How thick are your arteries? The scary truth about Atherosclerosis.

Atherosclerosis is a disease state that fits under the term “Cardiovascular disease” , and is one of the biggest preventable killers in Great Britain. One 2014 British Heart Foundation statistic showed that 28-29% of deaths in the UK were caused by cardiovascular disease [1].

Atherosclerosis is often confused with Arteriosclerosis. Arteriosclerosis is the hardening of the arteries, whereas Atherosclerosis is the thickening of the artery, causing the lumen to narrow.

What Defines Atherosclerosis? How does it Develop?

Atherosclerosis is clinically described as thickening of the arteries, this is caused by damage to the vascular cell lining.and then it becoming clogged with fatty plaque deposits, called Atheromas. As the cell wall lining thickens the lumen diameter of the vessel will decrease causing reduced blood flow and blockages. Atherosclerosis is most likely to occur in large arteries.

In the primary stages of Atherosclerosis a fatty streak develops, these are large in terms of in vivo body structures (because they don’t need magnification to be seen.) The first stage of Atherosclerosis occurs from damage to the lining of the cell wall which attracts white blood cells. This increases the permeability of the cell lining and allowing lipids such as Low density lipoproteins (LDLs) to enter the lining. The white blood cells will then attempt to attack the LDLs by engulfing them. This develops into a foam cell. This foam cells then collect forming a fatty streak. This will continue to grow and develop until it partially or completely blocks the vessel.

The plaque may remain stable for some time, but it is like a ticking time bomb. Although the plaque is encapsulated in the wall, the capsules membrane can differ greatly. The thinner the membrane the more unstable the plaque. There are two fates to an atheroma, it will either rupture or cause thrombosis. Either one of these fates can be fatal leading to a heart attack, stroke or embolism.

What Causes Atherosclerosis?

The most likely causes are:

• High blood pressure
• Unhealthy diet, rich in salt, cholesterol and saturated fats.
• Cigarette smoking.

High blood pressure and a poor diet can cause damage to the lining of the vessel due to high turbulence. As soon as the endothelial lining of the vessel is damaged it is very difficult to undo without creating a fatty streak. High blood pressure, particularly around vein junctions can cause the most turbulence and therefore the most damage. Some of our veins are forked or branched, much like a road junction this can cause some ‘traffic’ as blood filters through, increased volumes leads to high blood pressure and damage to the cell wall. Cigarette smoke is full of potent toxic chemicals such as carbon monoxide which is carried by red blood cells. This can cause large amounts of damage to the cell wall creating optimal conditions for atheroma development. Additionally, nicotine in cigarette smoke can increase the blood viscosity thus increasing the likelihood of thrombotic blockages [1,2].

Who is Most At Risk?

Those most at risk to Atherosclerosis are those with/that are:

• Hyperlipidemia, High Blood Lipid Concentration
• Hypercholesterolemia, High Blood Cholesterol Concentration
• Overweight or Obese
• Lack of Physical Activity
• Diabetes
• Smoking
• Hypertension, High Blood Pressure
• Stress
• Inflammation
• Genetics, early onset of Cardiovascular Disease
• Heavy and regular Alcohol use [4].

Associated Conditions of Atherosclerosis

Other conditions can develop from Atherosclerosis include Angina, short periods of chest pains. Heart attacks, caused by the partial or complete blockage of the blood supply to the heart. Strokes, are very similar to a Heart attack, but in the brain, where the blood supply to the brain is either completely or partially blocked. Finally, Peripheral arterial disease (PAD) which is when the blood supply to the peripheral limbs, namely the legs is blocked. This can be severely painful for the person suffering from the disease [5].

Optimal Nutrition for Cardiovascular Protection

The main components to concentrate on are Fats, Fruits and vegetables and Salt, also considering how this affects body weight. There are two diets that are recommended to anyone at risk of cardiovascular disease of any kind, including Atherosclerosis. These are the Cardioprotective and the Mediterranean diets.

The Cardioprotective diet does what it says on the tin, it protects the heart and vessels. It does so by promoting a diet rich in unsaturated fats, anti-inflammatory essential fatty acids, wholegrains, Vitamins and minerals. The Mediterranean diet is much of the same, rich in fish providing essential fatty acids, wholegrains, plant oils and sterols.

To optimally prevent Atherosclerosis we recommend the following:

• Fruits and Vegetable should be consumed at a minimum of 4-5, 80g portions of fruits and vegetables. Rich in potassium to lower blood pressure and antioxidants to prevent free radical damage to the cell lining of the vessel. They are also high in water and low in calories which will help with weight loss if this is a risk factor.
• Wholegrains are a better choice over refined carbohydrates. They are rich in fibre which has been clinically shown to reduce high cholesterol levels ( a risk factor for atherosclerosis).
• Omega and essential fatty acids. You can find this in oily fish, avocados, nuts and seeds. Omega 3 fatty acids have been shown to reduce blood pressure, the inflammatory response, decreased risk of thrombosis, and atherosclerotic plaques[6].
• Try to moderate and reduce processed meats as they tend to be high in saturated fats, cholesterol, and salt. Additionally, avoid anything containing high levels of sugar, saturated or trans fats.

Exercise for Cardiovascular Protection

Lack of regular physical activity is a risk factor for many cardiovascular problems. Exercise has been clinically shown to reduce triglycerides and actively reduce cholesterol. Low levels of HDL and high levels of LDL are linked with increased risk of atherosclerosis. Exercise can help to reset the balance, increasing beneficial HDLs and harmful LDLs. One study also showed that exercise can stablise any established plaques to ensure they do not rupture. Exercise also helps to burn calories and reduce weight which lowers the risk factor of coronary associated disease [6,7,8].

For the best results exercise for up to 150 minutes a week, ideally x5, 30 minutes a week. This can be exclusively moderate exercise, such as walking, or a mixture of moderate and vigorous exercise.