Written by Dr. Albana Greca, MD, MMedSc
Hi there,
I am glad you are asking this, because smoking is a major cardiovascular risk factor, but it would not be medically accurate to say that it is always the single main cause of cholesterol buildup in the arteries.
Atherosclerosis usually develops over years through several interacting factors. LDL-containing particles can enter and remain in the artery wall, where inflammation and plaque formation develop. Smoking can accelerate this process, while high blood pressure, diabetes, kidney disease, ageing, and inherited risk can add further stress to the blood vessels.
For people with diabetes, understanding LDL cholesterol and cardiovascular risk is especially important because cholesterol treatment is only one part of protecting the arteries.
Cigarette smoke exposes the cardiovascular system to many harmful chemicals. Smoking can damage the cells lining blood vessels, increase inflammation, make blood more likely to clot, raise triglycerides, lower HDL cholesterol, and promote the buildup and narrowing of plaque inside arteries.
Oxidative stress from tobacco smoke can also modify lipoproteins, including LDL. But I would not describe atherosclerosis simply as cholesterol becoming “sticky.” Plaque is a complex mixture of cholesterol-containing particles, inflammatory cells, fibrous tissue, calcium, and changes within the artery wall.
No. A person who has never smoked can still develop atherosclerosis because of high LDL cholesterol, high blood pressure, diabetes, chronic kidney disease, genetic factors, or age.
Likewise, a smoker can have a cholesterol result that looks acceptable and still have significant cardiovascular risk. Smoking damages arteries and increases clotting risk independently of one cholesterol number. This is why I prefer to look at the whole cardiovascular risk profile rather than focusing on only LDL or smoking.
Our guide to controlling diabetes and reducing long-term risk explains why glucose, blood pressure, cholesterol, smoking, activity, and medications all need to be considered together.
Diabetes itself can damage blood vessels over time, and smoking adds another major vascular stress. Together they increase the risk of heart attack, stroke, peripheral artery disease, kidney problems, and other complications.
That is why smoking cessation belongs alongside glucose management, blood-pressure control, and cholesterol treatment when we try to prevent long-term diabetes complications.
If you have diabetes and smoke, our page on smoking and diabetes explains why quitting can make such an important difference to cardiovascular and overall health.
If you smoke, quitting is one of the most useful steps you can take to protect your arteries. You do not have to rely on willpower alone. Counseling combined with approved stop-smoking medication can improve the chance of quitting successfully.
Your clinician can also review the other factors that affect your cardiovascular risk, including LDL cholesterol, triglycerides, blood pressure, HbA1c, kidney function, physical activity, family history, and any previous heart or circulation problems.
Healthy eating and regular activity also matter, but they work best as part of a complete risk-reduction plan. Our guide to lifestyle habits that support diabetes management explains how food, movement, weight management when needed, sleep, and other daily habits fit alongside medical treatment.
Educational safety note: This information is for general education and does not replace individualized medical advice. Speak with your healthcare professional before starting smoking-cessation medication or changing any current treatment.
Last reviewed: September 2026