Does the risk of atherosclerosis increase as we age?

Yes. Atherosclerosis is considered a disease of aging. The likelihood and severity of plaque buildup in the arteries increase with age, even when other risk factors such as smoking, high cholesterol, or hypertension are controlled.

Research shows that by age 40, about half of adults have some form of atherosclerosis. By age 90, nearly everyone shows signs of it.
(Citation: Wang JC, Bennett MR. Circ Res. 2012;111(2):245–259.)

Atherosclerosis Progression

Adapted from Sports Plus Physio / Wikimedia Commons – educational reuse permitted.

Why does aging itself promote plaque buildup?

Aging affects the body’s cells, tissues, and immune system in several ways that make arteries more vulnerable to plaque formation.

1. Vascular aging – Over time, arteries lose elasticity and develop microscopic damage, making them more prone to lipid accumulation and inflammation.
2. Cellular senescence – Older cells stop dividing and repairing damage effectively. These senescent cells release inflammatory chemicals that worsen plaque growth.
3. Inflammation – Chronic, low-level inflammation (“inflammaging”) contributes to arterial thickening and calcification.

(Citations: Frismantiene A et al. Int J Mol Sci. 2023;24(24):17129; Zhang X et al. Ageing Res Rev. 2023;90:102041.)

Cellular Senescence Process

Adapted from Richardson et al., Cells (MDPI, open access).

How common is atherosclerosis in older adults?

Prevalence increases sharply with age:

• 58% of adults aged 40–49
• 87% of adults aged 60–69
• Nearly 100% of adults over 90

These figures come from autopsy and imaging studies across decades of research.
(Citation: Roberts WC, Ferrans VJ. J Chronic Dis. 1961;14(6):614–631.)

Does plaque calcification increase with age?

Yes. Calcification, which makes plaques hard and brittle, accelerates with aging. The Agatston coronary artery calcium (CAC) score is one measure used to track this.

CT Example: CAC Scoring Visualization

Adapted from Thomas D et al., via ResearchGate (educational use).

Older adults often show significantly higher CAC scores, reflecting both the duration and intensity of plaque development.
(Citation: Bild DE et al. Circulation. 2005;111(10):1313–1320.)

Coronary CT Example of Calcified Plaques

Adapted from Cleveland Clinic Journal of Medicine (used for academic illustration).

What role does the immune system play as we age?

As we age, our immune system changes—a phenomenon called immunosenescence. It becomes less efficient at resolving inflammation, allowing plaque to persist and grow. Persistent, low-level inflammation (“inflammaging”) contributes to the worsening of atherosclerosis over time.
(Citation: Aiello A et al. Ageing Res Rev. 2024;99:102112.)

What are the cardiovascular consequences?

Age-related plaque progression increases the risk of:

• Heart attack (myocardial infarction)
• Stroke
• Peripheral artery disease

These risks rise because plaques not only enlarge but can rupture, triggering clot formation.
(Citations: Wang JC, Bennett MR. Circ Res. 2012;111(2):245–259; Mortensen MB et al. Interv Cardiol Rev. 2024;19:e04.)

Plaque Rupture Illustration

Adapted from research illustration, educational reuse allowed (ResearchGate).

Can measuring plaque help personalize prevention?

Yes. Coronary artery calcium (CAC) scoring using CT imaging helps determine risk levels and guide preventive therapy. Higher CAC scores strongly predict cardiovascular events.
(Citation: Arnett DK et al. J Am Coll Cardiol. 2019;74(10):e177–e232.)

What can older adults do to counteract arterial aging?

• Maintain healthy cholesterol and blood pressure levels.
• Avoid smoking and manage blood sugar.
• Exercise regularly to improve vascular elasticity.
• Eat a balanced, Whole Food plant-based diet
• Get adequate sleep and manage stress.

Older Adults Exercising

Adapted from Wikimedia Commons (“Old people walking in winter, Croatia”).

Even modest lifestyle changes can slow plaque progression and lower the risk of heart disease at any age.

Are there emerging anti-aging treatments for atherosclerosis?

Scientists are exploring senotherapeutics—drugs that remove or modify senescent cells—to reduce inflammation and plaque formation. These are experimental but could, in the future, become part of cardiovascular disease prevention.
(Citation: Farr JN et al. Trends Cardiovasc Med. 2024;34(10):e123–e135.)

Takeaway

Aging itself drives the development of atherosclerosis by altering cellular and immune processes. While we can’t stop aging, understanding its effects helps us take proactive steps—through lifestyle, screening, and possibly future therapies—to maintain cardiovascular health.

Image Credits (Generic, Public Sources)

• Atherosclerosis diagram: Adapted from Sports Plus Physio / Wikimedia Commons.
• Cellular senescence schematic: Adapted from Richardson et al., Cells (MDPI, open access).
• CAC scoring figure: Adapted from Thomas D et al., ResearchGate (educational use).
• Coronary CT calcium example: Adapted from Cleveland Clinic Journal of Medicine.
• Plaque rupture diagram: Adapted from ResearchGate (open educational content).

References

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