Atherosclerosis is a disease in which plaque builds up inside arteries, restricting blood flow. It is a leading cause of heart attacks and strokes. Symptoms may include chest pain called angina, leg pain with walking called claudication, or no symptoms at all. Risk factors include high cholesterol, smoking, diabetes, high blood pressure, obesity, physical inactivity, and family history of early heart disease. Treatment focuses on lifestyle changes and medications to control risk factors and prevent serious complications.

1. ATHEROSCLEROSIS TREATMENT
Overview
Diseasescausedbyatherosclerosisare the leadingcause of illnessanddeathforbothmenand women
inthe UnitedStates,accordingtothe National Heart,Lung,andBloodInstitute.Althoughbreastcancer
isoftenthe illnessmostfearedbywomen,the disease affectsone outof eightwomenoverthe lifetime,
comparedto coronaryheart disease,whichisresponsibleformore thanone inthree female deathsin
America.Atherosclerosisisoftenthe firststage of coronaryheartdisease (CHD).
Oftenreferredtoas“hardeningof the arteries,”atherosclerosisoccurswhenyourarteriesnarrowand
become lessflexible.Thishappenswhencholesterol,fattysubstances,cell waste products,calciumand
fibrin—collectivelycalledplaque—collectonthe innerwalls.The arteriesrespondtothe buildupby
becominginflamed,which,inturn,resultsinthe formationof scartissue andthe collectionof othercells
inthe affectedareas,furthernarrowingthe artery.
Atherosclerosiscanaffectmediumandlarge arteriesanywhereinyourbody.If someone has
atherosclerosisinone partof theirbody,theytypicallywillhave atherosclerosisinotherpartsof their
bodies.Atherosclerosisrestrictsbloodflow,thuslimitingthe amountof oxygenavailabletoyourorgans.
Whenbloodflowtothe heart isreduced,forinstance,chestpain,orangina,mayresult.Similarly,when
bloodflowtothe arteriesinthe legsisreduced,legpaincalledclaudicationmayresult.
As the disease progresses,atherosclerosiscancompletelyclogarteries,cuttingoff bloodflow.This
usuallyhappenssuddenlywhenabloodclotformsinthe damagedarteriesontopof the
atherosclerosis.Thisisespeciallydangerousinarteriesnearthe brain,heartorothervital organs.If
bloodflowtothe heart isnearlyor completelyblocked,aheartattack resultsandmuscle cellsinthe
heartdie.The resultispermanentheartdamage.Similarly,if bloodflow isabruptlycutoff tothe brain,
thiscan cause a stroke,whichmay alsoresultinpermanentbraindamage.Andif bloodflow isabruptly
cut off to the legs,the legmay have tobe amputated.Thusatherosclerosiscanleadtoseriouslife-
threateningcomplicationsif notaddressedearlythroughpreventionandearlytreatment.
Atheroscleroticplaqueshave acholesterol- orlipid-richcore coveredbyafibrouscap.If thiscap
ruptures,itexposesthislipid-richcore toblood.The stickycore attractsplatelets,formingabloodclot,
calleda thrombus,atthe site.Thisclot can completelyclogthe arteryandcut off bloodflow.
More mature plaques(stable plaques) have athickfibrouscap,whichislesslikelytorupture.Softer,
fattierplaques(unstable plaques) have aweakercapandare more likelytorupture.
Surprisingly, the majorityof heartattacksoccur inarteriesthat were lessthan50 percentblocked
before the attack.So the degree of blockage ina particulararterydoesnotnecessarilypredictheart
attack risk.However,the overall total burdenof atherosclerosis throughoutall the arteriesdoesaffect
your riskof a heartattack.

2. We don’tknowwhatcausesplaque tobeginbuildingupinarteries.Some expertsthinkplaquebeginsto
accumulate inplaceswhere the innerlayerof anarteryis damaged.
The specificarteriesmostatriskfor atherosclerosis-inducedblockage are those goingtoyourbrain
(carotid),heart(coronary) andlegs(femoral oriliac).Atherosclerosisinthe legsisthe mostcommon
formof peripheral arterial disease (PAD)andcanleadto intermittentclaudication—severe pain,aching
or crampingwhenwalking,numbness,reducedcirculation,andif leftuntreated,gangrene (deathof
tissue).
While atherosclerosistypicallyprogressesgradually—sometimesevenstartinginchildhood—youare
mostat riskwhenarterial blockage buildsupquickly,completelyclosingoff anartery.Thiscan happenif
the plaque ruptures.
Risk Factors for Atherosclerosis
Overthe last twodecades,researchershave identifiedmanyriskfactorsfordevelopingcardiovascular
diseases.Theyinclude:
 Elevatedcholesterol levels(bothtotal cholesterol andLDL[“bad”] cholesterol)
 Elevatedtriglyceridelevels
 Low HDL cholesterol (the “good”cholesterol,whichclearsawayartery-cloggingLDL
cholesterol—the “bad”cholesterol)
 Highbloodpressure (hypertension)
 Cigarette smoking
 Diabetes(elevatedbloodsugar)
Advancedage
High cholesterol
More than half of womenoverage 55 needto lowertheirbloodcholesterol,andaquarterof all
Americanwomenhave bloodcholesterol levelshigh enoughtopose aseriousriskforcoronary heart
disease—aresultof atherosclerosis.
Cholesterolbeginscollectinginthe wallsof the arteriesatanearlyage.In fact,the earliesttype of
arterial lesion,the “fattystreak,”ispresenteveninyoungchildren.
Accordingto the National CholesterolEducationProgram(NCEP),elevatedLDLcholesterol isamajor
cause of coronaryheart disease.That’swhythe NCEPpanel recommendsaggressive treatment.
Treatmentmayinclude lifestyle changes,suchasexercisingmore andreducingthe amountof saturated
fat inyour diet,andmedication.A combinationof approachesistypicallyrecommended.

3. Otherlipidabnormalities,suchaselevatedtriglyceridesorlow HDL (the goodcholesterol),are also
associatedwithincreasedcardiovascularrisk.
Cigarette smoking
Smokingacceleratesthe developmentof atherosclerosis,increasesbloodpressureandrestrictsthe
amountof oxygenthe bloodsuppliestothe body.Quittingsmokingdramaticallyandimmediately
lowersthe riskof a heart attack and reducesthe riskof a secondheartattack inpeople whohave
alreadyhadone.
Diabetes
Havingdiabetesposesasgreata riskfor havinga heartattack in 10 yearsas heart disease itself,
accordingto NHLBI. Infact, cardiovasculardisease isthe leadingcause of diabetes-relateddeaths.
People withdiabeteswhohave notyethada heartattack have the same riskof future heartattack as
someone withknowncoronaryheartdisease.Because theirriskof heartattack isso high,NHLBI
recommendsthatpeople withdiabetesbe treated aggressivelywithLDLcholesterol–lowering
medicationandcarefullymanage theirbloodsugartoreduce theircardiovascularrisk.
Age
Generally,womenoverage 55 and menoverage 45 are at greatestriskfordevelopingatherosclerosis.
The risk of cardiovasculareventsincreaseswithage.
Other risk factors for coronary heart disease include:
 A familyhistoryof earlyheartdisease(before the age of 60) ina memberof yourimmediate
family(parent,sibling,child)
 Obesity
 Metabolicsyndrome
 Physical inactivityandsedentarylifestyle
 Postmenopausalstatus
 Increasedlevelsof high-sensitivityC-reactiveprotein(CRP),whichisamarker ofinflammation
Family History
Eventhoughit isnot includedinthe FraminghamRiskScore,familyhistoryisone of the biggestrisk
factors overall foratherosclerosis.Yourriskisgreaterif your fatheror brotherwasdiagnosedbefore age
55, if your motheror sisterwasdiagnosedbefore age 65 or if you have a siblingwithearlycoronary
disease.
Obesity

4. Overweightwomenare muchmore likelytodevelopheart-relatedproblems,evenif theyhave noother
riskfactors.Excessbodyweightinwomenislinkedwithcoronaryheartdisease,stroke,congestiveheart
failure anddeathfromheart-relatedcauses.
Inactivity
Notexercisingcontributesdirectlytoheart-relatedproblemsandincreasesthe likelihoodthatyou’ll
developotherriskfactors,suchashighbloodpressure anddiabetes.
Metabolic Syndrome
This deadlyclusterof riskfactorsincludesfivecomponents:abdominal obesity(alarge waistline);high
bloodpressure;glucose intolerance orhighfastingbloodsugarlevels(diabetesorprediabetes);
abnormal lipidssuchasa hightriglyceride level;andlow HDL (good) cholesterol.If youhave three outof
five of these riskfactors,youare diagnosedwithmetabolicsyndrome,whichisassociatedwitha
markedlyincreasedriskof cardiovasculardisease.
Stress
Althoughstresshasbeenimplicatedinthe developmentof atherosclerosis,itsexactrelationshipto
heartdisease has notbeendetermined.Regularexercise canreduce stressandimprove yourmood.
Postmenopausal status
A woman’sriskof developingatherosclerosisandheartdisease increasesonce she reachesmenopause.
Priorto menopause,womenare mainlyprotectedfromheartdisease byestrogen,the reproductive
hormone producedbythe ovaries.Thisprotectioniswhywomentendtodevelopheartdisease 10years
aftermen.Howeverthis10-yearprotectionisnotseeninwomenwhosmoke orhave diabetes.
Amongitsmany roles, estrogenhelpskeeparteriesfree fromplaque byimprovingthe ratioof LDL (low-
densitylipoprotein) andHDL(high-densitylipoprotein) cholesterol.Italsoincreasesthe amountof HDL
cholesterol,whichhelpscleararteriesof LDLcholesterol—thekindthatmostcontributestoplaque
buildup.
Estrogenalsohelpskeepthe liningof yourbloodvesselsstrongandpliable,whichhelpsreduce yourrisk
of atherosclerosis.Despitethe theoretical benefitsof estrogen,replacingnatural estrogenhormones
withdrugsaftermenopause isnotan effectivewaytopreventheartdisease andmayevenbe harmful.
High-sensitivity C-reactive protein
Chronicinflammationhasbeenshowntobe ariskfactor for cardiovasculardisease.While the reasons
are notfullyknown,inflamedatheroscleroticplaquesmaybe more prone torupture.C-reactive protein
(CRP) isa marker of inflammationthatcanbe measuredinthe bloodandisstronglylinkedtoobesity
and sedentarylifestyles.However,CRPhasbeenshowntopredictcardiovascularriskevenabove
traditional riskfactorassessment.Weightlossandexercise canlowerCRPlevels.Statins,acommon

5. classof medicationsusedtotreatcholesterol,canalsolowerCRP.SometimesdoctorswillorderCRP
testingtorefine riskpredictionamongintermediate-riskindividualswhenthe decisiontotreatwith
statintherapyisunclear.Olderorelderlyindividualswho have normal orevenlow levelsof cholesterol
but whohave highlevelsof CRPmayalsobenefitfromstatintherapy.
Global Risk Factor Assessment
The FraminghamRiskScore isa useful,office-basedriskpredictionmodel.Itassignsapointscore for
each majorriskfactor (age,smoking,total cholesterol,HDLcholesterol,systolicbloodpressure) to
predictyour10-year riskof developingfutureCHDevents.
If you have more than a 20 percentriskof future cardiaceventsoverthe next10 years,youshould be
treatedveryaggressively,the same assomeone withknownheartdisease.Intermediate-riskindividuals
withscoresbetween10percentand 20 percentshouldhave furtherevaluation.Low-riskindividuals
withscoresof lessthan 10 percentusuallydon’t needdrugtherapy,butshouldmake lifestyle changes
such as dietandexercise,whichare recommendedforeveryone.
Recently,several studieshave suggestedthatthe FraminghamRiskScore mayunderestimate
cardiovascularriskina substantial numberof individuals,particularlywomenandyoungeradults.The
Adult-TreatmentPanel(ATP) versionof the FraminghamRiskScore onlypredictscoronaryheartdisease
events,butforwomenunderthe age of 75, strokesare more commonthan the CHD eventspredicted
by the riskcalculator.Certainindividualswithlow- orintermediate-riskFraminghamRiskScoresmaybe
candidatesforothertestingif theyhave otherriskfactorssuch as a strongfamilyhistorythatare not
includedinthe FraminghamRiskScore.
Womenand youngadultsoftenhave low FraminghamRiskScoresforshort-termriskoverthe next10-
yearsbut have substantial lifetimerisk.Eventhe presenceof one majorcardiovascularriskfactorbythe
age of 50 is associatedwithincreasedlifetime riskof cardiovasculardisease andshortermediansurvival
comparedto womenwithoptimal riskfactorstatus.Thus“low-risk”overthe next10years isnot the
same as “no risk,”and itis imperative thatriskfactorsare screenedforandtreatedappropriately.Itis
importantto preventriskfactorsfromdevelopingthroughahealthylifestyle.
Recently,anotherglobal riskassessmenttool calledthe ReynoldsRiskScore wasdeveloped,whichhas
beenshowntohave improvedpredictive abilityforall cardiovascularevents comparedtothe
FraminghamRiskScore.Thistool incorporatesmanyof the traditional riskfactorsusedinthe
FraminghamRiskScore,butadds twootherimportantriskfactors:familyhistoryof premature coronary
arterydisease andhigh-sensitivityC-reactive.
Both riskassessmenttoolsweredevelopedamongpredominantlyCaucasianpopulationsandmaynot
applywell toindividualsfromotherracesorethnicities.
Symptoms of Atherosclerosis:

6. Often,youwill experiencenosymptomsof atherosclerosisuntil the disease hasprogressedsignificantly.
However,there are some conditionsthatmaysuggestatherosclerosisispresent,althoughthese
conditionsmayhappenforotherreasons.
Angina
If cloggedarteriespreventenoughoxygen-carryingbloodfromreachingyourheart,the heartmay
respondwithpaincalledanginapectoris.Episodesof anginaoccurwhenthe heart’sneedforoxygen
increasesbeyondthe oxygenavailablefromthe bloodnourishingthe heart.Silentanginaoccurswhen
the same inadequate bloodsupplycausesnosymptoms.Physical exertionisthe mostcommontrigger
for angina.Othertriggerscanbe emotional stress,extreme coldorheat,heavymeals,alcohol and
cigarette smoking.The painisa pressingorsqueezingpain,usuallyfeltinthe chestor sometimesinthe
shoulders,arms,neck,jawsorback.
Anginasuggeststhatcoronaryheart disease exists.People withanginahave anincreasedriskof heart
attack comparedwiththose whohave nosymptoms.Whenthe patternof anginachanges—if episodes
become more frequent,lastlongeroroccur withoutexercise—yourriskof heartattack insubsequent
daysor weeksismuchhigherandyoushouldsee yourhealthcare professionalimmediately.
If you have angina,learnitspattern—whatcausesananginaattack, what itfeelslike,how longepisodes
usuallylastandwhethermedicationrelievesthe attack.Anginaisusuallyrelievedinafew minutesby
restingor takingprescribedanginamedicine,suchasnitroglycerin.
Episodesof stable anginaseldomcause permanentdamage toheartmuscle.
Heart attack painmay be similartoangina,butthe symptomsof anginaquicklydisappearwithrest.
Heart attack pain,however,usuallypersistsdespiterestingortakingnitroglycerinandshouldbe
evaluatedimmediately.Like angina,heartattackpaincan be a pressure ortightnessinchest,arms,back
or neck.
Oftensymptomsincludeshortnessof breath,sweating,nausea,vomiting,indigestionordizziness.
Women,especiallythose withdiabetes,maynothave the typical symptoms of chestpainlike men,but
have othersymptomssuchas shortnessof breathor indigestion.A heartattackisan emergency.A delay
intreatmentcouldmeanmore of the heartmuscle tissue ispermanentlydamaged.
If you thinkyouare havinga heartattack, call 9-1-1. Afteryoucall 9-1-1, the operatormay recommend
that youchewone adult-strength(325mg) aspirinafterhe or she makessure youdon’thave an allergy
to aspirinora conditionthatmaymake takingit toorisky.If the operatordoesn’ttalktoyou about
chewinganaspirin,the emergencymedical techniciansorphysiciansatthe hospital willgive youone if
it’srightfor you.
Cardiac arrhythmias.

7. These occur whenthe heartmomentarilybeatstoofastorbeatsirregularly.Chestpain,dizziness and
shortnessof breathare symptomsof cardiac arrhythmias.Atherosclerosisisone cause of rapidor
irregularheartbeat;however,itcanalsobe causedby angina,valvularheartdisease,bloodclots,thyroid
abnormalities,electrolyte imbalanceorpreviousheartdamage.Arrhythmiasmaybe frequentor
infrequent.
Silent ischemia
Sometimesatherosclerosiscausesnosymptoms.Silentischemiaisaconditioncausedby
atherosclerosis,butisn’tassociatedwiththe chestpainorothersymptomscommonto othertypesof
heartconditions.Thisconditionoccurswhenarterieswithatherosclerosiscan’tdeliverenoughbloodto
the heart.An electrocardiogram(EKGorECG), a measurementof electrical impulsesproducedbythe
heart,may indicate silentischemia.However, unlessyouknow yourrisksforheartdisease anddecide,
withthe advice of your healthcare professional,thatyouneedaheartcheckup,youmay neverknow
youhave ischemia.Peoplewithdiabetesare especiallyatriskfor thiscondition.
Intermittent claudication.
Thislegdisorderpredominantlyaffectselderlypeople.Itcausessevere pain,achingorcrampinginthe
legswhenyouwalkdue toatherosclerosisinthe majorarteriesthatsupplybloodtothe legs(femoral
and iliac).Severecasesof peripheral arterial diseasecanleadtogangrene andamputation.
Transient ischemic attack (TIA) and strokes.
If you experience asuddenonsetof weaknessornumbnessonone side of yourface,armor leg,or an
inabilitytotalkorfindwords,or lose visioninone eye,youmaybe havingastroke or a TIA.Neurological
symptomsthatlastlessthan 24 hoursare calledTIAs,whereassymptomsthatpersistforlongerare
classifiedasstrokes.TIAsandstrokesare oftenthe resultof atherosclerosisinthe arteriesthat supply
bloodto the brain,suchas the carotidarteries.Thisisveryserious.If youthinkyouare experiencinga
stroke,youshouldcall 9-1-1 to seekmedical attentionimmediately.Thisisthe brain’sequivalentof a
“heart attack,”duringwhichthe brain isdeprivedof oxygen-carryingbloodsupply.Anydelayinmedical
treatmentmaypermanentlydamage yourbrain.
Diagnosis
The earlieratherosclerosisisdiagnosedthe better.You’ll wanttotake manyof the followingstepsto
determine if you’reatrisk for thiscondition.Discussotherstepslistedbelowwithyourhealthcare
professional.
Office-based Physical Exam.
All womenshouldundergoanannual examtoassesstheirriskfactorsforcardiovasculardisease andfor
any symptomsof atherosclerosis.The physical examshouldinclude measuringyourbloodpressure and
heightandweighttocalculate a bodymassindex (BMI).A normal bloodpressure islessthan120/80. If
youhave highbloodpressure,youshouldsee yourhealthcare professionalmore frequentlytomake

8. sure your bloodpressure isbeingadequatelytreatedtothe goal of lessthan130/85. If you’re
overweight,youhave ahigherriskof diabetesandmetabolicsyndrome.Yourdoctorshouldencourage
youto followahealthydietandto exercise regularlytoreduce yourrisk.Often,atherosclerosisisnot
diagnoseduntil youhave complications.However,before youexperience complications,yourhealth
care professionalmaybe able tohear a blowingsoundcalledabruitwhenholdingastethoscope over a
damagedartery.Also,youmayhave a decreasedpulseinthe affectedarea.Sometimes,atherosclerosis
causesthe bloodpressure ineachof your arms to be significantlydifferent,anothersymptomyour
healthcare professional caneasilycheck.More commonly,thereare noapparentsignsonphysical
examto suggestthe presence of atherosclerosis,andthusindividualswithriskfactorsmaybe referred
for additional testing.
Laboratory tests.
Beginningatage 20, womenshouldhave theirbloodcholesterol measured.If itisnormal,itcan be
recheckedeveryfiveyears.However,if itisabnormal,itshouldbe monitoredmore frequently,suchas
at leastonce a year.A complete lipoproteinlevel (abloodtestthatmeasurestotal cholesterol,LDL
cholesterol,HDLcholesterol andtriglyceridelevels) isrecommendedbyNHLBIas the initial testto
determine if yourcholesterollevelsare withinnormal ranges.Thistype of test,calledafasting
lipoproteintest,istakenwhenyouhaven’teatenforaprescribedamountof time—usuallybetween
nine and12 hours.Blood-level cholesterol ismeasuredinmilligramsperdeciliter(mg/dL;adeciliteris
one-tenthof aliter).If youare atriskfor highcholesterol orotherconditionsthatcontributetothe
developmentof heartdisease,yourhealthcare professional mayrecommendmore frequenttesting.
Here are “at-a-glance”guidelinesforyourcholesterol levels.Be sure toaskyour healthcare professional
if your bloodcholesterol goalsshouldbe differentbasedonanyindividual heartdisease risksyoumay
have,suchas diabetesandhighbloodpressure,orif yousmoke:
Total cholesterollevels:
Desirable:lessthan200 mg/dL
Borderline high-risk:200 to 239 mg/dL
Highrisk: 240 and above
HDL (highdensitylipoprotein) levels:
Optimal:above 60 mg/dL.(consideredprotectiveagainstheartdisease.)
40 to 50 mg/dL: the highthe level the lessyourriskforheartdisease
Lessthan 40 mg/dL: consideredamajorriskfactor forheart disease
LDL (low-densitylipoprotein) levels:
Optional goal forhigh-riskpatients:lessthan70 mg/dL

9. Optimal:lessthan100 mg/dL
Nearoptimal:100 to 129 mg/dL
Borderline high:130 to 159 mg/dL
High:160 to 189 mg/dL
Veryhigh:190 mg/dL and above
Accodingto NHLBI’supdated2004 cholesterol guidelines:
For indivdualsatveryhighriskforheartattack, such as those whohave hada recentheartattack or
unstable angina,the overall LDLcholesterol goalsshouldbe lessthan70 mg/dL; drugtherapywith
statinsisusuallyrecommendedtoreachthisgoal.
For paientsathighriskfor heart attack,LDL cholesterol goalsshouldbe lessthan100 mg/dL withan
optional goal of lessthan70 mg/dL,and drug therapyisusuallyrecommendedtoreachthese goals.
High-riskindividualsinclude people withknownatherosclerosis(suchasthose withapriorheart attack,
stroke or peripheral arterial disease),people withdiabetesorkidneydiseaseorpeople withenoughrisk
factors to give thema10-year riskof a heart attack of more than 20 percentunderthe FraminghamRisk
Score.Studiessuggestthathigh-riskandveryhigh-riskpatientsmaybenefitfromstatintherapyevenif
theircholesterol levelsare notelevatedtopreventfurtherevents.
For moderatelyhigh-riskpatients:LDLcholesterol goalsshouldbe set forlessthan130 mg/dL (orbetter
yet,lessthan100 mg/dL) anddrug therapyshouldbe usedatLDL levelsof 100 to 129 mg/dLto reach
thisgoal.Moderatelyhigh-riskindividualsincludethose whose10-yearriskof a heartattack is10
percentto 20 percent,those withmore thantworiskfactors forheart disease,thosewithapositive
familyhistoryof premature coronarydiseaseorthose withthe metabolicsyndrome.
For low-riskpatients,LDLcholesterolgoalsshouldbe lessthan160 mg/dL.Low-riskindividualsare those
whose 10-yearriskof heartdisease islessthan10 percent,andwho have lessthantworisk factorsfor
heartdisease.Usually,lifestyle changessuchasdietandexercise are recommendedfirst,butdrug
therapycan be addedif these are not enoughtomeettheirgoal.
Note that lifestylechangessuchasdietandexercise are recommendedforeveryone—eventhose on
drug therapy!Whenlifestylechangesalone are notadequate,the mostcommonclassof medications
usedto treathighcholesterol iscalledstatins(examplesinclude atorvastatin(Lipitor),simvastatin
(Zocor),rosuvastatin(Crestor),pravastatin(Pravachol),lovastatinandfluvastatin).Statinsare highly
effectiveinreducingcholesterol levelsandalsoreduce the riskof havingafirstor recurrentheartattack.

10. In fact,while there are several typesof cholesterol-loweringmedicationsavailable,atthistime the
groupof cholesterol medicationscalledstatinshave beenshowntobe the mosteffectiveatreducing
cardiovascularevents.Thus,if cholesterol-loweringmedicationsare indicated,statintherapyshouldbe
the firsttherapyusedforpreventingsubsequentcardiovasculareventsinmostindividuals,especiallyin
high-riskandveryhigh-riskindividuals.If anindividual cannottolerate one particularstatindue toside
effects,usuallyothertypesof statinsatlowerdosescanbe tried.Once an individual ismaximizedonthe
highestdose of statintolerated,if theirLDLcholesterol isstill notatgoal,anothercategoryof
cholesterol medicationscanbe addedtotheirregimen.
Triglyceride (anothertype of lipid) levels:
Ideal:Lessthan100 mg/dL
Normal:lessthan150 mg/dL
Borderline high:150 to 199 mg/dL
High:200 to 499 mg/dL
Veryhigh:500 mg/dL and higher
Normal triglyceridesare consideredlessthan150 mg/dL.If you’re atmoderate or highriskfor heart
disease andstill have hightriglycerides(despite reachingyourcholesterol goal withastatin),youmay
require anadditional medication.Thisincludesafibrate suchasgemfibrozil (Lopid)orniacin.Fishoil and
omega-3fattyacids mayalso helpreduce triglyceridelevels.The maintargetof therapyisachievingyour
LDL goal.A secondarytargetisyour non-HDLcholesterol.Non-HDLisyourtotal cholesterolminusyour
HDL cholesterol.Thisnumberreflectssome of the otheratherogeniclipidproblems,suchaselevated
triglycerides.The non-HDLgoal istypically30pointshigherthanyour LDL goal.For example,if yourLDL
goal is lessthan100 mg/dL,yournon-HDL goal islessthan130 mg/dL).Specifictreatmentdependson
your cholesterollevel andotherriskfactors,butingeneral,the firststage of treatmentislifestyle
changes,suchas improvementsindietandexercise.If lifestylechangesdon’twork,statindrugsare
usuallytriedfirst,and othermedicationsmaybe addedif necessary.
LDL particles.
Cholesteroliscarriedintothe vessel wallthroughparticlescalledlipoproteins.Dependingonitssize,
each particle carriesdifferentamountsof cholesterol withinit.Manypatientswithdiabetesor
metabolicsyndrome donothave elevatedbloodlevels of total orLDL cholesterol,buttheyhave
elevatedtriglyceridesandlowlevelsof the goodHDL cholesterol.Thisisassociatedwithapatternof
small,dense LDL-particlesize,whichislinkedtopromotingatherosclerosis.A standardlipidbloodtest
will give youthe LDL level concentrationbutdoesnottell youaboutyourtotal particle count.Incertain
caseswhenmore informationisneededtodetermine yourrisk,yourdoctormayorderteststo measure
your LDL particle size oryour total LDL particle count.Ina givenlipidbloodconcentration,therewillbe
more total particlesif yourparticle size issmall andfewertotal particlesif yourparticle size islarge.

11. There isalso a testcalledapolipoproteinB(apoB),whichisagood estimate of yourtotal countof the
bad atherogenicparticles.
Your doctor mayorder bloodtestsotherthanlipidlevels,todetermineyourriskof heartdisease.These
include:
 Fastingsugar (highlevelsmaymeandiabetesorprediabetes)
 Insulinlevels(highlevelsmaymeandiabetesorprediabetes)
 Kidneyfunction(abnormal kidneyfunctionisariskfactor forheart disease)
 C-reactive protein(highlevelsof CRPsuggestinflammationinthe bodyandisa markerfor
increasedriskof heartdisease)
Ankle brachial index.
Thissimple testperformedinahealthcare professional’soffice screensforperipheral arterial disease
(PAD).The bloodpressure readingmeasuredineachlegisdividedbythe average bloodpressure
readinginbotharms. Normally,the bloodpressure inthe legsisthe same orhigherthanthe blood
pressure inthe arms,so a value of 1 or higherisnormal.AnABI of lessthan0.90 suggestsperipheral
arterial disease.Evenif youdon’thave anysymptoms,butdohave PAD,youshouldbe treated
aggressivelywithmedical therapybecauseyouhave ahigherriskforfuture cardiovascularevents,
includingheartattacksandstrokes.There are otherteststhatcan helpyourhealthcare professional
determine if youhave atherosclerosis.These are:
Coronary angiography (or arteriography)
. Thistestis usedto explore the coronaryarteries.A dye isinjectedintothe arteryof anarm or legviaa
fine tube,orcatheterthat passesthroughthe aorta intothe arteriesof yourheart.Your heart and blood
vesselsare thenfilmedwhile yourheartpumps.The picture thatisseen,calledanangiogramor
arteriogram,showsanyblockagescausedbyatherosclerosis,aswellasotherproblems.Thisisan
invasive testandisonlyusedforhigh-riskindividualswhoare believedtohave agood chance of having
significantcoronaryheartdisease.Thisisthe mostaccurate way to assessthe presence andseverityof
coronary disease.Sometimesthisisdone incombinationwithanultrasoundprobe,whichispassed
throughthe catheterdownintothe coronary arteries.Thisprocedure iscalledintravascularultrasound
or IVUS.IVUS allowsforevenbetterdetailof the arterial wall toassessthe severityof alesionandthe
type of plaque buildup,suchas“soft”plaquesvs.“hard”plaques.
You may alsobe injectedwithafluidthatblocksX-rays,calleda“contrastmedium”or“dye,”which
allowsgettervisibilityof certaintissues.The injectionmaystingandleave ametallictaste inyour
mouth,a warm or cool sensationatthe injectionsite andinsome cases,hives.Manyof these dyesare
iodine-based,soyouneedtotell yourhealthcare professional if youare allergictoiodine.

12. If your healthcare professional decidesthatyouneedtohave an angiography,youmayhave to fastfour
to six hoursbefore the testbecause of the sedative medicationsyoureceive duringthe test.
If a significantblockageisfoundduringthe angiogram, the cardiologistmaytryto openup the blockage
witha balloonwithorwithouta stent—aprocesscalledangioplasty.
Imaging tests.
To studyyour arteriestodetermine whetherornotyou have hardeningornarrowingof large arteriesor
calciumdepositsonarterywallsorto determine otherinformationaboutthe structure orfunctionof
your heart,yourdoctor may use imagingtechniquessuchasa computerizedtomography(CT) scanor a
magneticresonance angiogram(MRA),anoninvasive testthatgivessimilarinformationtoa CT scan
withoutusingX-rays.A non-contrastcardiacCT can detectcalciumbuildupinthe arteries,whichisa
markerof atheroscleroticplaque (calciumshowsuponthe CT as brightwhite,similartobone,andcan
be seenwithoutcontrast).Thisiscalledacoronary arterycalcium(CAC) score and issometimesordered
inintermediate-riskindividualsforscreeningwhenfurtherassessmentof CHDrisk isneeded.People
withhighlevelsof CAChave alotof plaque intheirarteries,whichisassociatedwithincreasedriskof
cardiovascularevents.If youhave highCACscores,more intensifiedtreatmentsuchasstatinsmaybe
recommended,inadditiontolifestyle changes.
A cardiac CT withdye contrast (calledaCT angiogramor CTA) can furthershow whetherthere isany
narrowingor stenosisof the coronaryarteries.Because CTAshave the increasedriskof dye and
increasedradiationcomparedtonon-contrastCTs,theyare notrecommendedforroutine screening
where nosymptomsare presentbutmaybe usedforevaluationif youhave chestpainorangina.
Doppler ultrasound.
Your doctor mayuse an ultrasound tool calledaDopplerultrasoundtotake yourbloodpressure at
differentpointsonyourarm or leg.Bymeasuringthese pressures,yourdoctorcan gauge the bloodflow
throughyour arteriesaswell asthe degree of anyblockages.
Resting EKG.
An electrocardiogrammayshowsignsof priorheartdamage suchas an enlargedheartor areasof prior
heartattack. For many womenwithangina,the EKGat rest isnormal.Thisisnot surprisingbecause
symptomsof anginaoccur duringstress.Therefore,yourheart’sfunctioningmaybe testedunderstress,
typicallyexercise.
Exercise stress test.
Thistestshowshowwell the heartfunctionswithincreasedphysical activity.AnEKGandbloodpressure
are takenbefore,duringandafterthe workout.Otherstresstestsinadditiontothe EKGuse
radionucleotide markerssuchasthallium, orultrasound(echocardiography),totake picturesof the
heartbefore andafterthe stresstolookfor changesinthe heart that mightsuggestblockages.Usually
the stresstestinvolvesrunningona treadmill,butif youcan’tuse the treadmill,the heartcanbe

13. stressedusingmedicationssuchasdobutamine oradenosine orsome newerstressagentssimilarto
adenosine.
Treatment
Lifestyle changes(Diet,exercise,weightloss):
Diet.
Changingyourdietaryhabitsremainsthe singlemosteffectivewaytostopatherosclerosisfrom
progressing.Eatingadietlowinsaturatedfat andcholesterol reducesbloodcholesterol,aprimary
cause of atherosclerosis.Althoughsaturatedfatandtransfatsare definitelybadforyou,othertypesof
fat,such as polyunsaturatedfatsfoundinfish(omega-3),nutsandflaxseed,ormonounsaturatedfats
foundinolive oil,maybe goodforyou.Eating lesssaturatedfatand reducingcaloriesingeneral should
alsohelpyoulose weight.Inadditiontowatchingsaturatedandtransfats, itis alsoimportanttowatch
excesssugarintake,suchas sugar,honeyandhighfructose corn syrup,whichare frequentlyfoundin
sweetenedbeveragesanddessertsandalsohiddeninmany processedfoods.The bodywillconvert
excesscaloriessuchasfromsugars intotriglyceridesasa wayof storingenergy.Soloweringyoursugar
intake will alsoloweryourtriglyceride levels,inadditiontoyourbloodglucose levels.
Reducingsodiumintake isimportantforboththe preventionandtreatmentof highbloodpressure.The
DASH (DietaryApproachestoStopHypertension) diet,endorsedbythe majorheartorganizations,isone
strategyfor loweringhighbloodpressure.Itisrichin lower-calorie foodssuchasfruitsandvegetables
and whole grainsandlowinsodium.
The TherapeuticLifestyle Changes(TLC) Dietplan,developedbythe NHLBIcallsforlessthan7 percent
of yourcaloriestocome from saturatedfatand for lessthan200 mg of dietary cholesterol.Twenty-five
percentto 35 percentorfewerof total dailycaloriescancome from fat,providedmostof these calories
are fromunsaturatedfat,whichdoesn’traise cholesterol.Sodiumintake shouldbe limitedtonomore
than 2,400 mg per day. In addition,the guidelinesencourage the use of certainfoodsrichinsoluble
fibertoboostthe diet’sLDL-loweringpower.
Exercise.
You alsocan benefitfromexercise.Recentresearchfindsthatevenmoderate amountsof physical
activityare associated withlowerdeathratesfromcoronaryheartdisease.Aslittleas30 minutesof
moderate activityonmost,andpreferablyall,daysof the weekhelpsprotectthe heartandis
recommendedbythe AmericanHeartAssociation.However,the recommendationsrise to60 to 90
minutesof moderate activitymost,andpreferablyall,daysof the weekinwomenwhoneedtolose or
maintainweight.Examplesof moderateactivityare briskwalking,bicycling,rakingleavesandgardening.
Vigorousexercise includesrunning,jogging,swimminglapsandcross-countryskiing.Beingphysicallyfit
and active providescardiovascularbenefitsindependentof weightloss.Wearingapedometermayhelp
youkeeptrack of your physical activity.The AmericanHeartAssociationrecommendsaimingfor10,000

14. stepsa day,whichis five miles(2,000 stepspermile),butall stepscount.Aimtogetmore stepsinyour
day bytakingstairs insteadof elevators,parkingfartherawayandothersmall changes.
Weight loss.
If you are overweight,losingweightcanhelplowerbloodcholesterol levels.Itisalsothe most effective
lifestyle change toreduce highbloodpressure,anotherriskfactorforatherosclerosisandheartdisease.
The bestway to lose weightisthroughacombinationof dietandexercise.
Pharmacologic(drug) therapies:
1. Anti-platelet(orblood-thinning) medications.Yourdoctormay prescribe ananti-plateletmedication,
such as aspirinorclopidogrel (Plavix) toreduce yourchancesof a bloodclotif you have atherosclerosis
or are at highriskfor it.
2. Anticoagulants.Anticoagulants,suchasheparinorwarfarin(Coumadin),canalsohelppreventclots
fromforming.Warfarinmaybe prescribedif youhave heartarrhythmiascalledatrial fibrillationor
flutterorif you have had certaintypesof strokes.Neweranticoagulants,suchasdabigatran,
rivaroxabanandapixaban,canbe usedin place of warfarinforcertainindicationslike atrial fibrillation.
3. Cholesterol-loweringtherapies.Cholesterol- andtriglyceride-loweringmedications thatmaybe
recommendedinclude:
Statins.Six statindrugsare available inthe UnitedStates:atorvastatin(Lipitor),fluvastatin(Lescol),
lovastatin(Mevacor,Altoprev),pravastatin(Pravachol),simvastatin(Zocor) androsuvastatin(Crestor).
In addition,statinsare foundinthe combinationmedicationslovastatinandniacin(Advicor),
atorvastatinandamlodipine (Caduet),andsimvastatinandezetimibe (Vytorin).Statinsare most
effectiveatloweringthe LDLcholesterol,buttheymayalsohave modesteffectsonraisingHDL
cholesterol andloweringtriglycerides.Theyare generallythe first-linemedicationsused.Makesure you
talkto your healthcare professionaltosee if youare a candidate forstatintherapy.If youexperience
any side effectssuchasmuscle achesordark urine,stoptakingthe drug immediatelyandcall your
healthcare professional.
Niacin.Niacinisawater-soluble Bvitamin.Unfortunately,youcan’tloweryourcholesterol bytakinga
vitaminsupplement;tohave suchan effect,it mustbe takenindoseswell above the dailyvitamin
requirement.Althoughnicotinicacidisinexpensive andavailable overthe counter,nevertake itto
loweryourcholesterol withoutguidance fromahealthcare professionalbecause of potential side
effects.The extendedrelease formisavailable byprescriptionasNiaspan.Itdecreasestriglycerides,
raisesHDL-cholesterolandmodestlylowersLDL-cholesterol.Unfortunately,thismedicationcauses
some people toitchand flush(turnred).

15. Bile acidsequestrants.The three mainbileacidsequestrantscurrentlyprescribedinthe UnitedStates
are cholestyramine resin(Questran),colestipol (Colestid) andcolesevalam(WelChol).Available as
powders,tabletsorgranules,thesedrugsworkbybindingwithbile acidsthatcontaincholesterol inthe
intestines.Theycanbe prescribedalone orincombinationwithanotherdrug.
Fibrates.These drugsreduce triglyceridesbyreducingthe liver’sproductionof LDLcholesterol and
assistinginthe removal of triglyceridesfromthe blood.The mostwidelyusedfibratesinthe United
Statesare gemfibrozil (Lopid) andfenofibrate (Tricor).Fibratesare notrecommendedasthe sole drug
therapyforwomenwithheartdisease forwhomLDL cholesterolreductionisthe maingoal.
Cholesterolabsorptioninhibitors.Thisclassof drugslowerscholesterol bypreventingitfrombeing
absorbedinthe intestine.The firstapproveddruginthisclassisezetimibe(Zetia).Itmaybe usedalone
or togetherwitha statin.
Omega-3fatty acids.Omega-3fatty acidssuch as fishoil maybe helpraise HDL cholesterol andlower
elevatedtriglycerides.Itcanbe givenina prescriptionformoroverthe counter.
Drugs forperipheral arterial disease
If you have severe painorcrampinginyour legswhenyouwalk,yourhealthcare professional may
recommendclopidogrel (Plavix),cilostazol(Pletal) orpentoxifylline (Trental).Cilostazol isgenerally
avoidedinindividualswithcongestiveheartfailure.
If you take medicationtoimprove yourcholesterol,lowerbloodpressureortreatotherheart disease
symptoms,be sure toask about potential sideeffects;interactionswithothermedications,foodor
beverages;andwhenandhowyoushouldtake the prescribedmedications.
Revascularizationproceduresfor atherosclerosis
In the past,openingarteriesdamagedbyatherosclerosisaroundthe heartmeantperformingbypass
surgery(openheartsurgery),requiringthatthe chestbe openedsurgicallyandbloodflow redirected
aroundthe damagedartery.Now, alternativestoopenheartsurgery,suchasballoonangioplasty,allow
for a quicker,lesspainfulrecovery.However,noteveryone isacandidate forballoonangioplastyand
some people stillrequiresurgery.Also,noteveryone withatherosclerosisrequiresopeningthe arteries
withangioplasty.Some individualswithstable coronaryarterydisease andstable anginamaybe

16. candidatesfortreatmentwithaggressive medical therapyalone.These decisionsdependonthe
individual,the typesof blockages,the resultsof stresstesting,the severityof symptomsandother
factors.
Coronaryangioplastyorballoonangioplasty.Yourhealthcare professional will firstperformacoronary
angiogramto see whicharteriesare blocked.Throughacatheter(ortube) inyour leg(femoral) orarm
(brachial) artery,acatheterwill be advancedtothe heartand dye will be injectedintothe coronary
arteries.If angioplastyisindicated,the cardiologistwillpositionacatheterwithatinyballoononitstip
inthe narrowedcoronary.The balloonisinflatedanddeflatedtostretchor breakopenthe narrowing
and improve the passage forbloodflow.Typically,yourdoctorwill insertastent,asmall scaffolding
designedtopropthe arteryopen.Asthe ballooninflates,itexpands the stent.Angioplastyisnot
surgery,andit isperformedwhileyouare awake.Ittypicallytakesaboutone ortwo hours.But there is
recoverytime whichgenerallyinvolveslayingflatforthree tosix hoursafterthe procedure toallowthe
leg(or arm) artery to heal topreventbleeding.If angioplastydoesn’twidenthe arteryorif complications
occur, bypasssurgerymaybe needed.Patientswithcertaintypesof blockagesmaynotbe candidates
for angioplastyandmaybe referredforbypasssurgery.
One continuingchallenge cardiologistsface intreatingatherosclerosisisthatplaque depositsmay
return(a conditionreferredtoas restenosis).Evenpatientswho’ve hadangioplastiessometime require
future treatmentstowidenarteriescloggedwithnew blockage.Today,new drug-coatedstents
markedlydecrease the ratesof restenosiscomparedtothe oldergenerationof stents.Additionally,new
drugsand newtypesof stentsare indevelopment,andthe future ispromisingforadvancementsinthis
area.
Atherectomy.Coronaryatherectomyisaprocedure thatremovesplaque fromthe arteriesthatsupply
the heart muscle usingarotatingshaveror lasercatheter.Atherectomymaybe followedwithstenting
or balloonangioplasty.
Endarterectomy.Thissurgical procedure,performedundergeneral anesthesia,removesplaque from
your arteries.Foryourcarotidarteries,the surgeonmakesacut in yourneck,opensthe arterythere,
and removesplaque until the inside of the arteryiscleanandsmooth.
Thrombolytictherapy. If abloodclotis blockinganartery,yourdoctor may insertadrug directlyinto
that arteryat the pointof blockage tobreakup the clot at the time of angiography.Duringanacute
heartattack, if angioplastyisnotimmediatelyavailable atyourhospital,doctorsmaygive thrombolytic
therapyveintobreakup clotsin yourbody.There are some riskstothrombolytictherapyincluding
bleedinginthe brain.Thusif angioplastyisavailable,thisisgenerallypreferredtosystemicthrombolytic
therapyforheart attacks.
Coronaryartery bypass.Inthissurgery,a bloodvessel (usuallytakenfromthe leg,armor chest) issewn
ontothe blockedarterysobloodcan bypassthe blockedarea.Several bypassescanbe performedif
several arteriesare blocked.Bypasssurgeryrelievessymptomsof heartdisease butdoesnotcure it.You
will still needtomake lifestylechangeslike those describedearlierandtake medications.

17. Prevention
Try to follow these tips to prevent atherosclerosis:
Quitsmoking.Smokingacceleratesthe developmentof atherosclerosis,whichoftenleadstocoronary
heartdisease.Womenwhosmoke are twotosix timesas likelytosufferaheartattack as nonsmoking
women,andthe riskincreaseswiththe numberof cigarettessmokedperday.The goodnewsisthat
quittingdramaticallycutsyourrisk,evenduringthe firstyear,nomatterwhatyourage.
Loweryour bloodpressure.Evenslightlyhighbloodpressure levelscandouble yourriskforheart
disease.Normal bloodpressure islessthan120/80 mm Hg. High bloodpressure,orhypertension,isa
bloodpressure readingof 140/90 mm Hg or higher.Between120/80 mm/Hgand 139/89 mmHg is
consideredprehypertension.Highbloodpressure alsoincreasesyourchance of stroke,congestiveheart
failure and kidneydisease.Highbloodpressurecanbe treatedsuccessfullywithmedication.Commonly
prescribeddrugsinclude diuretics,angiotensin-convertingenzyme inhibitors(ACEinhibitors),
angiotensinIIreceptorblockers,betablockersandcalciumchannel blockers(CCBs).
If your bloodpressure isnottoohigh,you maybe able tocontrol it entirelythroughweightloss(if you
are overweight),regularphysical activityandcuttingdownonalcohol,aswell assaltand sodium.
Sodiumisan ingredientinsaltthatis foundinmanypackagedfoods,carbonatedbeverages,bakingsoda
and some antacids.
Get regularexercise andlose weight.Fortunately,itdoesn’ttake alotof time or efforttobecome
physicallyactive.Aslittle as30 minutesof moderate activityon most,andpreferablyall,daysof the
weekhelpsprotectthe heartandisrecommendedbythe AmericanHeartAssociation.The
recommendationsrise to60 to 90 minutesof moderate activitymost,andpreferablyall,daysof the
weekinwomenwhoneedtolose ormaintainweight.Examplesof moderate activityare briskwalking,
bicycling,rakingleavesandgardening.Vigorousexercise includesrunning,jogging,swimminglapsand
cross-countryskiing.Youcandividethe 30 to 90 minutesof moderate activityintoshorterperiodsof at
least10 minuteseach.If youalreadyengage inthislevel of activity,youcangetaddedbenefitsbydoing
more.
Control yourbloodsugar if youhave diabetes.Diabetesistypicallydiagnosedbya fastingglucose
(sugar) over125 mg/dL. Patientswithdiabetesshouldbe treatedtopreventcomplicationsfrom
cardiovasculardisease;treatmenttypicallyconsistsof acombinationof lifestyle changesand
medications.Yourgoal hemoglobinA1Cwithtreatmentshouldbe lessthan7percent.Those with
diabeteswhoalsohave goodsugarcontrol are much lesslikelytodevelopcardiovascularcomplications
than those withpoorsugar control.Those individualswithafastingglucose (sugar) of 100 to 125 mg/dL
may be consideredprediabetesorglucose intolerant.Thisisoftenassociatedwithmetabolicsyndrome,
and individualswithglucose intolerance are athighriskfor developingtrue diabeteswithinthe next10
years.Weightloss,healthydietandexerciseare importanttoimprove bloodsugarlevelsandprevent
the onsetof diabetes.

18. Loweryour LDL-cholesterollevel.Accordingtothe CentersforDisease Control andPrevention,about
one ineverysix adults—or16.3 percentof the UnitedStatesadultpopulation—hashightotal
cholesterol.More womenhave highcholesterol thanmen.
Keeptriglyceridesincheck.The lipoproteinprofilethatdeterminesyourcholesterol levelsalsomeasures
anotherfattysubstance calledtriglyceride.Producedinthe liver,triglyceridesare made upof saturated,
polyunsaturatedandmonounsaturatedfats.The optimaltargettriglyceridelevel forindividualswithout
heartdisease orheartdisease-relatedriskfactorsislessthan100 mg/dL.Formostpeople,cuttingback
on foodshighinsaturatedfatand cholesterol andeating more fiberwill lowerbothtotal andLDL
cholesterol.Regularphysical activityandweightlossif you’re overweightalsoreducesbloodcholesterol
levels.Losingextraweight,quittingsmokingandbecomingmore physicallyactive mayalsohelpboost
HDL cholesterollevels.Losingweight,exercisingandcuttingbackon sugar intake canhelplower
triglycerides.
Facts to Know
1. Atherosclerosisisoftenthe firststage of coronaryheartdisease.
2. Diseasescausedbyatherosclerosisare the leadingcause of illnessanddeathinthe United
States.
3. Atherosclerosisoccurswhenyourarteriesnarrow andbecome lessflexible because cholesterol,
fattysubstances,cell waste products,calciumandfibrin—collectivelycalledplaque—collecton
theirinnerwalls.The arteries respondtothe buildupbybecominginflamed,causingscartissue
and othercellstoform inthe affectedareas,furthernarrowingthe artery.
4. What causesplaque tobeginbuildingupisn’tknown.Some expertsthinkplaque beginsto
accumulate inplaceswhere the innerlayerof anarterybecomesdamaged,possiblybyelevated
cholesterol levels,elevatedtriglyceride levels,highbloodpressureorcigarette smoke.
5. A woman’sriskof developingatherosclerosisandheartdisease increasesasshe ages.Priorto
menopause,estrogenproducedinthe ovariesprovidessome protectionfromheartdisease.
However,hormone replacementinwomenaftermenopausedoesnotreduce the riskof
cardiovasculardisease.Andrememberthatwomenwithdiabetesorthose whosmoke are at
riskfor heartdisease throughouttheirlives.
6. Atherosclerosiscanaffectmediumandlarge arteriesanywhereinyourbody,restrictingblood
flowandlimitingthe amountof oxygenavailabletoorgans.
7. Smokingacceleratesthe developmentof atherosclerosis,increasesbloodpressure andrestricts
the amountof oxygenthe bloodsuppliestothe body.
8. Changinglifestylehabitsremainsthe singlemosteffective waytostopthe atherosclerosisfrom
progressing.Changingyourdiettoone low infat,especiallysaturatedfat,andcholesterol helps
reduce highbloodcholesterol,aprimarycause of atherosclerosis.
9. If you’re overweight,losingweightcanhelplowerbloodcholesterol.Itisthe mosteffective
lifestyle change forreducinghighbloodpressure,another riskfactorforatherosclerosisand
heartdisease.

19. 10. Highbloodpressure,smoking,highcholesterol,elevatedtriglycerides,obesity,diabetesandlack
of exercise jeopardizethe functionof the majorheartarteriesandare particularlythreatening
to women’shealth.
Key Q&A
1. What isatherosclerosis?Oftenreferredtoas“hardeningof the arteries,”atherosclerosisoccurs
whenyourarteriesnarrowand become lessflexible becausecholesterol,fattysubstances,cell
waste products,calciumandfibrin—collectivelycalledplaque—collectontheirinnerwalls.The
arteriesrespondtothe buildupbybecominginflamed.Thiscausesscartissue toformand other
cellstocollectinthe affectedareas,furthernarrowingthe artery.Atherosclerosisisaformof
arteriosclerosis,whichisageneral termfor the natural hardeningof yourarteriesthathappens
withage.
2. What causesplaque tobuildup?We don’tknow.Some expertsthinkplaqueaccumulatesin
placeswhere the innerlayerof anarteryis damaged,possiblybyelevatedcholesterol levels,
elevatedtriglyceride levels,elevatedbloodglucose,highbloodpressure andcigarette smoke.
Smokingespeciallyacceleratesthe developmentof atherosclerosisaswell asincreasingblood
pressure andrestrictingthe amountof oxygenthe bloodsuppliestothe body.Diabetesisalsoa
majorrisk factor,and stresshas alsobeenimplicated,althoughitsexactassociationwithheart
disease hasnotbeendetermined.There are alsogeneticfactorsthatpredispose individualsto
earlyatherosclerosis.
3. Will IknowI have atherosclerosisbyrecognizingthe symptoms?Notnecessarily.Oftenthe
disease progressesforalongwhile before complicationsorsymptomsarise.However,there are
some conditionsthatmayhintat an atherosclerosisdiagnosis,includingchestpain,orangina.
However,itisestimatedthattwo-thirdsof womenwhodie suddenlyfromcoronaryheart
disease hadnopriorsymptoms.Therefore itisimportantthatyougetscreenedfor
cardiovasculardisease riskfactorsandtreated asappropriate because waitingforsymptomsto
developmaybe toolate.
4. What can I do to preventatherosclerosis?Changingyourhabitsremainsthe single mosteffective
wayto stop the disease fromprogressing.Changingyourdiettoone low insaturatedfat and
cholesterol helpsreduce highbloodcholesterol,aprimarycause of atherosclerosis.A moderate
amountof the healthierpolyunsaturatedandmonounsaturatedfatssuchasinfish,nutsand
olive oil maybe helpful butbe aware of total caloriesconsumed perday.Eatinglesssugarand
eatinga dietenrichedinfruits,vegetablesandfibershouldalsohelpyoulose weight.If youare
overweight,losingweightcanhelplowerbloodcholesterol andisthe mosteffectivelifestyle
wayto reduce highbloodpressure,anotherriskfactorforatherosclerosisandheartdisease.
You alsocan benefitfromexercise.
5. Is atherosclerosisdangerous?Yes!Asthe disease progresses,itcancompletelyclogarteries,
cuttingoff bloodflow.Thisisespeciallydangerousinarteriesnearthe brain,the heartorother
vital organs.Completelyornearlyblockedbloodflow tothe heartcan leadtoa heartattack and
kill muscle cellsinthe heart.The resultispermanentheartdamage.Plaque mayalsobreakloose

20. suddenlyandtravel throughthe bloodstreamtoyourbrainor heart,causinga stroke or a heart
attack.
6. Whicharteriesare most at riskfor atherosclerosis?Althoughatherosclerosiscanaffectmedium
and large arteriesanywhere inyourbody,those goingtoyourbrain(carotid), heart(coronary)
and legs(femoral oriliac) are mostat risk.
7. How quicklydoesatherosclerosisoccur?While atherosclerosistypicallyprogressesgradually—
sometimesevenstartinginchildhood—youare mostat riskwhenarterial blockage buildsup
quickly, completelyclosingoff anartery.Thiscan happenif plaque rupturesanda clotforms.
8. Doesmy riskincrease asI age?Yes!Priorto menopause,womenare somewhatprotectedfrom
heartdisease,inpart,byestrogenproducedbythe ovaries.The body’sownnatural estrogen
helpskeepyourarteriesfree fromplaquebyimprovingthe ratioof LDL (low-densitylipoprotein)
and HDL (high-densitylipoprotein) cholesterol.Italsoincreasesthe amountof HDL cholesterol,
whichhelpsclearLDL cholesterol—the kindthatmostcontributestoplaque buildup—fromthe
bloodstream.However,supplemental estrogenorestrogentherapyisnotrecommendedafter
menopause topreventagainstatherosclerosisandheartdisease.Also,if youhave afamily
historyof earlyheartdisease orif youhave diabetesorsmoke,youare at riskforheart disease
evenbefore menopause.
9. Althoughriskincreaseswithage,atherosclerosisisaprocessthat developsoveryears,sodon’t
put off makinglifestylechangesuntilyouare olderbecause itmay be too late.Itis importantto
start withheart-healthyhabitsinyouthandmiddle age topreventcomplicationslaterinlife.
Adultswithevenone majorriskfactorforheart disease bythe age of 50 have an increased
lifetimeriskof cardiovasculardisease andshortermediansurvivalcomparedtoadultswithno
riskfactors.
For more informationvisitusourwebsite:http://www.healthinfi.com