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Most of the damage occurs when plaques become fragile and rupture. Plaques that rupture cause the formation of blood clots that can block blood flow or break off and travel to another part of the body. In either of these cases, if a clot blocks a blood vessel that feeds the heart, it causes a heart attack. If it blocks a blood vessel that feeds the brain, it causes a stroke.
Researchers now think that vulnerable plaque is formed in the following way. Fat droplets are absorbed by the artery, which causes the release of proteins (called cytokines) that lead to inflammation. The cytokines make the artery wall sticky, which attracts immune-system cells (called monocytes).