Knowing About Atherosclerosis: Helps to prevent Heart disease and stroke

By Dr. Juddith Lobo, Muscat
Chol, Stroke

By Dr. Judith Lobo, Muscat

• Arteriosclerosis; Hardening of the arteries; Plaque buildup – arteries:

 

Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries. High cholesterol levels can lead to hardening of the arteries. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

 

 

Causes, incidence, and risk factors:

 

Atherosclerosis is a common disorder that specifically affects the medium and large arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

 

Eventually, the plaques can make the artery narrow and less flexible, making it harder for blood to flow. If the coronary arteries become narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms.

 

Pieces of plaque can break off and move through the affected artery to smaller blood vessels, blocking them and causing tissue damage or death (embolization). This is a common cause of heart attack and stroke. Blood clots can also form around a tear (fissure) in the plaque leading to blocked blood flow. If the clot moves into an artery in the heart, lungs, or brain, it can cause a stroke, heart attack, or pulmonary embolism. In some cases, the atherosclerotic plaque is associated with a weakening of the wall of an artery leading to an aneurysm.

 

Risk factors for atherosclerosis include:

• Diabetes
• Heavy alcohol use
• High blood pressure
• High blood cholesterol levels
• High-fat diet
• Increasing age
• Obesity
• Personal or family history of heart disease
• Smoking

 

Atherosclerosis can affect many different organ systems, including the heart, lungs, brain, intestines, kidneys, and limbs (extremities).

 

Symptoms:

Symptoms usually do not occur until blood flow becomes restricted or blocked.

 

Treatment:

To help prevent atherosclerosis or its complications (such as heart disease and stroke), make the following lifestyle changes:

 

Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Foods high in soluble fiber also are part of a healthy diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:

• Whole-grain cereals such as oatmeal and oat bran
• Fruits such as apples, bananas, oranges, pears, and prunes
• Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

 

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

• Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Do not drink more than one or two alcoholic drinks a day.
• Exercise regularly for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight.

 

Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family. Have your blood pressure checked more often if you have high blood pressure, heart disease, or you have had a stroke. Talk to your doctor about how often you should have yours checked. Specific recommendations depend on your age and blood pressure readings.

• Everyone should keep their blood pressure below 140/90 mmHg
• If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure should probably be less than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.

 

Have your cholesterol checked and treated if it is high.

• Adults at risk should have their cholesterol checked yearly. If you are being treated for high cholesterol or a family history of cholesterol problems, you will need to have it checked more often.
• All adults should keep their LDL ("bad") cholesterol levels below 130-160 mg/dL.
• If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your LDL cholesterol should be lower than 100 mg/dL.
• Few medications have been found to clear up plaque. Consult the doctor for medications. For Females, Talk to the doctor about the safety of hormone replacement therapy for menopause.

 

Note: Current Guidelines no longer recommend vitamins E or C, antioxidants, or folic acid to prevent heart disease.

 

Knowing  About Cholesterol:

Cholesterol is a building block of our body’s cells. The liver makes cholesterol. Cholesterol travels to the body’s cells in the blood. We all need some cholesterol, but our bodies can make all the cholesterol we need. Certain foods are an added source of cholesterol.

 

Many people have the right amount of cholesterol. Other people have too much. High cholesterol sometimes runs in families.
There are different types of cholesterol. The two main types are often called “bad” and “good.” The bad cholesterol can damage the heart and arteries, but good cholesterol does not cause damage.

 

Bad Cholesterol (LDL Cholesterol):

Everyone should try to keep bad (LDL) cholesterol as low as possible. If your doctor or nurse tells you that you have high cholesterol, it means that your bad cholesterol is too high.

 

When you have too much bad (LDL) cholesterol in your blood, it can build up on the walls of your arteries. This buildup is called plaque (pronounced “plak”). Plaque can narrow your arteries and make it harder for blood to flow. Plaque can lead to heart attacks and strokes. Keeping bad cholesterol at a low level can help avoid these problems.

 

Good Cholesterol (HDL Cholesterol):

Good (HDL) cholesterol helps remove extra cholesterol from the body. When your good cholesterol is higher, your chance of heart disease is lower. If your good cholesterol is 60 or higher, that helps protect against heart attacks and strokes.

 

Triglycerides:

Triglycerides (try-GLIS-uh-rides) are a kind of fat found in your blood. The body makes triglycerides. They are also found in food. Your body needs this kind of fat, but it’s best to keep your triglycerides low. Less than 150 is usually the goal.
Just having high cholesterol does not cause any symptoms. Most people do not know they have high cholesterol unless they get tested. Having a blood test to check your cholesterol will tell you if your levels are on target.

 

Knowing about  Fat:

Saturated fat; Diet - fat; Polyunsaturated fat; Monounsaturated fat; Lipids:

 

Fats are organic compounds that are made up of carbon, hydrogen, and oxygen. They are a source of energy in foods. Fats belong to a group of substances called lipids, and come in liquid or solid form. All fats are combinations of saturated and unsaturated fatty acids.

 

Function:

Fat is one of the 3 nutrients (along with protein and carbohydrates) that supply calories to the body. Fat provides 9 calories per gram, more than twice the number provided by carbohydrates or protein.

 

Fat is essential for the proper functioning of the body. Fats provide essential fatty acids, which are not made by the body and must be obtained from food. The essential fatty acids are linoleic and linolenic acid. They are important for controlling inflammation, blood clotting, and brain development.

 

Fat serves as the storage substance for the body’s extra calories. It fills the fat cells (adipose tissue) that help insulate the body. Fats are also an important energy source. When the body has used up the calories from carbohydrates, which occurs after the first 20 minutes of exercise, it begins to depend on the calories from fat.

 

Healthy skin and hair are maintained by fat. Fat helps the body absorb and move the vitamins A, D, E, and K through the bloodstream.

 

Food Sources:

 

SATURATED FATS:

• These are the biggest dietary cause of high LDL levels ("bad cholesterol"). When looking at a food label, pay very close attention to the percentage of saturated fat and avoid or limit any foods that are high. Saturated fat should be limited to 10% of calories. Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream, cream, butter, biscuits, cakes, bacon , sausages ,processed meat and fatty meats.They are also found in some vegetable oils -- coconut, palm, and palm kernel oils. (Note: Most other vegetable oils contain unsaturated fat and are healthy.)

 

UNSATURATED FATS:

Fats that help to lower blood cholesterol if used in place of saturated fats. However, unsaturated fats have a lot of calories, so you still need to limit them. Most (but not all) liquid vegetable oils are unsaturated. (The exceptions include coconut, palm, and palm kernel oils.) There are two types of unsaturated fats:

• Monounsaturated fats: Examples include olive and canola oils.
• Polyunsaturated fats: Examples include fish, safflower, sunflower, corn, and soybean oils.

 

TRANS FATTY ACIDS:

These fats form when vegetable oil hardens (a process called hydrogenation) and can raise LDL levels. They can also lower HDL levels ("good cholesterol"). Trans fatty acids are found in fried foods, commercial baked goods (donuts, cookies, crackers), processed foods, and margarines.

 

HYDROGENATED AND PARTIALLY HYDROGENATED FATS:

This refers to oils that have become hardened (such as hard butter and margarine). Partially hydrogenated means the oils are only partly hardened. Foods made with hydrogenated oils should be avoided because they contain high levels of trans fatty acids, which are linked to heart disease. (Look at the ingredients in the food label.)

 

Side Effects:

Eating too much saturated fat is one of the major risk factors for heart disease. A diet high in saturated fat causes a soft, waxy substance called cholesterol to build up in the arteries. Too much fat also increases the risk of heart disease because of its high calorie content, which increases the chance of becoming obese (another risk factor for heart disease and some types of cancer).
A large intake of polyunsaturated fat may increase the risk for some types of cancer. Reducing daily fat intake is not a guarantee against developing cancer or heart disease, but it does help reduce the risk factors.

 

Recommendations:

• Choose lean, protein-rich foods such as soy, fish, skinless chicken, very lean meat, and fat-free or 1% dairy products.
• Eat foods that are naturally low in fat such as whole grains, fruits, and vegetables.
• Get plenty of soluble fiber such as oats, bran, dry peas, beans, cereal, and rice.
• Limit fried foods, processed foods, and commercially prepared baked goods (donuts, cookies, crackers).
• Limit animal products such as egg yolks, cheeses, whole milk, cream, ice cream, and fatty meats (and large portions of meats).
• Look at food labels, especially the level of saturated fat. Avoid or limit foods high in saturated fat.
• Look on food labels for words like "hydrogenated" or "partially hydrogenated" -- these foods are loaded with bad fats and should be avoided.
• Liquid vegetable oil, soft margarine, and trans fatty acid-free margarine are preferable to butter, stick margarine, or shortening.

 

Children under age 2 should NOT be on a fat-restricted diet because cholesterol and fat are thought to be important nutrients for brain development.

 

It is important to read the nutrition labels and be aware of the amount of different types of fat contained in food. If you are 20, ask your health care provider about checking your cholesterol levels.

 

The blood is sent to a laboratory, where the following are measured:

• Low density lipoprotein (LDL or "bad" cholesterol)
• High density lipoprotein (HDL or "good" cholesterol
• Total cholesterol
• Triglycerides
• Very low density lipoprotein (VLDL cholesterol, though this is often calculated from the triglyceride level)

 

Other blood tests, such as C-reactive protein (CRP), may be added to the profile in some laboratories.

 

The ideal values are different for people without coronary artery disease or other risk factors than for those with known coronary artery disease, diabetes, or high blood pressure. The desired values in adults are:

• LDL: 70 - 130 mg/dL (lower numbers are desired)
• HDL: greater than 40 - 60 mg/dL (higher numbers are desired)
• Total cholesterol: less than 200 mg/dL (lower numbers are desired)
• Triglycerides: 10 - 150 mg/dL (lower numbers are desired)
• VLDL: 2 - 38 mg/dL

 

Remember the Key Points: Summary

 

• Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.

• Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

• Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected. Examples of these diseases include coronary heart disease, carotid artery disease, peripheral arterial disease, and chronic kidney disease.

• The exact cause of atherosclerosis isn’t known. It may start when certain factors damage the inner layers of the arteries. Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries.

• Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets stick to the site of the injury. They may clump together to form blood clots. Clots narrow the arteries even more, limiting the flow of oxygen-rich blood to your body.

• Many factors raise your risk for atherosclerosis. Major risk factors include unhealthy cholesterol levels, high blood pressure, smoking, insulin resistance, diabetes, overweight or obesity, lack of physical activity, unhealthy diet, older age, and a family history of early heart disease.

• Atherosclerosis usually doesn’t cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don’t know they have the disease until they have a medical emergency, such as a heart attack or stroke. Other signs and symptoms depend on which arteries are narrowed or blocked.

• Your doctor will diagnose atherosclerosis based on your medical and family histories, a physical exam, and test results.

• Treatments for atherosclerosis may include lifestyle changes, medicines, and medical procedures or surgery. Lifestyle changes include following a healthy diet, being physically active, maintaining a healthy weight, quitting smoking, and managing stress.