Often if someone’s artery is THAT clogged you would likely have symptoms. Chest pain when exercising or emotional stress, or some equivalent (worsening shortness of breath on exertion, nausea on exertion, upper stomach pain on exertion). If someone lives a very sedentary lifestyle where they just lay on the couch all day they might not notice.
If that happens then you would do further testing, generally some sort of stress test or imaging study. But the rule of thumb is if an artery in the heart is more than 70% blocked you can start to have SOME sort of symptom. You can’t just screen the entire population due to cost reasons and just from a work force perspective, there’s not nearly enough cardiologists to do that many procedures
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