Does everyone with high cholesterol and high blood pressure automatically have coronary atherosclerosis?

Almost certainly if: High cholesterol and high blood pressure if unchecked leads almost certainly to atherosclerosis which manifests as heart disease, stroke, kidney disease or poor circulation. This can adversely affect quality of life and life expectancy.

No: Vascular diseases are multifactorial. However, not controlling your medical conditions, such as high cholesterol, high blood pressure, diabetes, etc. Can make you more prone to developing vascular problems, and clearly if you already have coronary or peripheral vascular disease, not managing these issues will lead to more rapid progression of the disease process.