Carotid artery disease occurs because of damage to the inner lining of the artery. This is a gradual process that is associated with smoking, high blood pressure, high cholesterol levels, and poorly controlled diabetes. These all may cause minor damage to the inner walls of an artery, and during the healing process, inflammation may occur and plaque may begin to form.

Over time, the area of plaque may grow and narrow the lumen of the artery, the channel where blood flows. It becomes a vicious circle as the narrower lumen increases pressure within the artery and blood turbulence, which leads to more arterial wall damage and more plaque formation.

What are the risk factors for carotid artery disease?
The risk of narrowing carotid arteries is the same as the risk for those diseases associated with narrowing of arteries anywhere else in the body, including heart attack, stroke, and peripheral artery disease.

Those at risk include indivuals who smoke and those with high blood pressure (hypertension), high cholesterol, poorly controlled diabetes, family history of atherosclerosis, and advanced age.

Metabolic syndrome also increases the risk for carotid artery disease. It is a grouping of many of the above listed diseases and to make the diagnosis, three of five of the following need to be present:
high blood pressure,
high blood sugar,
high triglycerides (one of the types of fat in the blood),
low HDL levels (another type of fat), and/or
large waistline, a sign of abdominal obesity.