What is atherosclerosis?
Atherosclerosis is injury and inflammation of the artery wall. Healthy arteries are important because they carry oxygen-rich blood from the heart to the entire body’s tissue and organs. A more accurate description of the most dangerous stage of disease would be “atheritis” or “arteritis” meaning inflammation of the arteries. “Sclerosis” or hardening/calcification is a more benign later healed benign stage of the disease.
Acne is a relevant analogy most of us know. Inflammation in the skin (artery wall) creates pimples/plaque (in areas where turbulence adds mechanical shearing forces) that are prone to rupture (homogeneous and heterogeneous plaque) when new. The preferred path is to heal and leave a scar. When plaque is becoming calcified, it is healing. Rising coronary calcium score is a good, not bad, trend if you are on a healing program.
Atherosclerosis is often called “hardening of the arteries” due to a buildup of calcium deposits in plaque that forms in the arteries. However, calcium presence is actually a sign of healing and increases over time with new plaque development (bad) and current plaque calcifying (good). Plaque that has little or no calcium is less stable, more prone to rupture, and more threatening.
When your artery walls thicken with plaque and narrow the lumen, blood flow to any organ can be reduced or interrupted, leading to disability (temporary or permanent) or death. Stress tests and angiograms are useful to detect this phenomenon. However, the greatest danger is sudden plaque rupture and blood clot formation, resulting in heart attack or stroke. The best test to evaluate this stage is ultrasound for the carotid arteries (affordable) and AI processed coronary artery CT (expensive).
Source: Cleveland Heart Lab
How are arteries important to your health?
The heart pumps blood into the aorta and arteries, which then branch out into smaller blood vessels, eventually delivering the oxygen and nutrients to individual cells. Without healthy arteries, the body's tissues and organs would not receive the oxygen and nutrients needed to function properly. Maintaining healthy arteries is crucial for overall health and wellbeing. Arterial health improvement is a great reflection of reduced oxidate stress, inflammation and overall health improvement.
The artery wall has three layers:
Adventitia (outer layer): composed of connective tissue that supports and protects the artery from external injury.
Media (middle layer): made of smooth muscle and elastic fibers. It is responsible for regulating the diameter of the artery, which affects blood pressure and blood flow.
Intima (inner layer): a thin layer of endothelial cells that regulate all kinds of activity, maintaining a smooth surface for blood to flow through.
Image Source: NIH U.S. National Library of Medicine
What causes plaque to develop in the arteries?
Plaque grows due to complicated interactions between genetics, high blood pressure, lipids, inflammation driven by oxidative stress and insulin resistance, diabetes, and other conditions. Arterial disease is like acne and plaque is like a pimple or pustule.
Plaque progresses as follows:
Homogeneous plaque: This fresh, soft vulnerable plaque is like a new pimple. It is the most dangerous stage of plaque evolution because it is most likely to rupture and cause a heart attack or stroke.
Heterogeneous plaque: This type of plaque is like a pimple that is healing. It can still rupture or erode because inflammation has not resolved. It is the most common stage of plaque seen on imaging of arteries. It is an uneven buildup of inflammatory material, fibrin, and calcium.
Calcified Plaque: This type of plaque is the scar that results when plaque heals. Like any scar, we carry it for the rest of our lives but it is no longer a threat. Calcified plaque is the residual scar of a rupture-related event that could have happened, but didn’t! Calcified plaque is less likely to rupture, but can still cause problems by narrowing the artery and restricting blood flow.
As plaque is developing, it is vulnerable to rupture. A clot forms in the artery lumen. If the clot blocks an artery feeding your heart, you experience a heart attack. If it blocks an artery feeding your brain, you experience a stroke. Both can result in death or disability, but they can also be prevented by making artery walls thinner/less inflamed and healthier.
Atherosclerosis and its progression is more common but not inevitable as we age. Most adults have it starting in the thirties.
Using new science, testing, and treatments, we can halt and reverse the disease in our arteries.
Take the first step to prevent heart attack and stroke. Request a complementary Discovery Zoom Call with Dr. Backs and begin your journey to prevention and a healthy, happy life.