Yes, you can have atherosclerosis with normal cholesterol levels. Atherosclerosis is a condition in which arteries become narrowed or blocked due to a build-up of fatty material called plaque. Cholesterol is one of the components of this plaque, however, it is not the only one. Other factors such as age, family history, smoking, diabetes, and high blood pressure can all contribute to the development of atherosclerosis, even in those with normal cholesterol levels.
In addition, certain types of cholesterol, such as LDL (low-density lipoprotein) and triglycerides, are more strongly associated with atherosclerosis than other types, such as HDL (high-density lipoprotein). Generally, people with higher levels of LDL and triglycerides and lower levels of HDL have a greater risk of developing atherosclerosis. Therefore, it is possible to have normal cholesterol levels overall, but still have a higher risk of developing atherosclerosis due to an unbalanced ratio of LDL to HDL or higher levels of triglycerides.
For these reasons, it is important to monitor all aspects of your cholesterol, not just your overall cholesterol levels. Additionally, lifestyle modifications, such as eating a heart-healthy diet, exercising regularly, and avoiding smoking, can help reduce your risk of developing atherosclerosis, even with normal cholesterol levels.