Atherosclerosis or atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide, accounting for about one-third of all global deaths. This is similar to what is seen in Malta where 33 per cent of all deaths in 2022 were due to ASCVD.
ASCVD encompasses a broad range of medical conditions affecting the heart and blood vessels, including heart attack, stroke, cardiac arrest, angina and aneurysms. As the name suggests, ASCVD is characterised by atherosclerosis which is the build-up of cholesterol in artery walls.
Cholesterol in itself is actually essential for life as it is vital to the production of many hormones, and forms part of essential structures in our cells and synthesis of other important substances. The problem arises when excessive amounts are being transported in particular forms in our bloodstream.
Atherosclerosis begins early in life when cholesterol from our bloodstream enters our artery walls to form a fatty deposit. Over time, this slowly builds up into a plaque which may cause narrowing of arteries and blood flow restriction or a piece of the plaque may break off, enter the blood stream and block off blood flow elsewhere.
Atherosclerosis starts at a young age and although everyone will eventually have some degree of atherosclerosis, there is much we can do to delay or avoid the onset of ASCVD.
There are many identified factors which hugely increase your risk of developing one or more of these conditions. Though some of these factors such as age, sex, ethnicity and family history cannot be changed, there are many others that are modifiable.
These include obesity, chronic inflammation, high blood pressure, type 2 diabetes, abnormal levels of lipids in the blood and smoking. These modifiable risk factors can be changed and controlled through our lifestyle choices, as well as appropriate medication.
Maintaining a healthy weight has possibly the most profound effect on lowering high blood pressure
Smoking is a known cause of a wide range of health issues, including ASCVD. It is estimated that tobacco smoking causes 10% of all ASCVDs − this also includes second-hand smoke exposure. The detrimental effect of smoking on arteries through various mechanisms has long been known and smoking cessation is the simplest way of reducing excess risk of ASCVD. Complete abstinence is, of course, the main recommendation, nevertheless stopping smoking at any stage is beneficial.
Abnormal levels of lipids in our bloodstream (what is commonly referred to as ‘cholesterol’) play a causal role in the development of ASCVD.
This risk is accurately measured through a simple blood test which measures ApoB − the form of cholesterol which causes atherosclerosis. By taking measures to reduce your ApoB, you are directly reducing your ASCVD risk. This may be done aggressively using prescribed medication such as statins but also through avoiding refined and starchy carbohydrates, as well as limiting your consumption of saturated fats. Cholesterol consumed as part of your diet actually has little impact on this.
High blood pressure, or hypertension, also makes atherosclerosis worse over time as it leads to damage of the inner wall of the arteries. Hypertension typically causes no symptoms and is only diagnosed following routine blood pressure monitoring, thus highlighting the importance of getting your blood pressure checked regularly and accurately. The sort of damage caused by the mechanical force of high blood pressure typically occurs over many years and although ageing and family history are important risk factors, there are several risk factors which are modifiable.
Maintaining a healthy weight has possibly the most profound effect on lowering high blood pressure − an approximate reduction of 1mmHg with every 1kg of weight lost. Exercise, particularly endurance exercise, is also very effective at reducing blood pressure if done consistently. This would typically include doing some sort of aerobic exercise such as brisk walking or cycling for a long duration at an intensity which elevates your heart rate slightly but at which you may still hold a conversation.
Along with good sleep hygiene and consistent management of stress levels, these lifestyle factors have the potential to reduce blood pressure with the same potency as a pharmacological alternative. Nevertheless, there are effective pharmacological medications which may also be used, typically in combination with lifestyle changes.
Numerous other preventable conditions are associated with an increased risk of atherosclerosis − being overweight or obese, metabolic dysfunction (this includes having elevated levels of insulin to being insulin resistant and finally having full blown type 2 diabetes) and having low grade chronic inflammation which may stem from numerous causes including having excess fat, consuming a poor diet, being physically inactive and not maintaining good oral hygiene. All these risk factors are complexly interrelated to each other, which also implies that by taking steps to prevent or reduce one will typically improve other risk factors.
Having a healthy, balanced diet and not over-consuming calories (the cause of obesity) and being physically active are vital to longevity. Maintaining sufficient muscle mass, getting consistently good sleep, having effective stress management tools and positive social connections are also key to preventing the development of atherosclerosis along with appropriately prescribed medication when required.
Philip Borg is a longevity medicine specialist, as well as a consultant interventional radiologist, and leads The Longevity Clinic at St James Hospital.
The next longevity medicine feature will discuss how to decrease the risk of developing cancer.