Genetics and age. Some people have a genetic predisposition for high cholesterol or high blood pressure despite strict dietary changes. In these cases, medication, in addition to lifestyle changes, may be needed to manage these conditions and avoid or slow the progression of atherosclerosis.

As for age, the older your arteries get, the more time plaque has to form. Everyone will have some plaque buildup as they get older, but it will be much worse if you smoked, ate a high fat diet, didn’t exercise or had other habits in your younger years that put you at greater risk. You can’t redo the past but you can make changes going forward that will stop any further damage.