Atherosclerosis: symptoms, causes, treatment and which doctor to see
How plaque builds up in the arteries, the warning signs in the heart, brain and legs, the tests used, treatment options and when to see a cardiologist.
Also known as: Arteriosclerosis; Hardening of the Arteries; Plaque, Atherosclerotic
What atherosclerosis is
Atherosclerosis is the slow build-up of a fatty, waxy deposit called plaque inside the walls of the arteries, the vessels that carry oxygen-rich blood from the heart to the rest of the body. Plaque is made of cholesterol, fat, calcium, cells and other substances from the blood. Over years it thickens and stiffens the artery wall, which is why the condition is often called hardening of the arteries.
As plaque grows, the channel inside the artery narrows and less blood gets through. A second danger is that a plaque can crack. The body treats the crack like a wound and a blood clot forms on top of it, which can block the artery suddenly. This is how most heart attacks and many strokes happen. Atherosclerosis can affect arteries anywhere, but the problems it causes depend on where it is worst: the heart, the brain, the legs, the kidneys or the gut.
The process usually starts early in adult life and progresses silently for decades. It cannot be reversed with a single treatment, but its progress can be slowed considerably, and the risk of heart attack and stroke cut, by controlling the factors that drive it.
Symptoms
Most people have no symptoms until an artery is badly narrowed or suddenly blocked. What you notice depends on which arteries are affected:
- Heart (coronary arteries) — chest pain, pressure or heaviness on exertion that settles with rest (angina), breathlessness, or pain spreading to the arm, jaw or back
- Brain (carotid and brain arteries) — sudden weakness or numbness of the face, arm or leg, slurred speech, loss of vision in one eye or sudden confusion
- Legs (peripheral arteries) — leg pain on walking, usually in the calf, that eases after a few minutes of rest; cold feet or slow-healing wounds
- Kidneys — usually no symptoms, but it can raise blood pressure or reduce kidney function
In people with diabetes and in some women and older adults, heart symptoms can be vague: tiredness, breathlessness or discomfort in the upper abdomen rather than classic chest pain. Do not wait for textbook symptoms before seeking advice.
Causes and risk factors
Plaque begins where the inner lining of the artery has been damaged. The things that damage it, and so raise your risk, are well known:
- High LDL cholesterol and other abnormal blood fats
- High blood pressure
- Diabetes and prediabetes
- Smoking or chewing tobacco in any form, including beedis, gutka and second-hand smoke
- Being overweight, especially around the waist
- Physical inactivity and a diet high in fried foods, refined carbohydrates, sugar and salt
- A family history of early heart disease or stroke
- Older age, and chronic kidney disease
Doctors in India frequently see heart attacks in people in their thirties and forties, and South Asians are known to develop heart disease earlier than many other groups. Diabetes, high blood pressure and abdominal weight gain are common here and often go unnoticed for years, which is why regular screening matters even if you feel well. Read more about high blood pressure and type 2 diabetes.
Problems it can cause
Atherosclerosis is the main cause behind several serious conditions. Narrowed heart arteries cause coronary artery disease and heart attacks. Narrowed or clot-blocked brain arteries cause transient ischaemic attacks and stroke. Narrowed leg arteries cause peripheral arterial disease, which in severe cases can lead to ulcers and gangrene. Plaque can also weaken the wall of the aorta, the body's largest artery, and contribute to an aneurysm, and it can reduce blood flow to the kidneys.
How it is diagnosed
The doctor will ask about symptoms, your family history and habits, check your blood pressure, pulses in the neck, wrists and feet, and listen for a whooshing sound over narrowed arteries. Tests are chosen according to which arteries are suspected:
- Lipid profile and blood sugar tests to look for cholesterol problems and diabetes, along with kidney function tests
- ECG to look at the heart's electrical activity, and an echocardiogram to see how the heart is pumping
- Stress test — an ECG recorded while you walk on a treadmill, or a scan after a medicine that makes the heart work harder
- Doppler ultrasound of the neck or leg arteries to see narrowing and blood flow
- Ankle-brachial index — comparing blood pressure at the ankle and the arm, a simple check for leg artery disease
- CT coronary angiography or a calcium score scan in selected people
- Angiography — dye injected through a thin tube passed into the arteries, with X-ray pictures; usually done when a procedure to open an artery is being considered
Treatment
Treatment aims to slow the build-up of plaque, prevent clots and relieve symptoms. Almost everyone needs a combination of lifestyle change and medicines; some people also need a procedure.
Lifestyle changes
Lifestyle changes are the foundation and work alongside medicines, not instead of them. Stopping all tobacco is the single most useful step. Regular brisk walking or other activity most days, a diet built around vegetables, fruit, whole grains, pulses and nuts with less fried food, sugar and salt, keeping to a healthy weight and limiting alcohol all help. Your doctor or a dietitian can adapt this to the food you actually eat at home.
Medicines
Cholesterol-lowering medicines, most often statins, slow plaque growth and make existing plaque more stable. Blood thinners, such as antiplatelet medicines, reduce the chance of a clot forming on a plaque. Medicines to control blood pressure and blood sugar are equally important. Many of these are taken for life, and stopping them on your own, even when you feel well, can raise the risk of a heart attack or stroke.
Procedures
When an artery is severely narrowed or symptoms persist despite medicines, a specialist may suggest angioplasty, in which a balloon opens the artery and a stent is usually placed to keep it open, or bypass surgery, in which a blood vessel from elsewhere is used to route blood around the blockage. Narrowed neck arteries are sometimes cleared surgically. Whether you need a procedure, and which one, depends on the pattern of narrowing, your symptoms and your overall health; ask your doctor to explain the reasons and the alternatives.
Prevention and living with it
- Get your blood pressure, blood sugar and cholesterol checked regularly from your thirties, earlier if heart disease runs in your family
- Take prescribed medicines every day and keep follow-up appointments
- Quit tobacco completely; ask your doctor about support to stop
- Aim for regular physical activity that you can keep up, such as daily walking
- If you have had a heart attack or stent, ask about cardiac rehabilitation
- Know the warning signs of heart attack and stroke, and make sure your family does too
When it is an emergency
Call 112 or 108, or go to the nearest emergency department immediately, if you or someone else has:
- Chest pain, pressure or tightness lasting more than a few minutes, especially with sweating, breathlessness, nausea or pain in the arm, jaw or back
- Sudden weakness or numbness of the face, arm or leg, especially on one side
- Sudden difficulty speaking or understanding, loss of vision or severe dizziness
- A cold, pale, painful leg or foot that has come on suddenly
With heart attack and stroke, every minute counts, because treatment to open the blocked artery works best when given early. Do not drive yourself to hospital.
Which doctor to see
Screening for the risk factors behind atherosclerosis, and treating them, is often done by a general physician or an internal medicine specialist. A cardiologist is the right doctor if you have chest pain or breathlessness on exertion, an abnormal ECG or stress test, or have had a heart attack. Leg artery disease may be managed together with a vascular surgeon, and stroke symptoms with a neurologist.
You can find cardiologists in Bengaluru or general physicians in Bengaluru on The Doctor Index, each with a registration you can check.
Questions to ask at your appointment
- Which of my arteries are affected, and how badly?
- What are my main risk factors, and what targets should I aim for?
- Which medicines do I need to take long term, and why?
- Do I need a stress test, angiography or any procedure?
- What symptoms mean I should go to hospital straight away?
Common questions
Questions people ask
- Can atherosclerosis be reversed?
- Plaque that has built up over years does not simply disappear. However, quitting tobacco, controlling cholesterol, blood pressure and sugar, and taking prescribed medicines can slow its growth, stabilise existing plaque and greatly lower the chance of a heart attack or stroke.
- Is atherosclerosis the same as arteriosclerosis?
- Not exactly. Arteriosclerosis is a general term for thickening and stiffening of artery walls. Atherosclerosis is the commonest type, caused specifically by fatty plaque building up inside the wall. In everyday use, many people use the two words interchangeably.
- I am thin and active. Can I still have blocked arteries?
- Yes. Being slim and active lowers risk, but family history, diabetes, high cholesterol, high blood pressure and tobacco use can still lead to plaque. This is why regular checks of sugar, blood pressure and cholesterol are worthwhile for everyone, not only for people who are overweight.
- If I have a stent, can I stop my medicines?
- No. A stent opens one narrowed section, but the underlying disease remains in your arteries. Blood thinners are especially important after a stent to stop clots forming on it. Never stop or change these medicines without talking to your cardiologist first.
This condition is usually assessed by a cardiologist. Every profile shows the doctor’s registration and what has been checked.
Cardiologists in Bangalore
A few cardiologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Atherosclerosis; ask the clinic whether the doctor sees it.
Related conditions
- Angina
- Arrhythmia
- Atrial Fibrillation
- Cardiomyopathy
- Congenital Heart Defects
- Coronary Artery Disease
- Heart Attack
- Heart Failure
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Atherosclerosis
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Atherosclerosis — Public-domain health-topic summary
Atherosclerosis: symptoms, causes, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-0238.