Atherosclerosis is a disease that develops when fat, cholesterol, calcium, and other substances found in the blood build up in your arteries, creating plaque. Also called "hardening of the arteries," it is a very common condition — and you may not know you have it.
Atherosclerosis reduces the flow of blood in the body and increases the risk of blood clots forming. Although it's often related to heart disease, hardening of the arteries can affect the arteries anywhere in the body. Diseases linked to atherosclerosis, such as heart attack, stroke, aneurism, and general ischemia (lack of blood supply to the body), are the leading cause of death in the world.
Fortunately, there are tests that can you help find out if you are developing this condition before it becomes a serious health concern. Knowing the signs and symptoms of atherosclerosis — and the tests available for detecting it — can help you take steps to prevent ongoing heart and vascular conditions.
Who Is at Risk for Atherosclerosis?
Hardening of the arteries doesn't just happen to the elderly. "We think of atherosclerosis as an old person's disease, but we see it in babies," says Donald Lloyd-Jones, MD, director of the Framingham Center for Population and Prevention Science at Boston University and past president of the American Heart Association.
A 2026 Heart Association study showed that almost 80% of all young adults already showed signs of cardiovascular disease, including hardening of the arteries. These findings are just the latest evidence of this often overlooked health concern.
About half of Americans ages 45-84 have atherosclerosis. Although you might be born with a higher risk of getting plaque, contributing factors such as eating fatty foods, lack of exercise, smoking, diabetes, high blood pressure, and obesity can increase your risk of getting atherosclerosis.
What Are the Signs That You Might Have Atherosclerosis?
"Atherosclerosis is often a silent condition," says Ambar Kulshreshtha, MD, MPH, PhD, a volunteer member of the Heart Association's Council on Quality of Care and Outcomes Research and a primary care doctor in Atlanta. "When symptoms do occur, they can include chest pain, which may indicate angina or heart attack, or neurological symptoms such as numbness or weakness."
Symptoms depend on which arteries are blocked and on the limitations of blood flow. For example, in the heart, the symptoms may include chest pain, a racing heartbeat, or shortness of breath. If the atherosclerosis is in the carotid arteries, which supply blood and oxygen to your brain, you may have a whooshing sound, called "bruit," that your doctor can hear through a stethoscope. This type of blockage may also cause a mini-stroke (called a transient ischemic attack, or TIA).
When arteries in the legs are affected, you could have pain, aching, heaviness, or cramping in your legs. If plaque builds up in the arteries in the neck, this might affect your ability to process thoughts or cause memory issues or weakness on one side of the body, or face or vision problems. If you have hardening of the mesenteric artery, which delivers oxygen-rich blood to your small and large intestines, symptoms might include severe pain after meals, weight loss, or diarrhea.
In his primary care practice, Kulshreshtha often identifies patients who are at risk for atherosclerosis through a cardiovascular risk assessment, which includes measuring blood pressure and lipids (fat) in the blood, screening for diabetes, assessing smoking history, and other cardiovascular risk factors (such as family history.) However, about 20% of cardiovascular events happen without any known risk factors.
Why Does Early Detection Matter?
"Early detection of atherosclerosis is challenging because the disease is often silent until blood flow becomes significantly impaired, such as when plaque has built up to significantly narrow an artery or becomes ruptured," Kulshreshtha says. Relying on symptoms alone may miss the disease in its early stages."
Lloyd-Jones agrees. "Family history is incredibly important," he says. "If your family includes a history of heart attack or stroke before 50, or a history of high cholesterol or onset of high blood pressure, you should talk to your doctor. High cholesterol and high blood pressure can be addressed with lifestyle changes and medication."
How Do I Know if I Have Atherosclerosis?
Screening is essential to find out if you're developing atherosclerosis. The following are the most common diagnostic tests your doctor may perform.
Risk Factor Assessment
Your doctor may use a cardiovascular risk calculator such as the ASCVD risk calculator and the PREVENT equations to estimate your future risk of heart attack or stroke and guide preventive actions. These calculators gather information about your age and other conditions such as blood pressure and cholesterol to create an overall risk and guide strategies for any changes in lifestyle or medications.
When should I have this test? Screening for risk factors such as high blood pressure can start early, including in children, so if you're a high-risk patient (like those with a family history), you can be identified sooner and routinely tested throughout your life.
Bloodwork
For many people, basic blood tests can provide the essential information your doctor needs to begin figuring out whether you're at risk for atherosclerosis. These tests can show if you have Lipoprotein(a), or Lp(a), a cholesterol-carrying lipoprotein in your blood. Lp(a) is mostly inherited, and when it is high, it can increase your risk of heart disease and stroke.
A high Lp(a) level (125 nmol/L or higher) can raise your risk for a heart attack or stroke. “If you have high Lp(a), it’s increasing your risk and we need to factor it in with your other risk factors,” Lloyd-Jones says. “There are no therapies specifically for Lp(a) yet, but there are things you can do to knock down your other risks, such as monitoring your weight.”
Another blood test for hsCRP, or high-sensitivity C-reactive protein, may reveal unseen risks that could lead to increased atherosclerosis. This is a signal of inflammation that is linked to an increased risk of heart attack or stroke.
When should I have this test? Lloyd-Jones recommends having a full lipid panel, as well as blood pressure and blood sugar measurements, by age 21.
Ankle Brachial Index (ABI) test
An ABI is a simple test to find out how well blood is flowing through your legs. The doctor compares the blood pressure in your leg to the blood pressure in your arm to see whether the arteries in your legs are functioning normally.
When should I have this test? If you're younger than age 50, with diabetes and one additional risk factor, such as smoking or high blood pressure, or over the age of 70
For most people, there are no risks associated with having an ABI test, but this test is not recommended if you have a blood clot in your leg, or if you have severe pain in your legs.
Coronary Artery Calcium (CAC) scan
Beyond the risk factor assessments, the most-used test to detect atherosclerosis is a coronary artery calcium (CAC) scan. "We don't use it in all patients, but in those with intermediate risk on our calculators or a strong family history," Kulshreshtha says. "Other tests, such as CT angiography, are not used for screening, but are used when patients have symptoms such as chest pain."
The CAC scan is recommended for certain patients who have maturing plaque. Calcium is created in response to the plaque and is deposited based on the amount of plaque in the arteries. If your CAC score is zero, your risk is low. If it's over 100, that suggests you could have plaque that may cause trouble.
When should I have this test? "I typically don't recommend CAC before age 40," Lloyd-Jones says. "But if you have a family history or other risk factors, testing at age 35 is reasonable. It's most useful for people with intermediate risk to help determine if statins could help them."
CT Angiogram
Early detection using tests such as calcium scoring and ankle brachial index (ABI) can be readily done by your primary care doctor. If you're having symptoms of atherosclerosis, your primary care doctor can also order advanced testing, with a cardiologist (a heart specialist) consultation if needed.
You can take that one step further, and not just look for calcium. You can do a CT angiogram, which injects dye into the arteries to find out what's going on inside them.
When should I have this test? This test is more expensive, invasive, and involves radiation. "We don't tend to do that very often," Lloyd-Jones says. "Insurance won't pay for it unless you already have heart disease."
Ultrasound
Ultrasound is another way to look at the arteries in the neck. It's a sensitive way to look at the thickening of the wall in the arteries. This test requires a technician and savvy reader.
When should I have this test? "We use this in studies," Lloyd-Jones. says. "It gets offered in screenings, but it's not as reliable. I don't use it as often in asymptomatic people."
Coronary Computed Tomography Angiography
Coronary computed tomography angiography (CCTA) is a specialized heart imaging test that uses a CT scan combined with an iodine-containing dye (contrast material) injected into a vein to produce clear, 3D images of the blood vessels supplying blood to your heart.
CCTA can help your doctor see if plaque is narrowing or blocking your coronary arteries. It can also show how severely plaque has built up inside the arteries or identify non-coronary issues that may be causing symptoms, such as a blood clot in the lungs, a collapsed lung, or abnormalities in the aorta.
When should I have this test? This test is best for people who are having chest pain or unusual symptoms who have a low to moderate risk of coronary artery disease, including those evaluated in emergency rooms. It also may be recommended for people with unclear results from previous diagnostic tests or if you've developed new symptoms after having a normal stress test in the past.
But there may be risks if you have kidney problems or allergic reactions to the contrast dye. And a CCTA does include exposure to X-ray radiation.
What Else Is Being Done to Detect Atherosclerosis?
Because atherosclerosis affects so many people, research is ongoing to learn more. At the Nora Eccles Harrison Cardiovascular Research and Training Institute at the University of Utah, Christopher Audu, MD, PhD, heads up a team that hopes to address atherosclerosis at the molecular and cellular levels. As an adult and pediatric vascular surgeon-scientist and principal investigator at the Audu Lab, he is focused on exploring the microscopic causes of vascular disease, starting with the enzymes that can affect diseases like cancer or metabolic disorders.
"Our molecular understanding of atherosclerosis is limited, and we have very few medicinal chemistry efforts toward reversing the disease," he says. "There is one more thing that makes early detection difficult: Detection involves tests on otherwise healthy people, which means that said tests have to have an indication to be done, and subsequently someone has to pay for the test and its interpretation. If a test is developed that screens for a disease process that may not lead to clinical symptoms for decades, that is a difficult proposition for patients, for payers, and for test interpreters."
One of the missions of Audu and his team of researchers is to find the enzymes responsible for creating atherosclerosis and come up with more targeted treatments in the future. "This research is still in its infancy," Audu says. But there are a number of studies being performed that combine different biological data layers, such as genes, proteins, and molecules, to give a complete picture of health and disease.
Eight Steps Toward Health
While researchers explore new ways to understand and treat atherosclerosis, there are steps you can take to improve your health and advocate for early detection of this silent condition, regardless of your age or family history.
"Patients should discuss their family history of heart disease or stroke with their physicians and make cardiovascular risk assessment a routine part of their health care, including during annual physical examinations," Kulshreshtha says. "Remember that the absence of symptoms does not mean the absence of risk. Similarly, symptoms such as chest pain or leg pain should never be dismissed as simply a normal part of aging, as they may be warning signs of underlying cardiovascular disease."
Lloyd-Jones adds that these everyday health measures help people understand how lifestyle choices influence heart, kidney, and metabolic health over time and provide practical steps to improve overall health. He recommends embracing the American Heart Association's "Life's Essential 8" approach to cardio health.
The health behaviors and health factors in Life's Essential 8 are:
- Manage your weight
- Be more active
- Eat better
- Get enough sleep
- Quit tobacco
- Control your cholesterol levels
- Keep track of your blood sugar
- Manage your blood pressure
Although all eight areas are important to improve overall heart and vascular health, Lloyd-Jones encourages his patients to start with one healthy practice. "Pick one that you'd like to improve," he says. "You can make a difference in your own lives. Focusing on your health today will pay dividends in the long run."
