Managing cholesterol and adopting a heart-healthy lifestyle

Despite the many continued advances in healthy lifestyle and medicine, heart disease remains the leading cause of death in the United States. According to annual statistics from the CDC, someone in the United States has a heart attack every 40 seconds and heart disease is responsible for one in five deaths. The most common type of heart disease is coronary heart disease, which is caused by coronary artery disease (CAD). Common risk factors for developing CAD are tobacco use, high blood pressure, high cholesterol, diabetes and a family history of premature coronary artery disease. CAD is caused by blockages in the arteries, which feed the heart muscle. The main component of these blockages is cholesterol.

What exactly is cholesterol? Cholesterol is a waxy substance produced by the liver. Not all cholesterol is bad, in fact, it is an important cellular building block. However, your liver naturally produces all of the cholesterol needed to build cells. The rest of the cholesterol in our bodies comes from what we eat. Processed foods and animal products can be high in saturated and trans fats which stimulate the liver to produce more cholesterol.

It is this excess cholesterol which causes a problem. When we have more cholesterol than the body needs to perform its cell building function, the cholesterol starts to accumulate in our artery walls. It first appears in the arteries as a “fatty streak.” Studies have shown that people who eat a typical American diet can start developing fatty streaks during childhood. Over time, as more cholesterol accumulates in the artery wall, it develops into plaque. The plaque triggers an inflammatory response and the body sends in helper cells to try to clean up the mess.

Unfortunately, these helper cells change the cholesterol matrix and can actually make the plaque worse. The body then begins to lay down calcium in the artery wall at the site of the plaque buildup to create a roof over the plaque to keep the cholesterol matrix separate from the blood which is pulsing through the artery. This process can go on for many years until the plaque either slowly becomes big enough to limit the blood flow, or the plaque ruptures. Plaque rupture means that the roof that was covering the cholesterol cracks, or falls off altogether, and suddenly the blood is exposed to the cholesterol matrix in the plaque. The body sees this as an injury and it starts to form a clot at the site of the “injury.” This clot limits the blood flow to the heart that is downstream from the clot. Limited or no blood flow means less oxygen and not enough oxygen to the heart means heart attack.

Because plaque development is a lifelong process, in 2018 the American Heart Association and the American College of Cardiology Guidelines on Lipid Management recommended screening the general population for high cholesterol starting at age 20. This involves a blood test to check for your levels of cholesterol. Together, in conversation with your healthcare provider, your overall risk of heart disease is assessed. Both for people who already have heart disease, and those who are at risk for developing heart disease, the management of high cholesterol is a key way to decrease overall risk.

Adopting a heart-healthy lifestyle is the first step in managing high cholesterol. A heart-healthy lifestyle includes a diet that is high in vegetables, fruits, whole grains and lean protein. There is mounting evidence that supports diets limiting animal proteins, which tend to be higher in saturated fat. In terms of exercise, it is recommended that people get at least 30 minutes of moderate intensity exercise on most days of the week. In addition, stress management is another important component of a heart-healthy lifestyle.

Depending on a person’s overall risk for heart disease, interventions such as medications are often needed in addition to a heart-healthy lifestyle. Your healthcare provider can help you determine your overall risk and make recommendations about how aggressively your cholesterol should be treated.

The most common medications used to treat high cholesterol are statins. Statins have been studied extensively and have been shown to not only help lower cholesterol but also to help stabilize plaque. In general, a stable plaque is a safer plaque. Large clinical trials have also shown that statins decrease risk of death or adverse outcome from heart disease. Of course, as with all medications, there is a risk of side effects. This is why the decision to start a medication is made through a shared decision-making process with your healthcare provider and considers your overall risk for heart disease.

Some people are unable to tolerate statins or continue to have plaque progression despite taking oral medications. There have been some exciting developments in lipid management over the past few years. There are now injectable and oral medication options that work differently than statins and can be used in addition to, or in the place of, statins. These newer medications have been shown to significantly decrease cardiovascular events in very high-risk populations.

After joining the Heart & Vascular Center at Valley View in 2007, I saw firsthand the impact of heart disease on the people of our community. I became passionate about preventing heart disease, either from occurring in the first place or slowing its progression in people who had already developed heart disease. Talk to your primary care provider or one of the providers at the Heart & Vascular Center at Valley View about your risk for heart disease and what steps you can take to decrease your risk. There are many excellent resources in our community to help reduce your risk of heart disease including cardiopulmonary rehabilitation therapy and more at Valley View’s Heatlh4Life program, the public health department, local health clubs, and various incentive programs offered by employers or health insurers. Adequately treating cholesterol and addressing the risk factors which put someone at risk for the development or progression of heart disease are key steps in reducing the potentially life changing effects of heart disease on you and your loved ones.

Julianne Doherty, PA-C, is a clinical lipid specialist and has provided advanced lipid management to patients at Valley View for the past 13 years. For more information, visit www.vvh.org/heart-and-vascular or call 970.384.7290.