Risk Factors for Atherosclerosis, or Hardening of the Arteries
Knowing your personal risk can help you make changes that may help

The potential risks of atherosclerosis—such as heart disease, heart attack, and stroke—are some of the top 10 leading causes of death in the United States. For this reason, it’s important to understand what causes the hardening of the arteries. Knowing the risk factors of atherosclerosis can empower you to make the choices to prevent it.
“Atherosclerosis is a progression over many years,” says Lawrence Phillips, MD, cardiologist at NYU Langone Health. “Even if somebody is told at some stage that they have atherosclerosis or narrowing of their blood vessels, it doesn't mean that they're going to have an event, like a heart attack or a stroke. Instead, it's a wake-up call that you need to modify your risk even further.”
Understanding Atherosclerosis
When levels of LDL (“bad”) cholesterol in the body are too high, it can form plaque. Plaque builds up on the walls of blood vessels, which can cause the wall to thicken. As a result, this plaque buildup may narrow the channel and reduce blood flow.
This process of hardening arteries is called atherosclerosis (pronounced “ath-er-oh-skluh-ROH-sis”). Even when it’s mild, the reduced blood flow can limit the oxygen and nutrients that the rest of the body needs.
When atherosclerosis becomes severe, however, plaque may block arteries to the organs. For example, a blocked artery to the heart can result in angina, or chest pain from reduced blood flow. Worse, if a piece of brittle plaque breaks off and gets stuck, it may lead to a heart attack or stroke.
Causes of Atherosclerosis
There’s no single cause of atherosclerosis: A variety of factors may increase your risk. “When we think about risk factors for atherosclerosis we're thinking in two categories: one being modifiable and those that are non-modifiable,” says Dr. Phillips.
“The non-modifiable [risk factors] will be your age, your gender, and your ethnicity,” says Dr. Phillips. Because atherosclerosis progresses as you age, it’s more common the older you get.
As for modifiable risk factors, the chances of atherosclerosis are higher if you:
- Have high cholesterol or high triglycerides
- Smoke cigarettes
- Have high blood pressure
- Are overweight or inactive
- Have diabetes
- Eat an unhealthy diet, such as a diet high in saturated fat
“It's important that everybody know their risk for developing atherosclerosis because the outcome can be a heart attack, a stroke, or even death. We know that atherosclerosis can be delayed and stopped from progressing by knowing your numbers and modifying your risk,” says Dr. Phillips.
Lawrence Phillips, MD, is a cardiologist at NYU Langone Health. Dr. Phillips is the assistant professor of the Department of Medicine at NYU Grossman School of Medicine, the assistant clinical director for strategic affairs at Leon H. Charney Division of Cardiology, the director of the Nuclear Cardiology Laboratory, the medical director for Outpatient Clinical Cardiology, and the associate director of the Cardiovascular Disease Fellowship Program.
00:00:00.000 --> 00:00:01.999
(upbeat music)
00:00:02.000 --> 00:00:06.099
So atherosclerosis is a narrowing
of the arteries in the body.
00:00:06.100 --> 00:00:09.066
They could be narrowing in the arteries to the heart,
00:00:09.067 --> 00:00:12.699
to the kidneys, to the legs, to the brain,
00:00:12.700 --> 00:00:15.966
but overall, you're looking at deposits
00:00:15.967 --> 00:00:19.766
of outside material into the blood vessel walls.
00:00:19.767 --> 00:00:24.666
(upbeat music)
00:00:24.667 --> 00:00:27.066
The narrowing is being caused by
00:00:27.067 --> 00:00:29.032
kind of filling in the walls.
00:00:29.033 --> 00:00:31.266
It can occur early in teen years
00:00:31.267 --> 00:00:34.332
and progress over years 'til older age.
00:00:34.333 --> 00:00:37.766
The material that gets put into the walls
includes cholesterol,
00:00:37.767 --> 00:00:40.966
fat, the body's immune cells,
00:00:40.967 --> 00:00:44.432
as well as other materials like fibrin.
00:00:44.433 --> 00:00:47.532
By depositing material into the blood vessel walls,
00:00:47.533 --> 00:00:51.232
it causes narrowing.
It's kind of like overstuffing a suitcase,
00:00:51.233 --> 00:00:53.632
and as you put more and more into the walls
00:00:53.633 --> 00:00:55.932
of the vessel, you end up having,
00:00:55.933 --> 00:00:58.832
first, the vessel push out, but then narrow,
00:00:58.833 --> 00:01:01.832
restricting blood flow, causing disease.
00:01:01.833 --> 00:01:04.799
When we think about risk factors for atherosclerosis,
00:01:04.800 --> 00:01:07.799
we're thinking in two categories, one being modifiable,
00:01:07.800 --> 00:01:09.399
and those that are non-modifiable.
00:01:09.400 --> 00:01:12.299
So the non-modifiable ones will be your age,
00:01:12.300 --> 00:01:14.866
your gender, your ethnicity.
00:01:14.867 --> 00:01:18.632
The modifiable ones are your blood pressure,
your cholesterol,
00:01:18.633 --> 00:01:21.899
obesity and being overweight,
tobacco use,
00:01:21.900 --> 00:01:24.499
and sedentary lifestyles,
as well as your diet.
00:01:24.500 --> 00:01:28.499
So one of the problems with attacking atherosclerosis
early on,
00:01:28.500 --> 00:01:30.532
is you might not have any symptoms.
00:01:30.533 --> 00:01:33.966
What you need to do is, first, know your numbers,
00:01:33.967 --> 00:01:37.466
and second, learn how to modify your risk.
00:01:37.467 --> 00:01:39.832
So since most patients are asymptomatic
00:01:39.833 --> 00:01:41.966
when they're developing the atherosclerosis,
00:01:41.967 --> 00:01:45.266
having routine follow-up with a physician is very important.
00:01:45.267 --> 00:01:48.199
It's important that everybody know their risk
00:01:48.200 --> 00:01:51.466
for developing atherosclerosis because the outcome
00:01:51.467 --> 00:01:54.899
can be a heart attack, a stroke, or even death.
00:01:54.900 --> 00:01:58.666
So atherosclerosis is a progression over many years.
00:01:58.667 --> 00:02:02.199
Most people don't know that atherosclerosis actually starts
00:02:02.200 --> 00:02:04.566
in your teenage years, and it's the progression
00:02:04.567 --> 00:02:08.299
over your lifetime which causes you problems.
00:02:08.300 --> 00:02:11.532
So even if somebody is told at some stage that they have
00:02:11.533 --> 00:02:14.132
atherosclerosis or narrowing of their blood vessels,
00:02:14.133 --> 00:02:16.666
it doesn't mean that they're going to have an event
00:02:16.667 --> 00:02:18.732
like a heart attack or a stroke.
00:02:18.733 --> 00:02:21.466
Instead, it's a wake-up call
00:02:21.467 --> 00:02:24.433
they need to modify your risk even further.
- Atherosclerosis. Bethesda, MD: National Herat, Lung, and Blood Institute. (September, 17, 2020)
- Atherosclerosis. Dallas, TX: American Heart Association. (Accessed on September 17, 2020)
- High cholesterol facts. Atlanta, GA: Centers for Disease Control and Prevention, 2020. (Accessed on September 21, 2020)
- Pathogenesis of atherosclerosis. Waltham, MA: UpToDate, 2020. (Accessed on September 17, 2020)