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A Series by David Grubin

Atherosclerosis, How To Keep A Silent Killer At Bay

In addition to these well-established risk factors for atherosclerosis, a number of newer markers of disease have caused considerable interest. However, we can go a long way to determining our risk for heart attack or stroke based on the simple measures described above. Emerging blood tests and imaging techniques may join the traditional tests described above in future years, but most will require more testing before adoption in routine practice.

How Do Risk Factors Cause Atherosclerosis?

Recent research findings have uncovered a new theory that links risk factors for atherosclerosis with fatty lesion formation and their complications such as heart attacks. When the function of the cells that make up the artery wall is perturbed by risk factors such as high levels of bad cholesterol, high blood pressure, cigarette smoke, or diabetes, it triggers a response similar to the body's reaction to foreign bodies or germs such as bacteria or viruses.

Smoking cigarettes puts you at higher risk
Smoking cigarettes puts you at higher risk
for atherosclerosis.
White blood cells, the same cells the body uses to combat infections, accumulate in arteries that have encountered risk factors. These visitors to the artery wall lead to metabolic mayhem that disturbs the normal architecture of the artery and sets the stage for accumulation of atherosclerotic plaques. We used to conceive of atherosclerotic plaques as collections of fat droplets in the artery wall. We now know that this view is highly over-simplified. Much more than a depot of waxy grease, the atherosclerotic plaque teems with inflammatory cells. In this way, the atherosclerotic plaque can be viewed as an internal pimple or abscess in the artery wall, not caused by bacteria but rather by the risk factors listed above. As this internal pimple progresses, it can rupture, akin to the bursting of a boil or a pimple on the skin. This disruption of the fatty plaque due to the inflammation process can cause a blood clot to form, suddenly stopping blood flow and leading to a heart attack or stroke. This inflammatory theory of atherosclerosis provides our best current concept of how risk factors link to the clinical complications of this disease, such as heart attacks.

How Can You Lower Your Risk of Atherosclerosis?

Certainly we cannot choose our parents or slow down the march of years, and thus influence the non-modifiable risk factors for atherosclerosis. However, we can do a great deal to reduce our risk of atherosclerosis, first and foremost by adopting a healthy lifestyle. Avoiding being overweight -- by following a prudent diet and incorporating physical activity into our daily lives -- can go a long way toward lessening a number of atherosclerotic risk factors, including disorders of the blood fats, development of diabetes or pre-diabetes, and the onset or aggravation of high blood pressure. Never smoking, or stopping if you do, can drastically lower risk of atherosclerotic complications.

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Funding is provided by Medtronic, AstraZeneca, and Mars, Incorporated - makers of CocoaVia. Additional funding is provided by the Fannie E. Rippel Foundation. A co-production of David Grubin Productions, Thirteen/WNET New York and WETA Washington, D.C.
Medtronic AsrtaZeneca MARS Thirteen/WNET NEW YORK