Cardiovascular Disease

By Jake Foster, PA

 

Cardiovascular disease remains the #1 killer in the world. The death toll from cardiovascular disease surged from around 12 million people in 1990 to over 20 million deaths worldwide in 2020. It is a silent killer, often with the first symptom of heart disease being sudden death from a heart attack seemingly out of the blue. The heart is wondrous organ, pumping ceaselessly through our lives, adjusting its rate and output quickly as the demand for blood in our tissues changes minute to minute with activity. The blood vessels perfused by the heart are also an impressive network of arteries, capillaries and veins stretching more than 60,000 miles in our body, enough to circle the globe more than twice. Although it’s a wonderful system, it is far from perfect. It is prone to develop plaques and hardening just through the course of our daily living. There is no debate as to the origin of these plaques, it is very well understood. Although there are many factors that contribute to cardiovascular disease, today we will focus on the role of LDL cholesterol in this development of cardiovascular disease, and what we can do about it.

 

“Cholesterol” has become somewhat of a dirty word over the last several decades. Cholesterol is a type of lipid that is essential to life, playing a vital role in every cell in our body. But it turns out, it is not the cholesterol itself that is the root problem in cardiovascular disease, it is the packaging particle the body uses to transport the cholesterol in our body that leads to problems. To transport cholesterol, it must be packaged in carrier molecules that we can refer to as lipoproteins (the 2nd “L” in LDL cholesterol). An unfortunate result of this packaging occurs when this lipoprotein penetrates the walls of our blood vessels, causing a cascade of events in the blood vessel wall which results in inflammation in the vessel, and eventually a scar like plaque formation in the artery. This plaque formation and hardening of the artery is the very “heart” of cardiovascular disease. These lesions in the arteries are the result of a function of both time and particle number; the higher the number of these particles, and longer they are in the bloodstream, the more rapidly these lesions form. We all have these lesions, even people in their teens start to develop them, and by the time we have reached the 4th or 5th decade of life, we could be sitting on a ticking time bomb in our blood vessels.

 

Getting these lipoprotein particles under control is essential to maintain cardiovascular health. The frustrating thing about this is that for a lot of people, no matter what is done with lifestyle, there will still be enough of these particles in the bloodstream to cause this damage in the blood vessels. Yes, of course, a healthy diet and regular cardiovascular exercise can bring some of these particles down and decrease your risk. But a lot of us will simply have too many of these particles, no matter how perfect our diet or our exercise routine is. This is due to a genetic predisposition many of us have where our liver simply makes more of these particles than is necessary.

 

Statin medications have been around for nearly 40 years. They are extremely effective in reducing the lipoprotein numbers and thereby reducing risk of these plaque formations and even stabilizing them when they do form. Unfortunately, “statins” carry a stigma these days much like the stigma “cholesterol” itself has carried for many decades. It is true that a non-trivial number of people have side effects from statins, such as muscle aches. This has led to a lot of hesitancy with people in starting these medications. But these are not permanent side effects and often can be avoided by simply switching to a different type of statin or even lowering the dosage of the statin. But the fact of the matter is that there really is no quicker way RIGHT NOW to reduce the risk of cardiovascular disease by lowering the harmful lipoprotein particle than with the use of a statin. These medications are best taken as early as possible if high levels of the harmful lipoprotein are detected in a routine blood test. There are promising new medicines in our future that may do an even better job than statins, even without side effects. But until we have these in hand, the best way to reduce the number of harmful lipoproteins is to start a statin if it is indicated. It is worth at least considering, your heart may very well depend on it.

A lipid panel is a routine blood test covered by insurers and can be done at your routine yearly wellness physical. It is very much worth your time to know what your LDL numbers are. Talk to your doctor about these numbers at your wellness visit, and you and your doctor can work together to determine your risk and what the best course of action could be to reduce the chance of cardiovascular disease being a part of your future.