What to Know About Atherosclerosis

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SPECIAL TO THE NEWS HERALD

As the primary cause of heart disease, atherosclerosis is the number one cause of death in both men and women; and chances are good that you may already have it.

Atherosclerosis is one type of hardening or stiffening that affects the inner lining of arteries. It’s caused by a buildup of plaque composed of cholesterol, fatty substances, products of cell waste, calcium and fibrin (a substance that helps blood clot). Inflammation is also involved–either as a cause or an effect of the plaque–and this results in scar tissue that further restricts the flow of blood.

Atherosclerosis is a gradual process, often starting in youth and developing over several decades. Eventually it may lead to partial or complete blockage of blood vessels, causing severe health problems and risks, including life-threatening heart attack or stroke.

Local cardiologist, Roger L. Seagle, MD noted that circulatory problems may also result from atherosclerosis.

“It can lead to peripheral vascular disease, which involves restricted circulation. You can get blockages to the arteries in either the legs or arms – or both. It causes people to have difficulty walking, and can result in loss of limbs.”

Know Your Risk Factors

The cause of atherosclerosis is unclear, and over the past decade doctors have come to regard inflammation as an important precipitating factor. This inflammation may be caused by disease or by damage to blood vessels related to high blood pressure, smoking or other causes. Once a vessel is damaged, it is more prone to the accumulation of fatty plaques.

Men typically begin to experience complications of atherosclerosis after age 45 and women a decade later.

Seagle said there was one exception to this rule. “It’s true that women run behind men about 10 years in their development of atherosclerosis, but that changes if a woman smokes. If she smokes, her risk is the same as a man of equal age.”

Prior to menopause, women are protected from heart disease by estrogen, which increases the liver’s production of HDL (high-density lipoprotein) cholesterol. HDL, the “good” cholesterol, helps to clear away LDL (low-density lipoprotein) cholesterol, thereby limiting the buildup of plaque. Estrogen also keeps the lining of blood vessels strong and pliable, further reducing the risk of atherosclerosis.

Because of the beneficial effects of natural estrogen production, it was once believed that estrogen replacement therapy reduced the risk of atherosclerosis in post-menopausal women. Recent studies, however, have found that hormone replacement is not only ineffective but potentially harmful, increasing the risk of heart attack and stroke.

Some individuals have an increased risk of atherosclerosis and heart disease simply because of their heredity--if a brother or father was diagnosed with atherosclerosis before age 55 or if a sister or mother was diagnosed before 65.

Diabetes is another major risk factor–in fact, the threat of a future heart attack is as great for diabetics as for those who have previously had an attack. As a result, diabetics must be particularly careful about taking preventive measures or starting early treatment.

Dr. Seagle explained, “Diabetes is perhaps ‘the’ major problem because it affects the walls of the arteries. It delivers a constant trauma to the arteries and allows cholesterol and calcium to enter the artery walls and create blockages.”

Though nothing can be done to change or control such risk factors as age, sex, or family history, there are a number of measures you can take to help reduce your risk of developing damaging atherosclerosis.

First, stop smoking. Smoking has many adverse effects on the heart and lungs and has been shown to accelerate the development of atherosclerosis. Even if you’ve smoked for decades, it’s never too late to quit. Within five to ten years of quitting, ex-smokers face the same risk of heart disease as non-smokers.

Second, follow a healthy, low-fat diet.

Dr. Seagle stressed the importance of sensible eating. “For heart health a low-fat diet is simply the best. Limit your cholesterol intake, as well as your fat intake. Fats really should not make up more than 30% of the caloric intake.”

High LDL cholesterol is a major risk factor. Fats most likely to increase LDL cholesterol are saturated fats, found in animal products, and trans-fatty acids, present in commercial baked goods and some margarines.

Monounsaturated fats, such as those in olive and canola oil, nuts and nut oil are actually beneficial when used in moderate amounts since they tend to increase HDL, the “good” cholesterol that helps sweep LDL from the blood vessels.

Fatty fish such as salmon are also desirable because they are high in omega-3 fatty acids, which help stabilize heart rate and blood pressure while reducing inflammation.

Fruits, vegetables, beans, onions, garlic and high-fiber foods such as whole grain bread and cereal all help improve cholesterol ratios.

The third key to avoiding atherosclerosis is the most dreaded – vigorous exercise. Regular aerobic exercise lowers blood pressure, increases HDL cholesterol and may keep blood vessels more flexible. Exercise can also reduce stress, which has been linked to the development of atherosclerosis. The Centers for Disease Control and Prevention recommends moderate to intense exercise lasting about 30 minutes four or more times a week.

Seagle identified exercise as the best way to increase levels of good HDL cholesterol. “The best and most potent thing you can do to raise HDL is exercise,” he said. “Eating canola oil and nuts, etc. will help, but it will not necessarily ‘raise’ the HDL. Rather, it will lower your LDL. But vigorous exercise has a direct correlation to raising HDL. It’s the best thing you can do reduce the development of atherosclerosis - besides stopping smoking cigarettes.”

Symptoms and Treatment

Atherosclerosis often progresses for a long time before any symptoms become apparent. It is therefore important to maintain a healthy lifestyle and to have your blood pressure and blood cholesterol checked regularly.

Among the most common symptoms of atherosclerosis is angina, a pressing or squeezing pain usually felt in the chest and sometimes in the shoulders, arms, back, neck or jaw. Angina occurs when the heart’s need for oxygen exceeds the amount available in the blood supply. Other symptoms of atherosclerosis include irregular heartbeats and severe pain or cramps when walking, a sign of peripheral vascular disease.

Dr. Seagle added, “Typically, chest pain or angina, shortness of breath with activity, change in your exercise tolerance (when things that you could always do before, start to get you fatigued) – these are symptoms related to hardening of the arteries. When you start to experience these symptoms you should see your primary care physician who may refer you to a cardiologist.”

For persons with high cholesterol or other risk factors indicating atherosclerosis, doctors can prescribe one of a number of effective cholesterol-lowering medications.

The definitive treatment for advanced atherosclerosis in arteries serving the heart is coronary bypass surgery–re-directing blood flow with a grafted artery from the leg or elsewhere. Less severe cases can be treated by balloon angioplasty. In this process, a balloon-tipped catheter is inserted into the affected artery. The balloon is then inflated and deflated to open the passage for improved blood flow. A stent may then be inserted to prevent re-narrowing.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.Even after undergoing balloon angioplasty or heart surgery, plaque deposits may return. The ultimate treatment involves lifestyle changes to prevent or slow the progression of atherosclerosis.