Diagnosing Atherosclerosis

Medically Reviewed by James Beckerman, MD, FACC on March 05, 2021

Atherosclerosis is sneaky. It starts early in life and progresses silently. By the time symptoms occur, it’s advanced and a serious problem.

There are tests for diagnosing atherosclerosis, but none of them are perfect. Some of them even have risk of harm. So testing isn't as simple as you might think.

If you're concerned about atherosclerosis, what should you do? What can you expect at the doctor's office if you ask about it?

Atherosclerosis Warning Signs and Symptoms

There are three serious diseases caused by atherosclerosis. Each has its own warning signs:

  • Coronary artery disease: The warning sign for atherosclerosis in the heart is chest pain when you’re active, or angina. It's often described as tightness and usually goes away with rest. Other symptoms may include shortness of breath or fatigue.
  • Cerebrovascular disease: Often, a transient ischemic attack (TIA) may happen before a stroke. Difficulty speaking and weakness on one side are symptoms of strokes and TIAs. The difference: In a TIA, the symptoms go away, usually within an hour, and do not leave permanent brain injury.
  • Peripheral arterial disease: You’ll have poor circulation in your legs first. Pain in the calf muscles when you walk (your doctor may call it claudication) is the most common symptom. Poor wound healing or fewer pulses in your feet are other signs.

It’s important to know that by the time symptoms like these show up, you may already have serious blockages.

Also, heart attacks and strokes can occur without any warning signs.

Tests to Diagnose Atherosclerosis

Diseases caused by atherosclerosis are the most common cause of death in the U.S. The one test that can directly show blocked arteries is called angiography. It’s an invasive test:

  • A thin tube is put inside an artery in the leg or arm.
  • It’s then threaded through the body's maze of branching arteries.
  • Injected dye shows arteries -- and any blockages -- on a monitor.

Angiography does have risk. Serious complications don’t occur often, but it's too high a risk for people who probably don’t have blockages.

Instead, a system was developed to separate people into risk groups. They can then be tested appropriately, according to risk level. Low-risk people get low-risk testing. Angiography is usually for people who already have a strong chance of atherosclerosis.

Tests to Evaluate Your Risk

Your blood pressure, cholesterol levels, age, family history, and medical history will help your doctor determine how likely you are to have it.

Once your doctor has identified your risk group, more tests may be needed, such as:

Stress test: With medicines or walking on an exercise treadmill, your heart is made to pump almost as hard as it can. That allows your doctor to see what symptoms you may have. If needed, images of the heart or EKGs can show any blockages.

Electron beam computed tomography (EBCT): A special CT scanner (CAT scan) snaps pictures of the heart. A computer figures out the amount of calcium in your heart's arteries. More calcium can mean more atherosclerosis.

Carotid artery ultrasound: The carotid arteries in the neck can be viewed with a risk-free ultrasound test. Atherosclerosis here increases your chance for heart attacks and strokes.

Angiography: This test can show a picture of blockages caused by atherosclerosis. It can be done on arteries in your heart, brain, or legs. Because it has some risk, angiography is usually done only on people with symptoms from their atherosclerosis. Typically, this means people with symptoms of blockages, such as chest pain.

Even low-risk testing might not be a good idea. The risk isn't the test itself -- it's what it might lead to.

Consider this: If you're already low-risk, a positive result on a stress test is probably a false positive, not real atherosclerosis. (Remember, the test isn't perfect.) You and your doctor may feel the need to get more tests -- maybe even angiography -- exposing you to needless anxiety and risk of complications.

Lowering Your Atherosclerosis Risk

It doesn't make sense to wait for symptoms before doing something. The good news is that over 80% of this risk may be avoidable:

Do what you can now to reduce your risk for this common and deadly disease.

Show Sources


Lorenz, M., Circulation, 2007.

Yusuf, S., Lancet, 2004.

Richard Stein, MD, national spokesman, American Heart Association; professor of medicine and director of urban community cardiology program, New York University School of Medicine, New York.

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