The etiology of arteriosclerosis has not been fully determined, and studies indicate that arteriosclerosis is a multifactorial disease, caused by multiple factors acting at different stages, which are referred to as risk factors. The primary risk factors include the following:

First, age and gender. Clinically, it is more common in middle-aged and elderly people over forty years old. After the age of forty-nine, the progression is fast, but early arteriosclerotic changes have also been found in autopsy of some young adults and even children. In recent years, clinical onset age tends to be younger. Compared to men, the incidence rate in women is lower, because estrogen has a protective effect against arteriosclerosis. Therefore, the incidence rate in women increases rapidly after menopause. Age and gender are unchangeable risk factors.

Second, abnormal lipid levels, with abnormal lipid metabolism being the most important risk factor for arteriosclerosis.

Third, hypertension, as the incidence of arteriosclerosis in patients with hypertension is significantly higher. Sixty to seventy percent of patients with coronary arteriosclerosis have hypertension, and patients with hypertension are three to four times more likely to have arteriosclerosis compared to those with normal blood pressure.

Fourth, smoking, as the incidence and mortality rate of coronary arteriosclerosis in smokers are two to six times higher than in non-smokers, and it correlates positively with the number of cigarettes smoked daily. Secondhand smoke is also a risk factor.

Fifth, diabetes and glucose intolerance, where not only is the incidence of arteriosclerosis in diabetic patients several times higher than in non-diabetics, but the progression of the disease is also rapid.

Sixth, obesity, defined as being more than twenty percent over the standard weight or a BMI greater than twenty-four. Obesity is also a risk factor for arteriosclerosis.

Seventh, family history, where a family history of coronary heart disease, diabetes, hypertension, and hyperlipidemia significantly increases the incidence of coronary heart disease.

Various theories have been proposed to explain the pathogenesis of coronary arteriosclerosis from different perspectives. These include the lipid infiltration theory, thrombosis theory, and smooth muscle cell clonal theory. In recent years, the endothelial damage response theory has gained more support, suggesting that the disease results from various risk factors ultimately damaging the arterial intima, and the formation of arteriosclerosis lesions is an inflammatory, fibro-proliferative response of the arteries to endothelial damage.