Preventing and Managing Atherosclerotic Cardiovascular Disease

Why ASCVD Matters

Atherosclerotic cardiovascular disease (ASCVD) is the number one cause of mortality worldwide, responsible for over 18 million deaths per year. It is incredibly common, affecting a staggering number of people to some degree over their lifetimes. Alarmingly, ASCVD does not just impact the elderly – over 50% of men and 33% of women will suffer a major cardiac event like a heart attack or stroke before the age of 65. This indicates that the disease process starts developing several decades earlier than the actual cardiac event occurs.

Due to the immense burden ASCVD places on both individuals and healthcare systems as a whole, increasing understanding of how to prevent and manage this disease is of paramount importance. The good news is that because ASCVD develops gradually over many years or decades, there are ample opportunities to intervene and alter its course through lifestyle and medical management.

What Is Atherosclerosis?

ASCVD encompasses any cardiovascular conditions related to the buildup of fatty deposits called plaque inside the arteries supplying blood to the heart muscle and brain. This process starts early in life as “fatty streaks” within artery walls that slowly consolidate over time into plaque.

Plaque buildup causes hardening and narrowing of the arteries, limiting blood supply to downstream organs and tissues. Pieces of plaque can also rupture, forming a clot that fully blocks the artery. This leads to acute events like heart attacks or strokes.

The root cause of plaque formation is the accumulation of cholesterol and related molecules within artery walls. Cholesterol production is a normal bodily process, but excessive levels in circulation, especially “bad” LDL cholesterol, drives the atherosclerotic disease process.

Atherosclerosis Development Over Decades

During youth and early adulthood, streaks of fat and cholesterol begin accumulating in artery walls. These early fatty streaks cause little impairment to blood flow on their own. However, over the course of 20-30 years these streaks consolidate into plaque deposits consisting of cholesterol crystals covered by layers of cells and tissue.

Plaque buildup causes remodeling and hardening of the arteries, slowly reducing blood supply. After several decades of progression, blood flow becomes critically impaired. Plaque can also physically rupture, producing clots that fully block arteries. This typically precipitates major clinical events like heart attacks or strokes.

Appreciating the gradual development of ASCVD over a lifetime is key to understanding the importance of prevention and managing risk factors early rather than waiting for disease to become clinically apparent.

Key Metrics and Tests

As cholesterol drives ASCVD progression, parameters related to blood cholesterol levels and plaque accumulation comprise the main metrics used to assess risk status and response to interventions. Key metrics include:

 
• Blood Lipid Profile: Measures total cholesterol with fractions of beneficial HDL, harmful LDL, and neutral triglycerides
• Coronary Artery Calcium Score: Quantifies calcification in heart arteries indicating plaque burden
• CIMT Test: Uses ultrasound to measure carotid artery wall thickness indicating plaque
• Angiography Imaging: Visualizes flow within heart arteries to identify blockages

Tracking lipid profile over time provides insight into the adequacy of lifestyle and medical management of cholesterol levels. Meanwhile CAC, CIMT and angiography assessments determine the actual extent of arterial plaque burden and blockages accrued.

Preventing Atherosclerotic Disease Progression

As ASCVD develops insidiously over decades, prevention must start early and continue lifelong. This relies on normalizing cholesterol levels through lifestyle approaches like:

 
• Eating an anti-inflammatory, whole food, plant-focused diet
• Exercising routinely to improve cholesterol metabolism
• Avoiding smoking to prevent arterial damage

Medications like statins may also control cholesterol if levels remain suboptimal despite diet and exercise changes. When combined with regular follow-up testing and screening for plaque burden, this preventative strategy can successfully alter the course of ASCVD, extending health span and longevity.

Key Takeaways

• Atherosclerosis causes heart attacks and strokes by slowly building up plaque inside arteries over a lifetime.
• Managing cholesterol levels early through lifestyle and medication prevents onset of clinical ASCVD events later in life.
• Changes in blood lipid profiles and plaque burden measurements gauge success controlling ASCVD progression.

The immense public health burden posed by atherosclerotic cardiovascular disease means increasing awareness of effective prevention is key. Appreciating that ASCVD develops over decades highlights the essential need to start management early rather than waiting for clinical events to occur. Using testing to monitor atherosclerosis progression along with controlling cholesterol can successfully alter the disease course and add healthy years to life.

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