Atherosclerosis is very common. It can start in childhood and risk increases with age, such that people over the age of 40, even with good general health, have a 50 per cent risk of developing severe atherosclerosis. Most people over the age of 60 will have some degree of atherosclerosis, although symptoms may not be noticeable until the condition is at an advanced stage.³

The first visible sign of atherosclerosis is as a yellowish, fatty streak or patch in the endothelium layer of cells lining arteries. Endothelial damage triggers plaque development, and the build-up of fat, cholesterol, calcium and other substances hardens the plaque and narrows the artery, restricting blood flow.

Many risk factors are associated with atherosclerosis including genetics (familial hypercholesterolaemia), ageing, an unhealthy diet (and not just saturated fats), excess body weight, smoking, excessive alcohol consumption, and lack of exercise. People of Black African, Caribbean African, or South Asian ethnicity in the UK are at higher risk of developing hypertension and type 2 diabetes, predisposing them to CHD.^7,8,9

Sustained levels of excess blood sugar (hyperglycaemia), for example in diabetes, can trigger auto-immune effects which promote atherosclerosis. Recent animal studies indicate that immune cell proteins undergo glycation and glycoxidation type reactions with blood sugars, permanently changing their immune functionality. One result is that T-cells target apolipoprotein B (APOB), a low-density lipoprotein (LDL), in arterial epithelial cells with the resulting inflammation leading to plaque formation.^10,11