Aortic atherosclerosis is plaque buildup in your aorta, the largest artery in your body

Aortic atherosclerosis occurs when fatty deposits (plaque) accumulate on the inner walls of your aorta. Your aorta carries blood from your heart to the rest of your body, so when plaque narrows it, blood flow slows down. This can happen in different sections of the aorta—in the chest (thoracic aorta), the belly (abdominal aorta), or both. Unlike atherosclerosis in smaller arteries, aortic plaque often causes no symptoms until it becomes severe.

The plaque forms over years or decades, usually starting with small fatty streaks that gradually thicken. As it builds up, the aorta's walls can weaken or become stiff. In some cases, the weakened wall bulges outward, creating an aneurysm. In other cases, a blood clot can form on the plaque surface and block blood flow suddenly.

Key Takeaways

  • Aortic atherosclerosis develops slowly as plaque narrows your aorta, and many people have no symptoms until the condition is advanced.
  • Risk factors include high blood pressure, high cholesterol, smoking, diabetes, and age over 60, though younger people can develop it too.
  • Doctors find aortic atherosclerosis through imaging tests like ultrasound, CT scan, or MRI, often during screening for other reasons.
  • Treatment focuses on slowing plaque growth through medication and lifestyle changes, and monitoring for aneurysm or blood clots.
  • Regular follow-up imaging is common to track whether the plaque is stable or worsening over time.

How plaque narrows your aorta and why it matters

Plaque is made of cholesterol, fat, calcium, and other substances. When it builds up on the aorta's inner lining, it hardens and thickens over time. As the plaque layer grows, the open space inside the aorta (called the lumen) shrinks. This narrowing means less blood can flow through, which reduces oxygen delivery to your organs and tissues.

The aorta is so large that significant narrowing usually takes years to develop. Many people have mild to moderate aortic atherosclerosis without noticing anything wrong. However, severe narrowing can cause leg pain when walking, reduced blood pressure in the legs, or problems with kidney function if the plaque is in the abdominal aorta. The real danger often comes not from the narrowing itself, but from complications like aneurysm (a bulging, weakened section) or a sudden blood clot that blocks flow entirely.

Who is at higher risk for aortic atherosclerosis

The same risk factors that cause atherosclerosis in other arteries increase your risk for aortic atherosclerosis. These include high blood pressure, high LDL cholesterol (the "bad" cholesterol), smoking, diabetes, obesity, and a family history of heart disease or stroke. Age matters too—the condition becomes more common after age 60, though it can develop earlier in people with multiple risk factors.

Men are diagnosed more often than women, particularly before age 75. However, women's risk rises sharply after menopause. People with chronic kidney disease, inflammatory conditions like rheumatoid arthritis, or a history of syphilis also face higher risk. Even if you have no symptoms, your doctor may screen for aortic atherosclerosis if you have several risk factors or a family member who had an aortic aneurysm.

How doctors detect aortic atherosclerosis

Aortic atherosclerosis is usually found by accident during imaging tests ordered for other reasons—a chest X-ray, CT scan, or ultrasound done for an unrelated problem. Doctors may see calcium deposits in the aorta on these images, which signals plaque buildup. If your doctor suspects aortic atherosclerosis based on symptoms or risk factors, they will order specific imaging to look at the aorta more closely.

The main imaging tests are an abdominal ultrasound (quick and uses no radiation), a CT angiogram (detailed images with contrast dye injected into your bloodstream), or an MRI (detailed images using magnetic fields, no radiation). Your doctor may also order blood tests to check cholesterol and kidney function, since kidney problems can both cause and result from aortic atherosclerosis. An ankle-brachial index test (comparing blood pressure in your arms and legs) can show whether narrowing is affecting blood flow to your legs.

What happens after diagnosis

Once aortic atherosclerosis is found, your doctor will determine how severe it is and whether you have complications like an aneurysm. If the plaque is mild and stable, treatment focuses on slowing its growth and preventing a blood clot. You will likely start or adjust medications: statins to lower cholesterol, blood pressure medications, and sometimes aspirin or other blood thinners to reduce clot risk.

Lifestyle changes are equally important. These include quitting smoking (if applicable), eating a heart-healthy diet low in saturated fat, exercising regularly as your doctor recommends, managing blood pressure and blood sugar, and maintaining a healthy weight. Your doctor will schedule follow-up imaging—usually every 6 to 12 months—to check whether the plaque is stable or growing. If an aneurysm is present or the plaque is severe, your doctor may refer you to a vascular surgeon to discuss whether intervention is needed.

When surgery or intervention becomes necessary

Most people with aortic atherosclerosis never need surgery. However, intervention may be recommended if an aneurysm grows large enough to rupture, if plaque severely narrows the aorta and causes symptoms, or if a blood clot suddenly blocks blood flow. A ruptured aneurysm is a medical emergency requiring immediate surgery.

Surgical options include open repair (traditional surgery to replace the damaged section of aorta) or endovascular repair (a less invasive procedure where a stent graft is placed inside the aorta through a catheter). Your surgeon will discuss which approach is safest based on your age, overall health, and the location and size of the problem. Recovery from open surgery takes several weeks; endovascular repair has a shorter recovery but requires careful monitoring afterward.

Living with aortic atherosclerosis long-term

Most people with aortic atherosclerosis live normal lifespans with regular monitoring and medication. The key is catching it early, managing your risk factors, and staying consistent with follow-up appointments and imaging. Your doctor will tell you what symptoms to watch for—sudden severe chest or back pain, leg pain at rest, or signs of a stroke—and when to seek emergency care.

Staying on your medications matters, even if you feel fine. Statins and blood pressure medications work silently to slow plaque growth and reduce your risk of a blood clot or aneurysm rupture. Regular exercise, a healthy diet, and not smoking give your medications the best chance to work. If you travel or see a new doctor, bring your imaging results and a list of your medications so they understand your condition and can monitor you appropriately.

Frequently Asked Questions

Can aortic atherosclerosis go away on its own?

No. Once plaque forms in your aorta, it does not disappear. However, medications and lifestyle changes can slow its growth and prevent it from worsening. Some people's plaque remains stable for years or decades with proper treatment.

Is aortic atherosclerosis the same as an aortic aneurysm?

No, but they are related. Atherosclerosis is plaque buildup that narrows the aorta. An aneurysm is a bulging, weakened section of the aorta wall that can rupture. Aortic atherosclerosis increases your risk of developing an aneurysm, but not everyone with atherosclerosis develops one.

What should I do if I have chest or back pain?

Seek emergency care immediately by calling 911 or going to an emergency room. Sudden severe chest or back pain can signal a ruptured aneurysm or a blood clot, both of which are life-threatening. Do not wait to see your regular doctor.

How often do I need imaging after diagnosis?

This depends on how severe your atherosclerosis is and whether you have an aneurysm. Your doctor will typically recommend follow-up ultrasound or CT every 6 to 12 months. If your condition is stable and unchanged over several years, the interval may lengthen.

Can I exercise if I have aortic atherosclerosis?

Yes. Regular moderate exercise like walking, swimming, or cycling is beneficial and helps slow plaque growth. However, ask your doctor what type and intensity of exercise is safe for you, especially if you have severe narrowing or an aneurysm.