Atherosclerotic cardiovascular disease, or ASCVD, refers to a group of conditions that develop when plaque accumulates inside the arteries. This plaque, made of cholesterol, fatty substances, cellular waste products, calcium, and fibrin, can narrow and harden arteries, restricting blood flow. Conditions such as heart attack, stroke, and peripheral artery disease are manifestations of ASCVD. Understanding the factors that contribute to this plaque buildup and actively managing them is important for preventing these serious health events.
Major Risk Factors
Several factors contribute to the development of ASCVD, broadly categorized into those that can be influenced and those that cannot. Among the modifiable risk factors, high blood pressure, or hypertension, significantly strains artery walls, promoting damage and plaque formation. This excessive force on blood vessel linings initiates a process that can lead to atherosclerosis.
High cholesterol, specifically elevated levels of low-density lipoprotein (LDL) cholesterol, directly contributes to plaque buildup within arteries. LDL cholesterol, often termed “bad” cholesterol, infiltrates artery walls, triggering an inflammatory response that forms atherosclerotic plaques. Conversely, low levels of high-density lipoprotein (HDL) cholesterol, which helps remove excess cholesterol from the arteries, can also increase risk. Diabetes, characterized by elevated blood sugar levels, damages blood vessels throughout the body over time. High glucose levels make artery walls stiffer and more prone to inflammation, accelerating atherosclerosis and increasing the likelihood of complications.
Smoking damages the inner lining of blood vessels, making them more susceptible to plaque formation. It also reduces oxygen delivery to the heart and increases blood clotting risk, increasing the chances of a heart attack or stroke. Obesity, particularly abdominal obesity, is linked to chronic inflammation, insulin resistance, and unfavorable cholesterol profiles, all of which promote ASCVD. Physical inactivity contributes to obesity, high blood pressure, and unhealthy cholesterol levels, while an unhealthy diet, rich in saturated fats, trans fats, cholesterol, sodium, and added sugars, directly fuels the processes that lead to plaque accumulation.
Non-modifiable risk factors also play a role in ASCVD development. Advancing age is a primary factor, as the risk of ASCVD increases as individuals get older, with arteries naturally stiffening over time. Sex also influences risk, with men developing ASCVD earlier in life than women, although women’s risk increases after menopause. A family history of early ASCVD in a parent or sibling suggests a genetic predisposition that can increase an individual’s susceptibility.
Assessing Your Risk
Healthcare professionals employ a systematic approach to assess an individual’s overall ASCVD risk, helping to guide personalized prevention strategies. This process often involves the use of risk calculators, which integrate various factors to estimate the likelihood of experiencing a cardiovascular event within a specific timeframe. Risk calculators, such as the Pooled Cohort Equations, consider factors like age, sex, cholesterol levels, blood pressure, diabetes status, and smoking history to generate a risk score.
Blood tests are a routine part of this assessment:
- Blood tests provide objective data on cholesterol levels, including total cholesterol, LDL, HDL, and triglycerides.
- Glucose levels are measured to identify prediabetes or diabetes.
- Regular blood pressure measurements identify hypertension.
- Discussions about lifestyle habits, such as diet, physical activity, and smoking status, are integrated.
- Family medical history, particularly any early onset of heart disease in close relatives, provides insight into potential genetic predispositions.
Strategies for Risk Reduction
Implementing specific strategies can lower an individual’s ASCVD risk by addressing modifiable factors. Adopting a heart-healthy eating pattern, with approaches like the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet emphasizing fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting saturated and trans fats, sodium, and added sugars. Regular physical activity helps maintain a healthy weight, improves cholesterol levels, and lowers blood pressure.
Maintaining a healthy body weight directly reduces the strain on the cardiovascular system and improves metabolic health markers. For individuals who smoke, cessation rapidly improves vascular function and lowers the risk of heart attack and stroke. Stress management techniques, such as mindfulness, yoga, or deep breathing exercises, can help mitigate the physiological effects of chronic stress, which can contribute to elevated blood pressure and inflammation.
Medical management also plays a role in risk reduction, particularly for individuals with established conditions like high blood pressure, high cholesterol, or diabetes. Adhering to prescribed medications, such as statins for cholesterol management, antihypertensives for blood pressure control, or glucose-lowering drugs for diabetes, is important for managing these conditions and preventing their progression. Regular medical check-ups allow healthcare providers to monitor risk factors, adjust treatment plans as needed, and provide ongoing guidance.
References
1. Goff, D. C., et al. (2013). 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Journal of the American College of Cardiology, 63(25_PA), 2935-2959.