I have read about artherosclerosis and I understand that it is a phenomenon caused by external lipidic cells coming into the body and creating a plaque that, when it breaks, will obstruct the artery.

The fact that it only affects "big arteries" is my understanding from wikipedia:

Most of the time, patients realize that they have the disease only when they experience other cardiovascular disorders such as stroke or heart attack

Actually I might be wrong because it also mentions:

These symptoms, however, still vary depending on which artery or organ is affected

My question is: Why do artherosclerosis affects only big arteries like aorta or cerebral arteries, and not the entire bloodstream grid of the body?

PS: I also read articles from INSERM but they do not mention where artherosclerosis happens.

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    $\begingroup$ Where did you read that it only affects large vessels? Can you please provide a quote and a link? $\endgroup$ May 20, 2023 at 12:18
  • $\begingroup$ @anongoodnurse Thanks for your comment, I might have misunderstood. I quoted some elements that led me to think that, and other elements I've just noted $\endgroup$ May 20, 2023 at 13:22
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    $\begingroup$ I don't understand what is making you think that from anything you quoted, nothing at all says "only large vessels". Strokes and heart attacks mostly involve fairly small vessels. $\endgroup$
    – Bryan Krause
    May 20, 2023 at 15:52
  • $\begingroup$ You are not reading enough to understand atherosclerosis even fairly superficially. You can get an answer by reading the first hit on Googling peripheral vascular disease. $\endgroup$ May 20, 2023 at 16:40
  • $\begingroup$ @anongoodnurse Thanks, indeed by googling it I found that these diseases are in any sort of vessels and the main cause is atherosclerosis Would you like to answer the question by stating that every part of bloodstream grid could be affected? $\endgroup$ May 20, 2023 at 16:54

1 Answer 1


Atherosclerosis can affect everything from the largest vessel, like the aorta, to small arteries with a diameter of <2.5 mm (this is labelled small vessel disease.)

Large vessels develop atherosclerosis early in life (in early childhood, in fact) and progresses rather slowly, but can be catastrophic (e.g. ruptured aortic aneurysms), whereas small vessel disease tends to occur in older individuals, and can progress more rapidly. Atherosclerosis of large vessels is often associated with smoking and hyperlipidemia, whereas small vessel disease (often called Peripheral Vascular Disease or Peripheral Artery Disease) is more often associated with diabetes, hypertension and is higher in races other than Caucasian.

There is a truly vast amount of information in the literature on atherosclerosis, but I have never seen a claim that it occurs only in the large vessels. However I have seen articles that can give that impression by focusing only on large vessels, so I can see where that misunderstanding comes from.

Large and small vessels atherosclerosis: similarities and differences
Understanding Peripheral Vascular Disease
Small vessel coronary artery disease: How small can we go with myocardial revascularization?


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