You can reduce your risk of developing atherosclerosis
Q: You mention atherosclerosis in many of your columns. Could you explain what this word means?
A: My readers ask me many questions about atherosclerosis, and for good reason: It is the No. 1 cause of premature death in developed nations, including the United States.
Atherosclerosis is a narrowing of the arteries. Arteries are blood vessels that supply fresh, oxygen-rich blood to the heart, brain, intestines and other organs. The narrowing is caused by the buildup of plaques in artery walls. The plaques are filled with LDL cholesterol - so-called "bad" cholesterol.
As a plaque grows inside the wall of an artery, it begins to block the flow of blood. At first, the blockage is so slight that there are no consequences. But if a plaque grows very large, it can starve the organ fed by the artery.
Another, more sinister, thing can happen with a plaque. Even if it is not big enough to block blood flow, that can change in an instant. Here's how:
The plaque has a cap of fibers that hold in the cholesterol. If there is inflammation inside the plaque, it can dissolve the fibers. Suddenly, the cap ruptures, spilling cholesterol into the inside of the artery. That can promptly cause a clot that completely blocks the flow of blood. Without oxygen and other nutrients that are carried in the blood, the organ's cells may die or suffer severe damage. This is how most heart attacks and many strokes happen. (I've put an illustration showing how atherosclerosis can lead to a heart attack on my website, AskDoctorK.com.)
There are many things you can do to reduce your risk of atherosclerosis. For example:
• Don't smoke.
• Maintain a healthy weight.
• Eat a healthy diet that is rich in vegetables and fruits; use healthy fat oils - monounsaturated (olive) and polyunsaturated (safflower, peanut, canola) - for cooking; and emphasize fish and plant protein sources (soy, beans, legumes).
• Exercise regularly.
• Control high blood pressure. You may need medication to do this.
• If you have diabetes, control your blood sugar.
High LDL cholesterol is a big risk factor for atherosclerosis. If diet and exercise alone do not bring your cholesterol down to target levels, you may need medication. The best medicine to lower cholesterol is a statin. Statins were developed only after basic scientific research discovered what prompts the liver to make large amounts of LDL ("bad") cholesterol.
That Nobel Prize-winning discovery made statins possible, and also led to the recent development of another powerful group of medicines that can lower LDL cholesterol. They're currently called PCSK9 inhibitors, but I'll bet (as with statins) we'll come up with a simpler name soon.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.