What Causes Plaque in the Arteries?

Plaque consists of fatty deposits that accumulate on the walls of your arteries. With plaque buildup, the artery walls harden and their passageway narrows, limiting blood flow to other organs and body parts that need oxygen and nutrient-rich blood to function. This results in a condition known as atherosclerosis and can lead to a number of other serious cardiovascular conditions. 

Causes of Plaque

Plaque consists of cholesterol, fat, calcium, fibrin, and cellular waste products. Its formation involves a complex process in which waxy cholesterol adheres to the arterial walls, causing them to thicken, harden, and narrow. This eventually leads to atherosclerosis. 

Cholesterol is found in every cell in the body. It plays an important part in the production of vitamin D, hormones, and substances that aid in food digestion. There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

HDL, also known as the “good” cholesterol, takes cholesterol from other parts of the body back to the liver, which then eliminates it from the body. LDL, or the “bad” cholesterol, is responsible for creating the buildup of plaque in the arteries. 

When plaque builds up in the arteries, the body responds by sending white blood cells that attempt to digest LDL, which then turns into toxins. More and more white blood cells are attracted to the area where the change is occurring, leading to inflammation in the artery wall. This process causes muscle cells in the artery walls to rapidly increase in number, forming a cover over soft plaque. If this dangerous soft plaque breaks off, it can form a clot, impeding blood flow to organs and body parts.

Plaque formation due to cholesterol can be caused by various factors, including the following.

• Diet: Foods that are high in saturated fats and trans fats
• Weight: Being overweight can lead to increased triglyceride levels as well as heightened risk of heart disease
• Exercise: Daily physical activity can help lower cholesterol levels, but also lower triglycerides and raise HDL
• Age and sex: As people age, cholesterol levels are prone to increase. In postmenopausal women, LDL rises while HDL can decrease
• Heredity: Cholesterol issues may run in families. Genes determine how much cholesterol the body makes

To help lower cholesterol, experts recommend making several lifestyle changes.

• Quitting smoking: Apart from increasing the risk of other serious conditions like respiratory and heart diseases, tobacco reduces HDL
• Diet change: Reduce foods high in saturated fat like red meat, dairy, and sugar and eat more vegetables, fruit, poultry, fish, and whole grains
• Control both blood sugar and blood pressure: Watch blood sugar levels, especially with diabetes, and keep blood pressure within a healthy range

Risk Factors for Plaque

Plaque build-up in the arteries is inevitable, but many risk factors may lead to atherosclerosis. Several of these risk factors can be controlled and help delay or prevent atherosclerosis, while others can’t be controlled.

The following risk factors should be carefully monitored. 

• High cholesterol level
• Hypertension: A blood pressure of 130/80 mm Hg or higher over time is considered high if it remains at that level or goes above it
• Smoking: Blood vessels not only narrow as a result of smoking, but smoking also raises cholesterol levels and blood pressure
• Insulin resistance: When the body can't use its insulin properly, it builds up a resistance that may lead to diabetes
• Being overweight or obese
• Older age: Atherosclerosis risk increases with age, especially with unhealthy lifestyle choices. In men, the risk increases after age 45. In women, the risk increases after age 55
• Family history of early heart disease: Atherosclerosis risk increases if your father or brother was diagnosed with heart disease before 55 years or if your mother or sister was diagnosed with heart disease before 65 years

Reducing Plaque

To reduce atherosclerosis risk caused by plaque, experts recommend lifestyle changes that include eating a healthy diet without any processed foods or animal products. Primarily plant-based diets (fruit, vegetable, legumes, whole grains) have been shown to improve blood flow and reverse coronary artery disease to some degree.

An artery-friendly eating plan like the Mediterranean diet is rich in fruits and vegetables but also includes olive oil, nuts, fish, and limited portions of meat, dairy, and wine. Whichever eating plan you select, be sure to watch calorie consumption and maintain a healthy weight to lower your risk for heart disease, diabetes, and other conditions.  

In addition to diet, experts recommend that adults get at least 150 minutes (that's 2.5 hours) of moderate physical activity each week.

Even with the lifestyle changes noted above, plaque won’t entirely disappear. With treatment, healthcare providers are able to target smaller blockages of soft plaque by reducing the cholesterol that will shrivel the plaque. To remove the cholesterol within the plaque, prescribed statins target LDL cholesterol. These include atorvastatin (Lipitor) and rosuvastatin (Crestor), which work by hindering the liver enzyme responsible for cholesterol production. Ezetimibe (Zetia) may also be included in a patient’s protocol to impede cholesterol absorption in the digestive tract.

A Word From Verywell

In spite of the asymptomatic nature of plaque buildup in the arteries, it's important that you have your cholesterol levels regularly checked to lower your risk of heart disease. The American Heart Association advises all adults 20 and older check their blood cholesterol every four to six years as long as their risk remains low. By the time you've reached age 40, your healthcare provider may monitor your levels more closely based on your age, gender, family history, and other factors. They will determine which treatment is best for your case—whether lifestyle changes, medication, or some combination of both—depending on the results of your cholesterol measurements.