may cause symptoms such as aches, pain or cramping. But these symptoms may be subtle—or nonexistent. Since atherosclerosis progresses gradually, symptoms usually don’t start until the 40s and 50s in men, and 55 to 65 in women, when the disease has significantly narrowed arteries.

But younger adults and even children can have moderate or severe disease. "Half of the time, a person with advanced atherosclerosis experiences chest pain, or angina, during walking or stress," says Dr. Shah. "For others, the first sign is unfortunately sudden cardiac death or a massive heart attack."

Some risk factors can't be changed, such as age, sex and family history, according to Dr. Shah, but you can change others to prevent or stabilize atherosclerosis:

  • exercise regularly
  • maintain a healthy weight
  • don't smoke

Atherosclerosis and Your Diet

To slow atherosclerosis, consider a Mediterranean-style diet, which is low in saturated and trans fats (found in some packaged snacks, baked goods and fried foods) and rich in fatty fish (such as salmon, albacore tuna, mackerel, sardines and anchovies), fruits, vegetables, legumes, whole grains, nonfat dairy and nuts.

For the diet, you want to eat mostly fatty fish, fruits, vegetables, legumes, whole grains, nonfat dairy and nuts, along with a small amounts of alcohol, such as wine (one-half to one drink per day in women; one to two drinks per day in men). Avoid overconsumption of alcohol, which may increase the risk of cardiovascular disease.

What About Fish Oil Supplements?

Research shows modest benefits to taking a fish oil supplement containing omega-3 fatty acids and a plant sterol supplement, but food sources, such as fatty fish, are better for omega-3s, according to Dr. Shah.

Talk to Your Doctor About Atherosclerosis

It's vital to ask your doctor if you’re at risk for atherosclerosis, summarizes Dr. Shah. "Your doctor will check your blood pressure; ask about your smoking history; and order tests to measure your blood glucose, cholesterol and triglyceride levels; then use that information to derive your Framingham risk score for cardiovascular disease," he explains.

"If your score is high, treatment may include medication to lower LDL, or "bad" cholesterol levels or prescription niacin to raise HDL or ‘good’ cholesterol levels.

If your score is moderate, an imaging test may help determine whether you need treatment now.

In the absence of symptoms, your doctor may also order one of several tests that either directly measure plaque or indirectly identity a narrowed artery.

The sooner you get control of atherosclerosis, the better: "I encourage even teenagers to ask their doctors about atherosclerosis,” says Dr. Shah. "By the time you're in your 50s, the disease has advanced to the point that we can only prevent half of heart attacks and strokes—and prevention is what counts."

Publication Review By: the Editorial Staff at

Published: 01 Jul 2009

Last Modified: 21 Jan 2015