A heart attack or stroke may seem like a sudden, out-of-the-blue event, but it’s actually the final, dramatic chapter in a story that has been quietly unfolding inside your arteries for decades. This story is the timeline of atherosclerosis, a process driven by high cholesterol, and understanding it highlights the critical need for early intervention.
The 20s and 30s: The Silent Beginning. The process often starts in young adulthood. Excess LDL cholesterol begins to seep into the artery walls, creating fatty streaks. These are the earliest form of plaque and cause no symptoms. At this stage, the damage is microscopic and largely reversible with aggressive lifestyle changes.
The 40s and 50s: Plaque Progression. Over the next couple of decades, these fatty streaks grow into more complex plaques. They accumulate more cholesterol, cells, and fibrous material, forming hard bumps that begin to protrude into the artery. The artery starts to narrow, but the body can often compensate, so symptoms are still unlikely unless the blockage becomes severe.
The 50s, 60s, and Beyond: The Risk of Rupture. As plaques mature, some become unstable, with a thin cap covering a soft, inflammatory core. This is the most dangerous stage. An event—like a surge in blood pressure or inflammation—can cause this cap to rupture. The body’s clotting response kicks in, forming a thrombus that can completely block the artery within minutes.
This final event is the heart attack or stroke. It’s the culmination of a lifelong process. This timeline powerfully illustrates why you can’t wait for symptoms. The time to intervene is in the early decades, by managing cholesterol and slowing down the progression of plaque before it reaches the critical, unstable stage.