Atherosclerosis

Atherosclerosis is perhaps the single most deadly disease in the World, yet there is a good chance that most people, even those at high risk for heart disease, don’t really understand how it develops.

The fact is, long before any symptoms are clinically evident, atherosclerosis begins as a malfunction of specialized cells that line our arteries.

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What Causes Atherosclerosis?

The exact cause of atherosclerosis isn't known. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age.

Atherosclerosis may start when certain factors damage the inner layers of the arteries. These factors include:

• Smoking

• High amounts of certain fats and cholesterol in the blood

• High blood pressure

• High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. Fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

Over time, the plaque may crack. Blood cells called platelets clump together to form blood clots where the cracks are. This narrows the arteries more and worsens angina (chest pain) or causes a heart attack.

Researchers continue to look at why atherosclerosis develops. They hope to find answers to such questions as:

• Why and how do the arteries become damaged?

• How does plaque develop and change over time?

• Why does plaque break open and lead to clots?

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Who Is At Risk for Atherosclerosis?

Coronary artery disease (atherosclerosis of the coronary arteries) is the leading cause of death in the United States.

The exact cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your chance of developing it. These conditions are known as risk factors. Your chances of developing atherosclerosis increase with the number of risk factors you have.

You can control most risk factors and help prevent or delay atherosclerosis. Other risk factors can't be controlled.

Major Risk Factors

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL cholesterol (sometimes called good cholesterol).

• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over a period of time.

• Smoking. This can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't allow enough oxygen to reach the body's tissues.
Insulin resistance. This condition occurs when the body can't use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used.

• Diabetes. This is a disease in which the body’s blood sugar level is high because the body doesn’t make enough insulin or doesn’t use its insulin properly.

• Overweight or obesity. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat.

• Lack of physical activity. Lack of activity can worsen other risk factors for atherosclerosis.

• Age. As you get older, your risk for atherosclerosis increases. Genetic or lifestyle factors cause plaque to build in your arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms.

- In women, the risk increases after age 55.

• Family history of early heart disease. Your risk for atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.

Although age and a family history of early heart disease are risk factors, it doesn't mean that you will develop atherosclerosis if you have one or both.

Making lifestyle changes and/or taking medicines to treat other risk factors can often lessen genetic influences and prevent atherosclerosis from developing, even in older adults.

Emerging Risk Factors

Scientists continue to study other possible risk factors for atherosclerosis.

High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for atherosclerosis and heart attack. High levels of CRP are proof of inflammation in the body.

Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.

People with low CRP levels may get atherosclerosis at a slower rate than people with high CRP levels. Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk of atherosclerosis.

High levels of fats called triglycerides in the blood also may raise the risk of atherosclerosis, particularly in women.

Other Factors That Affect Atherosclerosis

Other risk factors also may raise your risk for developing atherosclerosis. These include:

Sleep apnea. Sleep apnea is a disorder in which your breathing stops or gets very shallow while you're sleeping. Untreated sleep apnea can raise your chances of having high blood pressure, diabetes, and even a heart attack or stroke.

Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event—particularly one involving anger.

Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors for atherosclerosis. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day.