Atherosclerosis Treatments: Lifestyle, Medications, and More by Cardiovascular Group

Key Takeaways

Atherosclerosis develops when plaque accumulates, restricting blood flow.
Lifestyle and medication choices play a significant role in treatment and prevention.
Procedures and long-term care help manage advanced or high-risk cases

Understanding Atherosclerosis

Atherosclerosis is a disease in which arteries become narrowed and hardened due to the buildup of plaque. This process can reduce or block blood flow, leading to severe conditions such as a heart attack, stroke, or peripheral artery disease.

The disease develops slowly and often begins years before symptoms appear.

What Is Atherosclerosis

Atherosclerosis occurs when fatty deposits, called plaque, build up inside your arteries. These deposits are made of cholesterol, fats, calcium, and cellular waste.

Over time, plaque causes arteries to become stiff and lose their flexibility. Damage to the endothelial cells that line your arteries often starts the process.

High blood pressure, smoking, diabetes, and high LDL cholesterol increase this damage. Once the lining is injured, harmful particles, such as oxidized LDL, enter and trigger an immune response.

Your immune system sends white blood cells to clear the particles. Instead, they absorb the lipids and turn into foam cells.

These foam cells accumulate, creating fatty streaks that are the earliest visible sign of atherosclerosis. Atherosclerosis is a significant cause of cardiovascular disease, including coronary artery disease and stroke.

It can also affect arteries in the legs, kidneys, and other organs.

Plaque Formation and Growth

Plaque growth follows a stepwise process. Initially, fatty streaks appear, but as more foam cells and lipids accumulate, they form larger deposits.

Smooth muscle cells migrate into the artery wall and produce collagen, creating a fibrous cap over the plaque. The fibrous cap is important because it helps stabilize the plaque.

If the cap is thin or weakened by inflammation, it may rupture. A rupture exposes the inner plaque material to the bloodstream, causing a clot to form.

This clot can completely block blood flow.

Key factors in plaque growth include:

Endothelial damage from high blood pressure, smoking, or diabetes
Oxidative stress and reactive oxygen species (ROS) that damage cells
Chronic inflammation that weakens the fibrous cap

As plaque enlarges, it narrows the artery, restricting blood flow. This can cause angina, shortness of breath, or reduced blood flow to the legs.

Common Symptoms and Complications

You may not notice symptoms until the artery is severely narrowed or blocked. When symptoms appear, they depend on which arteries are affected.

Coronary arteries: chest pain (angina), shortness of breath, or heart attack
Carotid arteries: transient ischemic attack (TIA) or stroke
Peripheral arteries: leg pain while walking (claudication)
Renal arteries: chronic kidney disease or worsening kidney function

Complications can be life-threatening. A ruptured plaque may cause sudden clot formation, leading to a heart attack or stroke.

Aneurysms can form when the walls of an artery weaken. Arrhythmias may occur if blood flow to the heart is disrupted.

Because atherosclerosis progresses slowly, regular checkups and early detection are essential. Recognizing symptoms like chest pain, fatigue, or leg discomfort can help you seek care before serious complications develop.

Risk Factors and Assessment

Atherosclerosis develops from a combination of lifestyle habits, inherited traits, and health conditions that increase your risk of cardiovascular events. Understanding which risks you can change and which you cannot helps guide prevention, treatment, and long-term monitoring.

Major Modifiable Risk Factors

The most important risks you can control include high blood pressure, abnormal cholesterol, diabetes, obesity, and tobacco use. These factors directly affect the arteries and increase the likelihood of plaque buildup.

High blood pressure damages artery walls and makes them more prone to plaque formation. Maintaining a blood pressure reading of under 130/80 mmHg is often recommended for prevention.

Abnormal cholesterol levels, exceptionally high LDL (“bad” cholesterol) and low HDL (“good” cholesterol), play a central role. Elevated triglycerides also add risk, particularly when combined with obesity or insulin resistance.

Type 2 diabetes and high blood sugar accelerate atherosclerosis. Even prediabetes can raise your risk.

Monitoring glucose levels and maintaining a healthy weight are key steps. Lifestyle behaviors such as smoking, poor diet, and physical inactivity worsen these risks.

Quitting tobacco, eating more fruits and vegetables, and exercising at least 150 minutes per week improve cardiovascular health.

Non-Modifiable and Emerging Risks

Some risks, such as age, sex, and family history, cannot be changed. Men generally face an earlier onset, while women’s risk rises after menopause.

A family history of early heart disease increases your likelihood of developing atherosclerosis. Emerging factors also matter.

Metabolic syndrome, which combines high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol, sharply increases cardiovascular risk. Inflammation markers, such as C-reactive protein (CRP), are being studied as predictors of cardiovascular events.

High CRP levels may indicate a higher risk, even when cholesterol levels appear normal. Other contributors include chronic stress, poor sleep, and certain autoimmune conditions.

These are not always included in standard risk scores, but they can still affect long-term outcomes.

Cardiovascular Risk Scoring and Evaluation

You should undergo a structured cardiovascular risk assessment if you are between 40 and 75 years old or have multiple risk factors for cardiovascular disease. This often involves a 10-year risk score that estimates your chance of a heart attack or stroke.

Standard tools include the ASCVD Risk Estimator, which uses age, sex, race, cholesterol levels, blood pressure, diabetes status, and smoking history. In some cases, additional testing, such as coronary artery calcium (CAC) scoring, helps refine your risk, especially when decisions about statin therapy or aspirin use are unclear.

Risk assessment guides whether you need primary prevention (before your first cardiovascular event) or secondary prevention (after a heart attack, stroke, or diagnosis of vascular disease). Regular evaluation with your clinician ensures that changes in weight, blood pressure, or cholesterol are tracked and treatment is adjusted as needed.

Lifestyle Changes for Atherosclerosis

You can slow the progression of atherosclerosis and lower your risk of complications by focusing on daily habits that directly affect your arteries. Diet, exercise, body weight, and tobacco use each play a measurable role in how well your blood vessels function and how likely plaque buildup is to lead to serious events.

Heart-Healthy Diet Recommendations

Your diet has a significant impact on cholesterol, blood pressure, and inflammation. A heart-healthy eating plan emphasizes fruits, vegetables, whole grains, nuts, and legumes while limiting foods high in saturated fat, trans fat, sodium, and added sugar.

Replace butter and processed meats with healthier fats, such as olive oil or canola oil, or foods rich in alpha-linolenic acid, like walnuts and flaxseeds. These changes can help improve your lipid profile and reduce plaque buildup.

Practical tips include:

Choose whole grains over refined grains.
Aim for at least 5 servings of fruits and vegetables daily.
Limit processed snacks, sugary drinks, and fast foods.
Season meals with herbs, garlic, or lemon instead of salt.

Some evidence suggests foods like green tea and garlic may provide additional support for vascular health, though they should not replace proven dietary strategies.

Physical Activity and Exercise

Regular exercise improves circulation, lowers blood pressure, and helps prevent blood clots. You should aim for at least 150 minutes of moderate activity per week, such as brisk walking, cycling, or swimming.

Even short bouts of movement throughout the day add benefits. Taking the stairs, walking after meals, and stretching during long periods of sitting all support vascular health.

Strength training, performed 2–3 times per week, also helps by improving muscle mass and insulin sensitivity. Combining aerobic and resistance training produces the most significant impact on cardiovascular risk factors.

If you have existing heart disease, consult your doctor before starting a new exercise routine. A supervised cardiac rehab program may be recommended in some cases.

Weight Management Strategies

Excess body weight contributes to high cholesterol, high blood pressure, and type 2 diabetes—all of which worsen atherosclerosis. Maintaining a healthy weight reduces strain on your arteries and improves long-term outcomes.

A practical target is a BMI between 20 and 25, although your provider may adjust this based on your age and health status. Even a 5–10% weight loss can lead to meaningful improvements in blood pressure and lipid levels.

Strategies include:

Tracking daily calorie intake.
Combining balanced meals with regular exercise.
Limiting sugary drinks and processed foods.
Seeking support through structured weight programs if needed.

In some cases, medication or bariatric surgery may be considered when lifestyle changes alone are not enough, particularly in people with severe obesity or diabetes.

Smoking and Tobacco Cessation

Smoking and other forms of tobacco use directly damage your arteries, lower oxygen in the blood, and increase the risk of clots. Quitting is one of the most effective steps you can take to reduce cardiovascular risk.

Nicotine replacement therapy, prescription medications such as bupropion or varenicline, and behavioral counseling all improve quit rates. Combining medication with counseling works better than either approach alone.

The “Five A’s” approach can help:

Ask about tobacco use.
Advise quitting.
Assess readiness.
Assist with resources.
Arrange follow-up.

Avoiding secondhand smoke exposure is also essential, as it can harm blood vessels even in nonsmokers. Every attempt to quit matters, and support from healthcare providers, family, and community programs increases the chance of long-term success.

Medications and Pharmacotherapy

Medications for atherosclerosis target the underlying causes of plaque buildup, such as high cholesterol, high blood pressure, and abnormal blood clotting. They also help manage related conditions like diabetes, which can worsen arterial damage.

Cholesterol-Lowering Medications

Lowering cholesterol is one of the most critical steps in treating atherosclerosis. Statins are the first-line drugs because they reduce low-density lipoprotein (LDL) cholesterol and lower the risk of heart attack and stroke.

They work by blocking an enzyme in the liver that makes cholesterol. If statins are not enough, additional medications can be prescribed.

Ezetimibe reduces cholesterol absorption in the intestine. PCSK9 inhibitors, which are injectable antibodies, lower LDL levels more aggressively.

Fibrates primarily lower triglycerides and can increase HDL (good cholesterol), but they are less effective in reducing LDL. In some cases, fibrates are used together with statins, especially in people with mixed hyperlipidemia.

The choice of therapy depends on your cholesterol levels, other health conditions, and tolerance to side effects.

Blood Pressure and Blood Sugar Control

High blood pressure and high blood sugar both damage artery walls and speed up plaque buildup. Medications that lower these risks are crucial for slowing the progression of atherosclerosis.

For blood pressure, standard drug classes include:

ACE inhibitors and ARBs: relax blood vessels and protect kidney function.
Beta-blockers: reduce heart workload and blood pressure.
Calcium channel blockers: relax arterial walls and improve blood flow.
Diuretics: help the body remove excess salt and water.

If you have diabetes, controlling blood sugar is just as important as lowering cholesterol. Metformin is often the first choice, while other drugs, such as SGLT2 inhibitors and GLP-1 receptor agonists, not only lower glucose levels but may also reduce cardiovascular risk.

Antiplatelet and Anticoagulant Therapies

Blood clots can form on top of atherosclerotic plaques, blocking blood flow. To reduce this risk, your doctor may prescribe antiplatelet drugs such as aspirin or clopidogrel.

These medicines prevent platelets from clumping together and forming clots.

In some instances, especially if you have atrial fibrillation or a history of blood clots, anticoagulants may be used.

These include warfarin and newer direct oral anticoagulants (DOACs), such as apixaban or rivaroxaban.

Antiplatelets and anticoagulants are not interchangeable. Antiplatelets are typically used for long-term prevention of atherosclerosis, while anticoagulants are reserved for specific instances of increased clotting risk.

Because these medicines increase the risk of bleeding, your treatment plan must balance clot prevention with safety.

New and Emerging Drug Treatments

Standard therapies do not entirely prevent cardiovascular events, so new treatments are being developed. One example is antisense oligonucleotides, which block the production of specific proteins involved in lipid metabolism.

Cytokine-targeting drugs are also being studied to reduce inflammation inside artery walls, which plays a key role in plaque growth. PCSK9 inhibitors are already in use, but next-generation versions may offer longer-lasting effects.

Other approaches include anti-inflammatory antibodies, photodynamic therapy, and theranostics, which combine diagnosis and treatment into a single method.

These emerging therapies are primarily used in clinical trials or for patients who do not respond well to standard pharmacotherapy.

Interventional and Surgical Procedures

When blocked arteries restrict blood flow, lifestyle changes and medicines may not be enough. In these cases, doctors use procedures such as catheter-based techniques, stents, and bypass surgery to restore circulation and reduce the risk of heart attack or stroke.

Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention, often called angioplasty, uses a thin catheter inserted through a blood vessel in your wrist or groin. The catheter carries a small balloon that inflates inside the narrowed artery.

This widens the passage and improves blood flow to your heart. PCI is less invasive than open-heart surgery.

You usually recover faster and spend less time in the hospital. However, the artery can narrow again over time, which is why PCI is often paired with stent placement.

The procedure is most often used when you have chest pain (angina) or when tests show a high risk of a heart attack. It is also used in emergencies to open a blocked artery during a heart attack quickly.

Stents and Catheter-Based Treatments

A stent is a small mesh tube placed inside your artery after angioplasty. It helps keep the artery open and lowers the chance of it narrowing again.

Most stents today are drug-eluting, meaning they slowly release medication to prevent the buildup of scar tissue. Catheter-based treatments are performed through small punctures, rather than large incisions.

This makes recovery quicker and lowers the risk of complications compared to traditional surgery. You may need to take blood-thinning medicines after stent placement to prevent clots from forming inside the stent.

Skipping these medicines can raise your risk of a heart attack. Stents are widely used to treat coronary artery disease but can also be used to treat blockages in other arteries, such as those in the legs or neck.

Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting, or CABG, is a type of heart surgery. Instead of opening the blocked artery, the surgeon creates a new path for blood to flow around it.

This is done by using a healthy blood vessel from your chest, arm, or leg. CABG is usually recommended when you have multiple blocked arteries or when PCI is not likely to work well.

It is also preferred for people with diabetes and severe coronary artery disease. Recovery from CABG takes longer than PCI.

You may spend a week in the hospital and need several weeks at home before returning to regular activity.

Other Advanced Procedures

In some cases, doctors may use other techniques when PCI or CABG are not suitable. Atherectomy uses a catheter with a tiny blade or laser to remove plaque from the artery wall.

This can improve blood flow in areas where a stent may not fit well. Endarterectomy is a surgical option that removes plaque directly from inside the artery.

It is more common in the carotid arteries in the neck, which supply blood to the brain. Newer approaches, such as hybrid procedures, combine catheter-based treatments with surgery.

These methods are tailored to your specific condition and may reduce recovery time while still providing long-term benefits. Doctors choose these advanced procedures based on the location of the blockage, your overall health, and the severity of your disease.

Long-Term Management and Prevention

Managing atherosclerosis over the long term requires consistent attention to lifestyle, medical therapy, and clinical monitoring.

Secondary Prevention Strategies

Secondary prevention focuses on reducing the risk of another cardiovascular event after you have already been diagnosed with atherosclerosis or experienced a heart attack, stroke, or related condition.

You should follow a structured plan that often includes antiplatelet therapy (such as aspirin or clopidogrel) to lower the risk of clot formation. Statins are widely prescribed to reduce LDL cholesterol, which directly lowers cardiovascular risk.

In some cases, additional medications, such as ACE inhibitors or beta-blockers, are used to manage blood pressure and protect heart function. Lifestyle changes remain essential.

Quitting smoking, maintaining a healthy weight, and following a diet low in saturated fats and added sugars are proven to support long-term cardiovascular health. Regular physical activity, such as brisk walking or cycling for at least 150 minutes per week, contributes to better blood pressure and lipid control.

Monitoring and Follow-Up Care

Ongoing monitoring helps track your progress and ensures that treatments are working as intended. You should have regular follow-up visits with your healthcare provider to check blood pressure, cholesterol levels, blood glucose, and kidney function.

Routine tests may include:

Lipid profile to measure LDL, HDL, and triglycerides
Blood pressure checks to guide therapy adjustments
Electrocardiograms (ECGs) or imaging if symptoms change

Follow-up care also includes adjusting medications when needed. For example, if LDL cholesterol remains high despite statin therapy, your doctor may recommend adding ezetimibe or a PCSK9 inhibitor.

You play an active role in monitoring by tracking your weight, physical activity, and adherence to your medication. Consistent follow-up reduces the chance of missed warning signs and helps prevent complications.

Reducing Cardiovascular Events and Mortality

The main goal of long-term management is to lower the risk of future cardiovascular events such as heart attack, stroke, or sudden cardiac death. Evidence shows that combining medication with lifestyle modification provides the most significant reduction in cardiovascular mortality.

Key strategies include:

Blood pressure control: Keeping systolic pressure below recommended targets
Cholesterol management: Achieving LDL levels below guideline thresholds
Smoking cessation: Strongest single intervention to reduce event risk
Diabetes management: Controlling blood glucose to limit vascular damage

You can also reduce risk by limiting alcohol intake. Managing stress and ensuring adequate sleep are also essential.

Preventing recurrent events requires steady, long-term adherence. Short-term efforts are less effective.

Conclusion: Building a Long-Term Plan Against Atherosclerosis

Atherosclerosis develops silently over time, but with the right strategies, it can be managed effectively. Lifestyle changes such as eating a heart-healthy diet, staying physically active, quitting tobacco, and maintaining a healthy weight are powerful first steps in slowing plaque buildup. When these steps aren’t enough, medications that lower cholesterol, control blood pressure, and regulate blood sugar play a vital role. For advanced cases, interventional and surgical treatments—like stents or bypass surgery—help restore circulation and prevent life-threatening events. Long-term success requires consistent follow-ups, regular monitoring, and a commitment to both prevention and treatment. By staying proactive and partnering with cardiovascular specialists, you can take control of your health and protect your heart for years to come.

Take the first step toward better heart health—book an appointment with CVG Cares today to explore your treatment options.