Clinical studies have shown that, simply put, the more atherosclerotic plaque that a person has, the higher the risk of a heart attack.  For this reason, it is important to understand how to avoid it, measure it, and treat it.  Just as the pipes in your house can become lined with deposits (lime), the arteries can become lined with deposits (cholesterol and other organic materials).  The more slippery the arterial lining is, the less likely you are to accumulate this plaque.  Similarly, the less “sticky material” you have in your blood, the less likely you are to have it accumulate as plaque.  The process of atherosclerosis can take place at almost any age, however, the calcification of the plaque does not generally begin before the teen years, and is not common until middle age.  (This is why the heartscore test is not recommended for patients younger than 35 years old.)  Beginning as a fatty streak, the deposited “gunk” slowly damages the arterial lining (the endothelium) beneath it.  (A fair analogy would be the placement of a swatch of carpet upon a lawn: within a few days, if it is not removed, it damages the grass below.)  This is similar to how the human body responds to plaque: the cells below the plaque become damaged.  The body has the tendency to strengthen weak or damaged areas with the placement of a hard material called calcium.  The new material, which has bony characteristics, may be observable in as little as four weeks after deposition of the soft plaque.  In addition, the underlying plaque itself, can calcify.  Of the total plaque burden, there is about 4 times as much soft plaque, as hard plaque, in adults over 40.  For this reason, some cardiologists refer to the calcified plaque as the tip-of-the-iceberg.

Avoiding It:  By nature, the endothelial lining is very slippery.  If it remains healthy, it will remain slick.  Unfortunately, some substances in which we indulge appear to have the undesirable trait of “roughing up” this lining.  Substances which are believed to affect the arteries in this manner are:

• Tobacco (probably from the nicotine)
• Caffeine (recently suspected)
• Homocysteine (occurs naturally in the body)

Tobacco, especially in the form of smoke, is probably the strongest single factor in the development of atheroscelerosis.  Years of use can result in premature accumulation of plaque, and the damage seems to be somewhat independent of age.  It appears from recent studies that smoking also increases the tendency to form blood clots.  To keep the arteries as slippery as possible, one should not smoke.

Caffeine has been suspected off-and-on for many years as being deleterious to the vessels.  Recent studies seem to confirm this.  Avoidance of caffeine may be helpful to coronary artery health.

Homocysteine, which occurs naturally in the body, increases when there is a lack of folic acid.  Studies seem to indicate that too much of this substance can be very damaging to the arterial lining, therefore, if you are at high risk for heart disease you should make sure that you get enough of the appropriate vitamins.

It has been demonstrated in clinical studies that significantly reducing the cholesterol levels can have a mild reducing effect on the soft plaque.  Dr. Dean Ornish is the foremost advocate of reducing plaque, or reversing atherosclerosis.  He has published several books, all of which are available through the Wellness Shop at the HeartScore web site (www.heartscore.com).  In addition, there are several new drugs available, called statins, which can reduce the total cholesterol levels while at the same time lowering the LDL and raising the HDL.  They work by reducing the amount of cholesterol created by the liver.

Because atherosclerosis is contributed to by so many factors, it is very common for patients with “normal” cholesterol levels to exhibit the disease.  Aside from smoking and high cholesterol, other factors, which impact heart disease, are listed below:  (RISK FACTORS)

Obesity:  This condition induces the patient to maintain higher cholesterol levels, and generally poorer cardiac health.

Diabetes:  This condition affects many things, and while the exact ways in which it affects cardiac health may not be crystal clear, diabetics are at higher risk for atherosclerosis than the rest of the population.

Hypertension:   Patients with hypertension exhibit high blood pressure, which not only puts more strain upon the cardiovascular system, but may also increase the risk of dislodging a plaque.

Sedentary Lifestyle:  Without exercise, overall cardiac health can be compromised.  One particular positive effect of exercise is that it keeps the endothelium healthy.

High Stress:  A difficult factor to measure, there is little disagreement that continual stress is harmful to the heart.

Family History:  If a patient has a family history of heart disease, or stroke, they may be genetically more prone to accumulation of plaque.

Others:    Because the accumulation of plaque is such a complex process, there is an ongoing search for better predictors than those listed above.  Two, which are currently being considered as potentially better at predicting atherosclerosis, are Coenzyme A (CoA) and C-Reactive Protein (CRP).  Neither is commonly included in wellness testing programs today, but over time, that may change.