Doctor’s Tip: Atherosclerosis (hardening of the arterieies), part 1
Atherosclerosis is also known as plaque, or hardening of the arteries. It is common in Americans and other people on a Western diet as they age. However, it’s not normal — it doesn’t occur in people who are on a lifelong plant-based, whole-food diet with avoidance of salt, sugar and added oil. These people have blood pressures that don’t rise as they get older, and have total cholesterols of less than 150 and LDL (bad cholesterol) levels in the 30s and 40s.
Oxygen-poor blood returning to the heart through veins is pumped by the right ventricle of the heart through the lungs, where it takes on oxygen. The left ventricle then pumps blood through arteries to our organs and tissues, including our heart muscle (myocardium). The inside of our arteries is lined by an organ system called the endothelium. If our endothelium is stressed, through bad genes; through bad habits such as smoking, lack of exercise or unhealthy diet; or by conditions such as inflammation, high blood pressure, diabetes or high cholesterol, the endothelium starts to thicken. Eventually, plaque develops.
Ninety-nine percent of plaque is located in the walls of our arteries, not causing a blockage. If plaque in a coronary (heart) artery ruptures, a blood clot forms, blocking the blood supply to part of the heart muscle, resulting in a heart attack — the number one cause of death in America. If this happens in an artery in the brain, a stroke occurs — the number one cause of disability in the U.S. and a common cause of death.
Sometimes plaque grows slowly, causing an incomplete obstruction in an artery. If this occurs in a coronary artery, blood flow to the part of the myocardium supplied by that artery is insufficient when the person exerts, such as walking rapidly or walking uphill. This results in angina — chest pain with exertion. When similar blockages occur in the legs it is called peripheral vascular disease, which causes leg pain if the person walks very far — a condition called claudication. If the blockage becomes severe enough, gangrene of the toes and feet can occur.
Following are some other problems that can occur with incomplete, chronic arterial blockages:
• Plaque in the arteries of the brain contributes to dementia, including Alzheimer’s.
• Plaque in the arteries that supply blood to the eyes can lead to loss of vision.
• Plaque in the carotid arteries in the neck behaves somewhat differently than plaque elsewhere, in that small pieces can break off and go to the brain, causing small strokes, or causing TIAs (transient ischemia attacks) that are warning signs of an impending stroke.
• Plaque on heart valves causes narrowing and/or leaking of the valves.
• Plaque in the arteries that supply blood to the intestines can cause “intestinal angina” — abdominal pain after eating. If the blockages become severe enough, intestinal gangrene can occur, necessitating removal of the dead bowel.
• Plaque in the thread-like arteries to the penis leads to erectile dysfunction. E.D. is the “canary in the coal mine,” indicating atherosclerosis elsewhere in the body.
• Plaque in arteries to the kidneys can lead to severe high blood pressure. Plaque in arteries within the kidneys leads to chronic kidney failure.
Next week’s column will discuss how to prevent, diagnose, treat and reverse atherosclerosis.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and other medical issues, and to help people with hospital or other medical bills they don’t understand or think are too high. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.