It is a complex process which occurs over many decades. It leads to thickening of the wall of the artery, narrowing of the inner cavity of the artery (the lumen) and eventually to obstruction of blood flow.

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Atherosclerosis is the most common cause of coronary artery disease in adults. The changes which result from atherosclerosis can be divided into reversible and irreversible:

• The reversible changes generally occur in the first three decades of life. These do not result in clinical disease and can totally disappear with appropriate treatment, leaving behind an entirely normal artery. The reversible changes result in some swelling of the wall of the artery due mainly to some accumulation of lipids inside the cells which have gathered in the wall of the artery itself.
• The irreversible changes are called atherosclerotic plaque – or just "plaque". These occur later in life, except in unusually severe cases in which they may appear earlier. They can go on to cause chronic (ongoing) or acute (sudden) symptoms or a combination of the two. Plaque can be modified by vigorous treatment and the risks associated with it can be significantly reduced. But once formed, plaque never regresses completely.

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