Hard truths about hardening of the arteries.

• Author: Libby, Peter
• Position: HEALTH BEAT - Atherosclerosis

ATHEROSCLEROSIS, commonly called hardening of the arteries, causes heart attacks and strokes, as well as ravaging many other of the body's organs. It is on the rise worldwide and threatens to become a major cause of death, disability, and loss of useful life years not only in Western societies, but in the developing world. However, there is much that can be done to reduce the risk of suffering from this condition and its complications.

Arteries supply blood pumped by the heart to all of the body's tissues and organs. These remarkable structures are not just lifeless tubes that conduct blood, however. Rather, they are living structures populated by specialized cells that have numerous functions to maintain a healthy state under normal conditions. When perturbed, though, arteries can be the sites of development of fatty buildups of plaque or lesions. To understand how and why these form and what can be done about it, risk factors must be examined.

Careful observation of large populations has uncovered a number of indicators that predict plaque development and the complications that it causes. When a physician measures an individual's blood pressure, important information about the risk for artery disease is obtained. The higher the blood pressure, the more likely an individual will develop fatty plaques and their complications. Cholesterol measurements in the blood similarly correlate with cardiovascular risk. The higher a person's level of cholesterol, particularly when carried in small "packages" known as "bad cholesterol" or low-density lipoprotein (LDL) particles, the greater one's chances for a heart attack. Cigarette smoking, meanwhile, not only damages the lungs, but makes an individual more susceptible to atherosclerosis. People with diabetes have an accentuated risk as well.

Yet, the risk factors listed above can be avoided or modified. For example, one can stop smoking tobacco, treat high blood pressure, and manage diabetes. However, certain risks are inherent, including age, sex, and genetic makeup as reflected by a family history of atherosclerosis, particularly in close relatives such as parents or siblings, especially if they were afflicted with atherosclerosis at a relatively young age. Men tend to develop atherosclerosis at younger ages than women but, after menopause, women "catch up" quickly. Indeed, atherosclerosis is a major cause of death and heart attack in females.

In addition to these well-established risk factors, a...