Atherosclerosis: symptoms, causes, stages, treatment and foods to eat

Atherosclerosis is one of those conditions that can develop quietly for years before causing noticeable symptoms. In simple terms, it happens when plaque builds up inside the walls of your arteries. Over time, this plaque can make the arteries narrower and less flexible, reducing the amount of oxygen-rich blood reaching important organs.

The arteries supplying the heart, brain, kidneys, legs and other parts of the body can all be affected. The problem becomes particularly serious when a plaque becomes unstable, ruptures, and triggers a blood clot. This can suddenly block blood flow and cause a heart attack or stroke.

The good news is that atherosclerosis is not simply an unavoidable consequence of ageing. Many of the factors that accelerate plaque formation can be controlled. Healthy eating, regular physical activity, avoiding tobacco, maintaining a healthy weight, and controlling cholesterol, blood pressure and blood sugar can all play an important role in reducing cardiovascular risk.

What is atherosclerosis?

Atherosclerosis is a condition in which plaque accumulates within the inner walls of arteries. This plaque is made up of cholesterol, fats, calcium, blood cells and other substances found in the bloodstream.

As plaque grows, the artery may become increasingly narrow. This can restrict blood flow to organs and tissues. A piece of plaque can also break away or a blood clot can form over a damaged plaque, potentially causing a sudden blockage.

Atherosclerosis is sometimes confused with arteriosclerosis. They are related but not identical. Arteriosclerosis is a broader term referring to thickening and loss of elasticity of the arteries. Atherosclerosis is one common type of arteriosclerosis and specifically involves plaque buildup.

Atherosclerosis can affect different arteries, leading to different conditions. For example, plaque in the coronary arteries can contribute to coronary artery disease, while plaque in the leg arteries can cause peripheral artery disease. When arteries supplying the brain are affected, carotid or other cerebrovascular disease can occur.

Who is affected by atherosclerosis?

Atherosclerosis can affect both men and women and becomes more common with increasing age. However, the process of plaque formation can begin much earlier in life and gradually progress over many years.

Your risk is higher if you have one or more of the following:

• High LDL cholesterol or other unhealthy lipid levels
• High blood pressure
• Diabetes or persistently high blood sugar
• Smoking or exposure to tobacco smoke
• Overweight or obesity
• Physical inactivity
• A diet high in saturated fats and highly processed foods
• A family history of cardiovascular disease or inherited high cholesterol
• Certain inflammatory conditions
• Increasing age

Having several risk factors at the same time can significantly increase the likelihood of plaque formation and cardiovascular complications.

People of South Asian ancestry, including people from India and neighbouring countries, are also recognised as having a higher cardiovascular risk, making attention to cholesterol, blood pressure, blood sugar, diet and lifestyle particularly important.

What are the symptoms of atherosclerosis?

One of the biggest challenges with atherosclerosis is that it may cause no symptoms in its early stages. A person can have significant plaque buildup without knowing it.

Symptoms usually appear when an artery becomes sufficiently narrowed to reduce blood flow, or when a complication such as a blood clot occurs. The symptoms depend largely on which arteries are affected.

Atherosclerosis affecting the heart

When the coronary arteries are affected, reduced blood flow may cause:

• Chest pain, pressure or discomfort
• Shortness of breath
• Reduced exercise tolerance
• Unusual tiredness
• Symptoms that appear during physical or emotional stress

Chest discomfort associated with reduced blood flow to the heart is commonly referred to as angina.

Atherosclerosis affecting the legs

When arteries supplying the legs become narrowed, a person may experience:

• Pain or cramping while walking
• Leg heaviness or aching
• Pain that improves with rest
• Coldness in the affected foot or leg
• Slow-healing wounds
• Changes in skin colour

Pain or cramping brought on by walking is known as intermittent claudication and is a classic symptom of peripheral artery disease.

Atherosclerosis affecting the brain

Plaque in arteries supplying the brain can increase the risk of a transient ischemic attack (TIA) or stroke. Warning symptoms can include sudden weakness or numbness, difficulty speaking, facial drooping, confusion or sudden vision problems.

Sudden neurological symptoms should never be ignored.

What causes atherosclerosis?

There isn’t one single cause. Atherosclerosis develops through a combination of artery-wall injury, inflammation and the accumulation of cholesterol-rich material within the arterial wall.

High blood pressure, high LDL cholesterol, diabetes and tobacco exposure can damage or disturb the artery’s inner lining. This creates an environment in which cholesterol and inflammatory cells can accumulate. Over time, a small fatty deposit can develop into a larger plaque.

Genetics also matter. Some people inherit conditions that cause very high cholesterol, making plaque formation possible at a younger age. Lifestyle factors can then add to the underlying risk.

What are the four stages of atherosclerosis?

There isn’t one universally used clinical staging system for atherosclerosis, and medical literature describes plaque development in slightly different ways. However, the disease process can be explained in four broad stages: endothelial dysfunction, fatty streak formation, plaque maturation and advanced or complicated plaque.

Stage 1: Endothelial dysfunction

The endothelium is the thin layer of cells lining the inside of blood vessels. Factors such as high blood pressure, high blood sugar, tobacco exposure and unhealthy cholesterol levels can impair its normal function.

This makes the arterial wall more susceptible to the retention of LDL and the recruitment of inflammatory cells.

Stage 2: Fatty streak formation

Cholesterol and inflammatory cells accumulate within the artery wall. Immune cells called macrophages can take up modified LDL and become foam cells.

Clusters of these cells form what is known as a fatty streak, an early visible manifestation of atherosclerosis.

Stage 3: Plaque maturation

The fatty streak can progress into a more established plaque. Smooth muscle cells and connective tissue contribute to the formation of a fibrous cap over a lipid-rich core.

As the plaque grows, the artery may become progressively narrower, reducing blood flow.

Stage 4: Advanced or complicated plaque

An advanced plaque can become unstable. Inflammation and structural changes can weaken the fibrous cap. If the plaque ruptures or erodes, a blood clot may form at the site.

That clot can suddenly obstruct blood flow and potentially cause a heart attack, stroke or other serious vascular complication.

What is the best treatment for atherosclerosis?

There is no single “best treatment” for everyone with atherosclerosis. Treatment depends on the arteries involved, the severity of disease, symptoms, cholesterol levels, blood pressure, diabetes status and overall cardiovascular risk.

The main goals are to slow or stabilise plaque progression, reduce the risk of blood clots and cardiovascular events, control risk factors and restore blood flow when necessary.

Treatment may include:

Heart-healthy lifestyle changes

A heart-healthy diet, regular physical activity, maintaining a healthy weight, avoiding tobacco and getting adequate sleep are important parts of treatment.

For many people, lifestyle changes are an essential foundation even when medicines or procedures are also required.

Cholesterol-lowering medicines

Statins and other lipid-lowering medicines may be prescribed when appropriate. Lowering LDL cholesterol is an important part of reducing atherosclerotic cardiovascular risk, and some cholesterol-lowering treatments can reduce or partially reverse plaque burden in selected patients.

Blood pressure and diabetes management

High blood pressure and uncontrolled blood sugar can accelerate vascular damage. Keeping these conditions under control can help reduce the risk of further complications.

Procedures

When an artery is severely narrowed or blocked, a procedure or surgery may sometimes be required. Depending on the location and severity of the blockage, treatment can include catheter-based procedures or bypass surgery.

Which foods reduce atherosclerosis?

No individual food can dissolve atherosclerosis on its own. The most useful approach is an overall eating pattern that supports healthy cholesterol, blood pressure, blood sugar and body weight.

The American Heart Association’s 2026 dietary guidance emphasises vegetables and fruits, whole grains, healthy sources of protein, unsaturated fats instead of saturated fats, minimally processed foods, and lower intake of added sugars and sodium.

Good choices include:

• Vegetables such as leafy greens, broccoli, carrots and beans
• Fruits such as apples, berries, oranges and guava
• Whole grains such as oats, barley and whole-wheat foods
• Pulses, lentils and beans
• Nuts and seeds in appropriate portions
• Fish, particularly oily fish
• Low-fat or minimally processed dairy options
• Healthy unsaturated fats such as those from nuts, seeds and suitable plant oils

Foods rich in soluble fibre, including oats and barley, can be particularly useful as part of a cholesterol-conscious diet.

The important point is consistency. Eating one “heart-healthy” food occasionally will not offset an otherwise unhealthy diet.

What not to eat with atherosclerosis?

There is no single food that every person with atherosclerosis must completely eliminate. However, certain foods should be limited because they can contribute to high LDL cholesterol, excess calorie intake, high blood pressure or poor metabolic health.

Try to limit:

• Deep-fried foods
• Processed meats such as sausages and certain cured meats
• Fatty cuts of meat
• Foods high in saturated fat
• Trans fats where present
• Highly processed snacks
• Bakery products made with large amounts of butter or shortening
• Sugary drinks
• Excess sweets and desserts
• Foods very high in sodium
• Excessively large portions

Current heart-health guidance places more emphasis on the overall dietary pattern rather than simply avoiding one nutrient. Replacing saturated fats with unsaturated fats and choosing minimally processed foods is particularly important.

Can garlic remove plaque from arteries?

Garlic is often promoted online as a natural way to “clean” or “unclog” arteries. The reality is more nuanced.

Garlic contains compounds that may have beneficial effects on cardiovascular risk factors. Some studies and meta-analyses suggest garlic preparations may modestly influence cholesterol, blood pressure and other vascular markers. However, the evidence is inconsistent, and garlic has not been proven to remove established arterial plaque in the way a medical procedure might.

Therefore, eating garlic as part of a healthy diet is reasonable for most people, but it should not replace prescribed cholesterol medicines, blood-pressure treatment, diabetes management or recommended cardiovascular procedures.

People taking blood-thinning or other medicines should also discuss concentrated garlic supplements with their healthcare professional because supplements can interact with medicines.

Are eggs bad for atherosclerosis?

Eggs are not automatically “bad” for someone with atherosclerosis.

Egg yolks contain dietary cholesterol, but cardiovascular health depends on the overall dietary pattern and a person’s individual risk factors. The American Heart Association has noted that dietary cholesterol should be considered in the context of the whole diet, particularly the amount of saturated fat and the quality of the foods eaten alongside it.

For example, an egg eaten with vegetables and whole grains is very different from eggs regularly consumed with processed meats, butter-heavy foods and refined carbohydrates.

If you already have atherosclerosis, high LDL cholesterol, diabetes or another cardiovascular condition, the appropriate amount of eggs can depend on your individual situation. It is sensible to discuss your diet with your doctor or a qualified dietitian rather than eliminating eggs unnecessarily.

How is atherosclerosis diagnosed?

Because early atherosclerosis often causes no symptoms, assessment may begin with a review of cardiovascular risk factors.

Your doctor may consider:

• Blood pressure measurement
• Lipid profile, including LDL cholesterol
• Blood glucose or HbA1c
• Family and personal medical history
• Smoking status
• Weight and waist circumference
• Physical examination

Additional tests depend on symptoms and the arteries suspected to be affected. These can include an ECG, exercise testing, vascular ultrasound or Doppler studies, ankle-brachial index, CT-based imaging or other cardiovascular investigations.

The aim is not simply to find plaque but to understand the individual’s overall cardiovascular risk and whether blood flow is being affected.

Can atherosclerosis be reversed?

This is an important question because people often assume that once plaque develops, nothing can be done.

The answer is that atherosclerosis can sometimes regress, particularly when risk factors are aggressively controlled. NHLBI notes that studies have shown possible reversal, especially in earlier disease, through heart-healthy lifestyle changes and medicines that achieve very low LDL cholesterol levels. However, severe or advanced atherosclerosis may not be completely reversible.

Even when existing plaque cannot be completely removed, treatment can still make a major difference by slowing progression, stabilising plaques and reducing the risk of heart attack, stroke and other complications.

When should you seek medical attention?

Atherosclerosis can become an emergency when blood flow is suddenly blocked.

Seek emergency medical care for symptoms such as:

• Sudden or severe chest pressure or pain
• Severe shortness of breath
• Sudden weakness or numbness on one side of the body
• Sudden difficulty speaking or understanding speech
• Sudden vision loss
• Sudden facial drooping
• Severe unexplained pain in a limb accompanied by coldness or colour change

These symptoms can indicate a heart attack, stroke or acute loss of blood flow and require urgent evaluation.

Frequently asked questions about atherosclerosis

What is atherosclerosis in simple terms?

Atherosclerosis is the gradual buildup of plaque inside artery walls. The plaque contains cholesterol, fat, calcium and other substances. As it grows, it can narrow the artery and restrict blood flow.

Who is affected by atherosclerosis?

Anyone can develop atherosclerosis, but the risk increases with age and is higher in people with high LDL cholesterol, high blood pressure, diabetes, smoking exposure, obesity, physical inactivity or a family history of cardiovascular disease.

What are the early symptoms of atherosclerosis?

Early atherosclerosis often has no symptoms. Symptoms usually appear when plaque significantly restricts blood flow or causes a complication. Depending on the affected artery, symptoms may include chest discomfort, breathlessness, leg pain while walking or neurological symptoms.

What are the four stages of atherosclerosis?

A useful four-stage description is endothelial dysfunction, fatty streak formation, plaque maturation and advanced or complicated plaque. The final stage may involve plaque rupture, clot formation and sudden arterial blockage.

What is the best treatment for atherosclerosis?

Treatment is individualised. It commonly involves lifestyle changes and management of cholesterol, blood pressure and blood sugar. Medicines may be needed, while severe blockages may require procedures or surgery.

Which foods are best for atherosclerosis?

Vegetables, fruits, whole grains, legumes, nuts, seeds, fish and foods containing unsaturated fats are generally good choices. The overall dietary pattern matters more than any single food.

What foods should be limited with atherosclerosis?

Limit foods high in saturated fat, highly processed foods, deep-fried foods, processed meats, excessive sodium, sugary drinks and foods high in added sugars.

Can garlic remove plaque from arteries?

No. Garlic may have modest effects on some cardiovascular risk factors, but there is not sufficient evidence to say that eating garlic removes established arterial plaque. It should complement, not replace, medical treatment.

Are eggs bad for atherosclerosis?

Not necessarily. Eggs can fit into a heart-healthy diet for many people. However, people with high cholesterol or established cardiovascular disease may need personalised dietary advice based on their overall risk and eating pattern.

Can atherosclerosis be prevented?

The risk can often be reduced by not smoking, exercising regularly, maintaining a healthy weight, eating a heart-healthy diet and controlling cholesterol, blood pressure and blood sugar. Regular health check-ups can also help identify risk factors before complications develop.

The bottom line

Atherosclerosis is a gradual disease, but its consequences can be sudden. Because it may remain silent for years, waiting for symptoms is not always the best approach. Understanding your cardiovascular risk and addressing factors such as high cholesterol, blood pressure, diabetes, smoking, diet and physical inactivity can make a meaningful difference.

There is also no magic food that can clean arteries overnight. Garlic, eggs and individual “superfoods” should be viewed in the context of the overall diet rather than as cures. The most effective strategy combines a heart-healthy lifestyle with appropriate medical treatment and regular monitoring.

If you have symptoms such as chest discomfort during activity, unexplained breathlessness, recurring leg cramps while walking, or sudden neurological changes, speak with a healthcare professional promptly. Early assessment and appropriate treatment can help reduce the risk of serious complications from atherosclerosis.

To consult a Cardiologist at Sparsh Diagnostic Centre, call our helpline number 9830117733.

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Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.