Someone in the United States has a heart attack every 40 seconds. Among people who experience one, one in five are "silent," meaning the damage occurs long before they realize it.
The challenge is that artery plaque often develops silently. In fact, it can begin years, even decades before a heart attack occurs, because plaque forms without warning. More than 40% of adults ages 50 to 64 with no known heart disease already have plaque in the arteries supplying their heart.
As Medical Director of Wellness Services at PartnerMD, I educate my patients on artery plaque and ways they can prioritize prevention, stay on track with their cardiovascular health, and maintain longevity for years to come.
In this article, you'll learn valuable insights about artery plaque and heart health, including:
Our arteries have a muscular wall and an inner layer of tissue that surrounds it called the endothelium. The endothelium acts like a nonstick Teflon coating and is slippery and thin, allowing for blood to flow easily through the artery.
This protective lining can become damaged. When the endothelium is injured, cholesterol and other substances can slip beneath the surface and accumulate within the artery wall, between the endothelium and the muscle layer.
This buildup is known as artery plaque (atherosclerotic plaque), and is made up of cholesterol, fat, calcium, and other substances. As it grows, your body triggers an inflammatory response, sending white blood cells to the area in an attempt to remove the buildup.
Think of your body as having a splinter or any type of injury. Just as our body recognizes a foreign object being present, so do our arteries when it notices plaque.
Over time, this inflammatory response causes a buildup of material that keeps growing and may eventually rupture. Once it ruptures, it can form a blood clot that blocks blood flow, potentially causing a heart attack or stroke. Surprisingly, many heart attacks can occur from smaller plaques that rupture, not necessarily the biggest blockages.
Myth: I'll know if plaque is building up.
Fact: Most people have no symptoms until plaque has significantly narrowed an artery or ruptured.
Although symptoms aren't always present, depending on where the plaque forms, some people may experience:
The buildup of plaque is known as atherosclerosis, a process that often develops silently over many years without causing symptoms. While plaque itself is the problem inside the arteries, the conditions it can lead to, such as heart attack, stroke, coronary artery disease, and peripheral artery disease, fall under a broader category known as cardiovascular disease.
Cardiovascular disease (CVD) is a group of conditions that affect the heart and blood vessels. Many forms of CVD are caused by atherosclerosis, making plaque buildup one of the leading contributors to cardiovascular disease worldwide. While approximately 20.5 million deaths are caused by CVD each year, 85% of those are due to coronary heart and cerebrovascular diseases.
Coronary artery disease (CAD) occurs when plaque grows within the walls of the coronary arteries, which are the blood vessels that supply oxygen-rich blood to the heart muscle.
These vessels become narrower with plaque buildup, causing less blood and oxygen to reach the heart. When this occurs, it is called ischemia. Often, this can contribute to chest pain (angina), shortness of breath, or even a heart attack if a plaque ruptures or blood clot forms.
There are two types of coronary artery disease: acute and chronic. With acute, you may have a sudden plaque rupture, while with chronic, the coronary artery may narrow over time and reduce the blood supply to a part of the muscle.
Just as plaque can build up in the arteries that supply blood to the heart like it does in coronary artery disease, it can also accumulate in the arteries serving the arms, legs, and other parts of the body outside the heart and brain. This condition is known as peripheral artery disease (PAD).
Peripheral artery disease is more common in the legs and can cause claudication, which creates symptoms such as leg pain or cramping during walking, numbness, weakness, or slow-healing wounds. Severe cases might increase the risk of infection, tissue damage, and amputation.
The formation of plaque is more common in people who have a high level of LDL ("bad") cholesterol.
When there is too much LDL cholesterol circulating in the bloodstream, it can accumulate within the artery walls and contribute to plaque buildup. It is also more likely to form if that cholesterol is packaged in a small particle and if there is damage to the artery lining. This damage can be caused from certain risk factors, including:
Another hidden risk factor that accelerates plaque is Lipoprotein(a), or Lp(a). This cholesterol-carrying particle is largely inherited, and elevated levels can increase your risk of heart disease and stroke.
While you can't fully prevent your chance of developing artery plaque or cardiovascular disease, there are ways to reduce your risk and take a proactive approach to your heart health.
High LDL cholesterol remains the biggest contributor to plaque formation. Make sure to control your cholesterol by eating a healthy diet, staying active, and taking cholesterol-lowering medication if prescribed.
A high blood pressure can damage the inner lining of your arteries, making it easier for plaque to form. Regularly monitor your blood pressure and limit sodium intake.
Smoking damages blood vessels, promotes inflammation, and accelerates plaque buildup. By making the choice to quit smoking, you reduce your cardiovascular risk.
Choose foods that support healthy arteries, including fruits, vegetables, whole grains, lean proteins, beans, nuts, and healthy fats like olive oil. Limit highly processed foods, saturated fats, and added sugars.
Aim for at least 150 minutes of moderate-intensity exercise each week. Regular physical activity helps improve cholesterol, blood pressure, blood sugar, and overall heart health.
One of the most important steps you can take is knowing your risk before symptoms appear.
Your physician may recommend monitoring blood pressure, cholesterol, blood sugar, inflammatory markers, and family history.
Depending on your age and risk factors, additional tests, such as a coronary artery calcium (CAC) scan may be an option. This noninvasive CT scan measures calcium deposits in the coronary arteries and can determine whether plaque has already begun to develop.
Although a CAC scan isn't recommended for everyone, it is a good option for people who have an intermediate cardiovascular risk and would like to determine whether more aggressive prevention strategies are appropriate.
Artery plaque doesn't just develop overnight, and neither does heart disease. The good news is many of the factors that contribute to plaque buildup can be identified and managed before symptoms appear.
By understanding your risk, making heart-healthy lifestyle choices, and working with your physician on a personalized prevention plan, you can make meaningful steps to protect your health for years to come.
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