Lifestyle choices related to physical fitness have profound effects on various aspects of age-related wear and tear. Atherosclerosis, the accumulation of fat deposits in the walls of blood vessels, is particularly affected by these decisions. Atherosclerosis leads to the formation of atheromas, which can burst and cause strokes and heart attacks, making it one of the main causes of death worldwide. The disease is caused by a disorder of cholesterol transport and immune cells called macrophages, which are responsible for removing excess cholesterol from the vascular walls. Over a lifetime, lifestyle choices that affect inflammation levels, immune function, and blood cholesterol levels can change the risk of developing atherosclerosis later on. Maintaining physical fitness over decades is an important factor in reducing this risk.