atherosclerosis

DEFINITION of atherosclerosis

Atherosclerosis is a progressive, inflammatory cardiovascular disease characterized by the accumulation of lipids, inflammatory cells, smooth muscle cells, and fibrous tissue within the intima (innermost layer) of medium and large arteries. This buildup forms plaques (atheromas) that can calcify over time, reduce arterial elasticity, narrow the vessel lumen, and ultimately lead to ischemia, thrombosis, or complete vessel occlusion. It is a leading underlying cause of coronary artery disease, peripheral artery disease, stroke, and other cardiovascular events. Atherosclerosis is the gradual buildup of plaque in the walls of your arteries. Arteries are blood vessels that carry oxygen-rich blood to organs and tissues throughout your body. Plaque (atheroma) is a sticky substance made of fat, cholesterol, calcium and other substances.

As plaque builds up, your artery wall grows thicker and harder. This “hardening of the arteries” is usually a silent process in the early stages. You may not notice symptoms for a long time. But eventually, as the plaque grows, the opening (lumen) of your artery narrows, leaving less room for blood to flow. This means less blood can reach your organs and tissues. Plus, the constant force of blood flow can lead to plaque erosion or rupture, causing a blood clot to form.

A narrowed artery is like a highway reduced to one lane. But a blood clot is like a barricade in the middle of the road. It blocks blood flow to certain organs or tissues the artery normally feeds. The effects on your body depend on where the blood clot forms. For example, blockages in a coronary artery deprive your heart of oxygen-rich blood, leading to a heart attack.

How common is atherosclerosis?

Atherosclerosis is very common. The complications of plaque buildup (including heart attacks and strokes) are the leading cause of death worldwide.

In America, about half of people age 45 to 84 have atherosclerosis but aren’t aware of it, according to the U.S. National Institutes of Health.

Symptoms and Causes

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Learn more about the signs of atherosclerosis.

What are the symptoms?

Atherosclerosis symptoms often don’t start until an artery is very narrow or blocked. Many people don’t know they have plaque buildup until they have a medical emergency like a heart attack or stroke.

You may notice symptoms of atherosclerosis if your artery is more than 70% blocked. You can have symptoms in different parts of your body, depending on the location of the blockage. Affected locations may include:

Heart

Coronary artery disease (CAD, which can lead to a heart attack) happens in the arteries that supply blood to your heart.

You may experience:

• Shortness of breath (dyspnea) during light physical activity.
• Chest pain or discomfort (angina).
• Pain in your back, shoulders, neck, arms or belly.
• Feeling dizzy or lightheaded.
• Heart palpitations.
• Fatigue.
• Nausea or vomiting that may feel like indigestion.

Digestive system

Mesenteric ischemia happens when you don’t have enough blood flow in parts of your digestive system. You may experience:

• Pain or cramping in your belly (abdomen) after eating.
• Bloating, nausea and vomiting.
• Diarrhea.
• Unintentional weight loss due to “food fear” (fear of pain after eating).

Legs and feet

Peripheral artery disease (PAD) refers to poor blood flow in the arteries in your limbs.

You may experience:

• Muscle pain (intermittent claudication).
• Burning or aching pain in your feet and toes when you rest, especially when lying flat.
• Changes in skin color (like redness).
• Cool skin on your feet.
• Frequent skin and soft tissue infections, often in your legs or feet.
• Sores on your feet or toes that don’t heal.

Kidneys

With renal artery stenosis (narrowing of the arteries that take blood to your kidneys), you may experience:

• Markedly elevated blood pressure that doesn’t respond to multiple medications.
• Changes in how often you pee.
• Swelling (edema).
• Feeling drowsy or tired.
• Skin that feels dry, itchy or numb.
• Headaches.
• Unexplained weight loss.
• Nausea, vomiting or loss of appetite.

Brain

With carotid artery disease, the first symptoms are usually a transient ischemic attack (TIA) or stroke.

You may experience:

• Dizziness.
• Drooping on one side of your face.
• Loss of feeling, loss of muscle strength or weakness on one side of your body.
• Severe headache.
• Slurred speech or difficulty forming words.
• Vision loss in one eye. You may notice a dark shade coming down over your field of sight.

What causes atherosclerosis?

Researchers believe atherosclerosis causes may include:

• High LDL cholesterol and triglyceride levels.
• Tobacco products.
• High blood pressure.
• Diabetes.

These factors can damage your artery’s inner lining (endothelium). This causes atherosclerosis to begin. The damage usually occurs slowly and over time.

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ETYMOLOGY of atherosclerosis

greek

Component	Origin	Meaning
athero-	Greek athḗrē (ἀθήρη)	Porridge or gruel (referring to the soft, pasty appearance of fatty plaques)
sclero-	Greek sklēros (σκληρός)	Hard
-osis	Greek -ōsis	Condition, process, or disease state

Literally: “a hardening porridge condition” — describing the characteristic hardening of arteries with soft, gruel-like fatty deposits.

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🔀 ALIASES / ALTERNATE TERMS

• Arteriosclerosis (broader term; atherosclerosis is the most common type)
• Hardening of the arteries (lay term)
• Coronary artery disease (CAD) (when affecting coronary arteries)
• Peripheral artery disease (PAD) (when affecting peripheral vessels)
• Arterial plaque disease
• Atheromatous disease
• Ischemic arterial disease
• Occlusive arterial disease

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🔗 RELATED TERMS

• Atheroma — the fatty plaque itself
• Arteriosclerosis — general hardening/thickening of arterial walls (atherosclerosis is a subtype)
• Stenosis — narrowing of the vessel lumen caused by plaque
• thrombosis — clot formation, often on a ruptured plaque
• embolism — clot or debris breaking off and traveling distally
• Ischemia — reduced blood/oxygen supply due to narrowing
• Calcified coronary lesion — a specific complication tracked in ICD-10
• Lipid-rich plaque — another specific plaque type with its own code
• Angioplasty / Stenting / CABG — common interventional treatments
• Dyslipidemia / Hypercholesterolemia — major risk factors
• Hypertension, Diabetes mellitus, Smoking — key comorbid risk factors

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CODING CORNER

🏥 ICD-10-CM CODES

Atherosclerosis codes are primarily found in categories I25 (Chronic ischemic heart disease) and I70 (Atherosclerosis). This is a large family — below are the most clinically essential codes.

General / Unspecified

Code	Description
I70.90	Unspecified atherosclerosis
I70.91	Generalized atherosclerosis
I70.8	Atherosclerosis of other arteries

By Specific Artery

Code	Description
I70.0	Atherosclerosis of aorta
I70.1	Atherosclerosis of renal artery
I67.2	Cerebral atherosclerosis

Coronary Atherosclerosis (Category I25)

Code	Description
I25.10	Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110	…with unstable angina pectoris
I25.111	…with angina pectoris with documented spasm
I25.118	…with other forms of angina pectoris
I25.119	…with unspecified angina pectoris
I25.83	Coronary atherosclerosis due to lipid rich plaque
I25.84	Coronary atherosclerosis due to calcified coronary lesion
I25.810	Atherosclerosis of CABG without angina pectoris
I25.700	Atherosclerosis of CABG (unspecified) with unstable angina pectoris
I25.708	Atherosclerosis of CABG (unspecified) with other forms of angina pectoris
I25.709	Atherosclerosis of CABG (unspecified) with unspecified angina pectoris

Peripheral / Extremity Atherosclerosis (Category I70.2x-I70.7x)

Code	Description
I70.201	Unspecified atherosclerosis of native arteries, right leg
I70.202	Unspecified atherosclerosis of native arteries, left leg
I70.203	Unspecified atherosclerosis of native arteries, bilateral legs
I70.261	Atherosclerosis of native arteries with gangrene, right leg
I70.262	Atherosclerosis of native arteries with gangrene, left leg
I70.291	Other atherosclerosis of native arteries, right leg
I70.292	Other atherosclerosis of native arteries, left leg
I70.293	Other atherosclerosis of native arteries, bilateral legs

Atherosclerosis with Ulceration

Code	Description
I70.231	Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232	Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233	Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.25	Atherosclerosis of native arteries of other extremities with ulceration

Bypass Graft Atherosclerosis

Code	Description
I70.601	Unspecified atherosclerosis of nonbiological bypass graft(s), right leg
I70.661	Atherosclerosis of nonbiological bypass graft(s) with gangrene, right leg
I70.701	Unspecified atherosclerosis of other type of bypass graft(s), right leg
I70.761	Atherosclerosis of other type of bypass graft(s) with gangrene, right leg

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🔧 COMMON CPT CODES (Related Procedures)

CPT Code	Description
93458	Left heart catheterization with coronary angiography
93454	Coronary angiography only
92920	Percutaneous coronary intervention (PCI), single vessel
92928	PCI with stent placement, single vessel
92933	PCI with atherectomy, single vessel
33533	CABG, arterial graft, single
35301	Thromboendarterectomy, carotid artery
35471	Transluminal balloon angioplasty, renal or visceral artery
93925	Duplex scan of lower extremity arteries (bilateral)
93926	Duplex scan of lower extremity arteries (unilateral or limited)
75710	Angiography, extremity, unilateral
75716	Angiography, extremity, bilateral

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⚠️ Coding Note: For inpatient coding, atherosclerosis of the coronary arteries should be coded with the highest level of specificity — always capture whether it involves native vessels vs. bypass grafts, the presence/type of angina, and complicating factors like lipid-rich plaque (I25.83) or calcified lesion (I25.84). The I70 category for peripheral atherosclerosis requires laterality, vessel type, and presence of ulceration/gangrene for full specificity.

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A Word from MedlinePlus

Atherosclerosis

Atherosclerosis, sometimes called “hardening of the arteries,” occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can narrow or completely block the arteries and cause problems throughout the body.

Atherosclerosis is a common disorder.

Causes

Atherosclerosis often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them.

Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them.

These blockages starve tissues of blood and oxygen. This can result in damage or tissue death. It is a common cause of heart attack and stroke.

High blood cholesterol levels can cause hardening of the arteries at a younger age.

For many people, high cholesterol levels are due to or worsened by a diet that is too high in saturated fats and trans fats.

Other factors that can contribute to hardening of the arteries include:

• Diabetes
• Family history of hardening of the arteries
• High blood pressure
• Lack of exercise
• Being overweight or obese
• Smoking

Symptoms

Atherosclerosis does not cause symptoms until blood flow to part of the body becomes slowed or blocked.

If the arteries supplying the heart become narrow, blood flow can slow down or stop. This can cause chest pain (stable angina or unstable angina), shortness of breath, and other symptoms.

Narrowed or blocked arteries may also cause problems in the intestines, kidneys, legs, and brain.

Exams and Tests

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound (“bruit”) over an artery.

Most people age 18 or older should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure. Ask your provider what schedule is best for you.

Cholesterol testing is recommended in all adults. The major national guidelines differ on the suggested age to start testing.

• Screening should begin at age 20 for both men and women.
• Repeat testing is not needed for five years for most adults with normal cholesterol levels.
• Repeat testing may be needed if lifestyle changes occur, such as large increase in weight or a change in diet.
• More frequent testing is needed for adults with a history of high cholesterol, diabetes, kidney problems, heart disease, stroke, and other conditions

A number of imaging tests may be used to see how well blood moves through your arteries. Check with your provider to see if any of these are recommended for you.

• Doppler tests that use ultrasound or sound waves
• Magnetic resonance arteriography (MRA), a special type of MRI scan
• Special CT scans called CT angiography
• Arteriograms or angiography that use x-rays and contrast material (sometimes called “dye”) to see the path of blood flow inside the arteries

Treatment

Lifestyle changes will reduce your risk for atherosclerosis. Things you can do include:

• Quit smoking: This is the single most important change you can make to reduce your risk for heart disease and stroke.
• Avoid fatty foods: Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Limit how much alcohol you drink: Recommended limits are one drink a day for women, two a day for men.
• Get regular physical activity: Exercise with moderate intensity (such as brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 to 90 minutes a day. Talk to your provider before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack.

If your blood pressure is high, it is important for you to lower it and keep it under control.

The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.

• Do not stop or change high blood pressure medicines without talking to your provider.

Your provider may want you to take medicine for abnormal cholesterol levels or for high blood pressure if lifestyle changes do not get you to your goals for these. This will depend on:

• Your age
• The medicines you take
• Your risk of side effects from possible medicines
• Whether you have heart disease or other blood flow problems
• Whether you smoke or are overweight
• Whether you have diabetes or other heart disease risk factors
• Whether you have any other medical problems, such as kidney disease

Your provider may suggest taking aspirin or another medicine to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your provider.

Losing weight if you are overweight and reducing blood sugar if you have diabetes or pre-diabetes can help reduce the risk of developing atherosclerosis.

Outlook (Prognosis)

Atherosclerosis cannot be reversed once it has occurred. However, lifestyle changes and treating high cholesterol levels can prevent or slow the process from becoming worse. This can help reduce the chances of having a heart attack and stroke as a result of atherosclerosis.

Possible Complications

In some cases, the plaque is part of a process that causes a weakening of the wall of an artery. This can lead to a bulge in an artery called an aneurysm. Aneurysms can break open (rupture). This causes bleeding that can be life threatening.

Alternative Names

Hardening of the arteries; Arteriosclerosis; Plaque buildup - arteries; Hyperlipidemia - atherosclerosis; Cholesterol - atherosclerosis

References

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414. PMID: 30894319 pubmed.ncbi.nlm.nih.gov/30894319/.

Libby P. The vascular biology of atherosclerosis. In: Bonow RO, Mann DL, Tomaselli GF, et al, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 13th ed. Philadelphia, PA: Elsevier; 2026: chap 22.

Marks AR. Cardiac and circulatory function. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 41.

Tokgozoglu L, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Tomaselli GF, et al, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 13th ed. Philadelphia, PA: Elsevier; 2026:chap 25.

US Preventive Services Task Force; Mangione CM, Barry MJ, et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. JAMA. 2022;328(8):746-753. PMID: 35997723 pubmed.ncbi.nlm.nih.gov/35997723/.

Writing Committee Members; Jones DW, Ferdinand KC, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025;82(10):e212-e316. PMID: 40811516 pubmed.ncbi.nlm.nih.gov/40811516/.

Review Date 1/27/2026

Updated by: Thomas S. Metkus MD, PhD, Associate Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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DERIVATIONS of atherosclerosis

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