Jorge Plutzky, MD |
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What is atherosclerosis?
Atherosclerosis is the build-up of cholesterol deposits (plaque) in arteries that carry oxygen to the heart, brain and elsewhere. This process, which develops over decades, is the underlying cause for most heart attacks and strokes. Although scientists are uncertain what causes atherosclerosis, high blood pressure, smoking and diabetes are believed to be risk factors.
How does the atherosclerosis progress?
As the cholesterol deposits build up along the inside of the artery walls, the blood flow decreases, and, thus, vital body organs and extremities get less oxygen. If the heart doesn’t get enough oxygen, a heart attack may occur. Similarly, a stroke may occur if the brain doesn’t get enough oxygen, and gangrene may occur if the oxygenated blood supply to the arms and legs is reduced.
How can one tell if they are at risk for developing atherosclerosis?
Work with your doctor to know your risk numbers - lipid profile (levels of bad LDL cholesterol, good HDL cholesterol and triglycerides), blood pressure, some measure of your fitness (weight, waist circumference, body mass index) and even your glucose values. These numbers help define your risk of future heart attack, stroke and diabetes. Ideally, your LDL should be less than 100 mg/dl, and your blood pressure should be around 120/80 mm Hg. Many other factors can contribute to atherosclerosis, including smoking and a family history of early heart disease.
Are risk patterns changing in the United States?
Yes. The increased use of preventive therapies like cholesterol-lowering medications has improved conditions for some of the population. However, there is still great concern regarding the obesity and type 2 diabetes epidemics among our youth. Type 2 diabetes, which also arises over years, brings many associated cardiovascular risk factors: central obesity (excess fat around the waist), higher triglycerides, decreased HDL, hypertension and increased indicators of inflammation (like C-reactive protein). Those with diabetes may have the same risk of a heart attack as a heart attack survivor.
How can I control risk factors for atherosclerosis?
Lifestyle changes – healthier eating, increased activity, improved weight – can decrease risk for diabetes and cardiovascular disease. Given how early diabetes and heart disease can begin, these practices should be promoted at an early age. However, when lifestyle changes are not enough, drug therapy is used. There is strong evidence that reducing LDL with a statin can significantly reduce the risk of a first or a recurrent heart attack. Statins may also favorably alter inflammation. There is also research focused on raising levels of HDL, the good cholesterol that evidently moves excess cholesterol away from arteries. Aspirin’s ability to inhibit blood clotting can also be important. High blood pressure and blood sugars should also be controlled.
What’s your advice on living a healthier lifestyle?
Eat right and be more active. Even small improvements can have a big impact on your risk of developing diabetes or cardiovascular disease. Simple dietary changes – avoiding trans fats, excessive simple carbohydrates, calorie-dense foods and large portions – can move you in the right direction quickly.
What if I am getting chest pains when I exert myself?
Exertional chest discomfort that comes from a lack of oxygen to the heart muscle is basically an issue of supply and demand. As the heart muscle’s demand for oxygen increases, arterial blockages can limit supply. Doctors, however, can manage this issue by altering the supply-demand relationship – decreasing demand with medications that lower blood pressure and heart rate. In some cases, an increased supply is needed, which is accomplished by stenting (putting in a tube) blockages or performing coronary bypass surgery. It is important to note that these procedures do not change why the blockages occurred, so continued improvement relies upon a better lifestyle and drug therapy.
If you are having chest discomfort, it is critical to see your doctor. Major new therapies and diagnostic tools, like advanced imaging techniques, are available.
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The Vascular Disease Prevention Program at Brigham and Women's Hospital offers state-of-the-art evaluation, treatment and counseling regarding all aspects of preventing heart and vascular disease, including cholesterol screening and treatment. To make an appointment or learn more about the program, call 1-800-BWH-9999 or visit us at
http://www.brighamandwomens.org/cvcenter/Medical/CVupdate/FurtherUnderstanding.aspx.
