By Daniel Walsh, MD

Atherosclerosis is a condition that causes several common forms of heart disease, including coronary artery disease (CAD) and peripheral artery disease (PAD). It occurs when plaque builds up inside the arteries, hardening them to a point where it become difficult for blood to flow from the heart to other parts of the body.

There is some evidence that our arteries harden as we get older, and that some people are more predisposed to atherosclerosis than others. There is also a great deal of evidence that there are many way we can modify our risk. These choices have even been shown to reverse the effects of the condition.

Daniel Walsh, MD
Daniel Walsh, MD

A type of cholesterol known as serum cholesterol is one of the substances creating the plaque build-up in arteries. In many patients, diet and exercise effectively lowers total serum cholesterol levels. People with lower intakes of dietary cholesterol and lower body fat have the lowest 25-year risk of death from heart attack. If you are overweight, you will not receive the same benefit from lower cholesterol as those who are leaner.

Effective regular exercise helps lower both your cholesterol and body fat. You’re eating habits can also make a difference. A number of diets have received attention, but the strongest evidence for a beneficial health effect comes from studies of the Mediterranean diet. This diet, in addition to regular physical activity, emphasizes abundant plant foods, with meat, fish, poultry, eggs and dairy products (mainly cheese and yogurt) consumed in low to moderate amounts. Olive oil is the principal source of fat and dessert is typically fresh fruit.

As you can see, the Mediterranean diet does not ask you to give up foods you may enjoy, just to consume less of them and in balance with other foods. It even allows for the consumption of wine in low to moderate amounts. Olive oil is probably the most critical part of the Mediterranean diet. It contains a very high level of monounsaturated fats, most notably oleic acid, which epidemiological studies suggest may be linked to a reduction in coronary heart disease risk. There is also evidence that the antioxidants in olive oil improve cholesterol regulation and “bad” cholesterol reduction, and that it has other anti-inflammatory and anti-hypertensive effects.

Total fat in the Mediterranean diet represents just 25 to 35 percent of the total calories consumed, with eight percent or less of that being saturated fat. A 2011 systematic review actually found that a Mediterranean diet appeared to be more effective than a low-fat diet in bringing about long-term changes to cardiovascular risk factors, such as cholesterol levels and blood pressure.

After looking at the Mediterranean diet, it shouldn’t be a surprise to learn that people with diabetes also need to be concerned about atherosclerosis. People with diabetes appear to have more fat in their abdomens, and the presence of the disease probably amplifies the impact of cholesterol abnormalities. Diabetes is associated with blood clotting and an increased risk for vascular complications. People with diabetes also have a higher rate of death from heart disease and PAD, and are 17 times more likely to require major limb amputation as a result of atherosclerosis. Managing your diabetes wisely can have a positive impact on all these health concerns.

There are also drug therapies, should dietary modifications fail. Numerous drugs have been proven to decrease the risk of coronary and cerebrovascular events. Use of “statin” drugs has also been demonstrated to decrease the rate of aneurysm expansion. The choice to use any of these medications should made in consultation with your physician.

Tobacco users also increase their risk of complications associated with atherosclerosis, from fatal heart disease to numbness in the lower extremities that can lead to amputation. Researchers are still working to better understand exactly how this occurs, but the effects are very clear. Cigarette smoking lowers levels of “good” cholesterol. It also increases the level of carbon monoxide in the body, which makes the smoker more likely to suffer an injury of the arterial wall, experience blood clotting or the narrowing of blood vessels. If you are smoker, there is no greater way to modify your risk for atherosclerosis than quitting. There are many tobacco cessation programs in the community available at little or no cost to you.

Even if you don’t smoke and maintain a healthy diet, high blood pressure can increase your risk for atherosclerosis. Autopsy studies have shown that hardening in the major blood vessels of the heart, brain, and kidneys is more extensive and more severe in patients with hypertension than in those with normal blood pressures. Control of hypertension has been demonstrated to prolong life and reduce the risk of cardiovascular complications. Get regular wellness exams with a primary healthcare provider to ensure your blood pressure is under control.

There is little doubt that lowering serum cholesterol, smoking cessation and prevention of hypertension will reduce the impact of atherosclerosis. The Center for Cardiovascular Health at Brattleboro Memorial Hospital can provide you with more education and access to resources to help keep your heart healthy. Talk to your primary healthcare provider about a referral or contact the Center directly for more information.

Daniel Walsh, MD is a Cardiovascular Surgeon. He is a member of the medical staff at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and he sees patients at BMH every other Monday in the BMH Center for Cardiovascular Health.