We all want to live long, happy and healthy lives – and taking care of our hearts is an essential part of good health and longevity. In this blog I want to tell you a bit about cholesterol and how this complex substance relates to heart disease. In an upcoming blog we’ll look at how to prevent the build-up of the wrong kinds of cholesterol so that we can maintain or restore good heart health.

There was a time when doctors thought of cholesterol as a single compound. We now know that cholesterol actually comes in a wide variety of sizes and shapes, and the names we give to these types are based on their density. The lightest and most buoyant cholesterol is now classed as “very low density lipoprotein” or VLDL. For a variety of reasons, VLDL is the most problematic form of cholesterol you can have in your bloodstream. The second common form of cholesterol is abbreviated “LDL,” which stands for low-density lipoprotein. This form of cholesterol is the most plentiful in most human beings. LDL poses a problem for us because it is easily oxidized into a form which triggers inflammatory reactions within the bloodstream – and as we’ll see below, that is a critical step in developing plaque deposits. Two more common forms of cholesterol are called intermediate density lipoprotein, or IDL, and high-density lipoprotein or HDL.

“Plaque” is the thick, viscous layer that builds up inside the artery walls and blocks the blood flow to the heart. Plaque is generated when LDL cholesterol, the most common form, is damaged or oxidized within your bloodstream by either blood sugar or free radicals. Your immune system sees this damaged LDL as an undesirable substance and sends white blood cells, the same ones tasked with destroying bacterial invaders, to attack and engulf the damaged LDL cholesterol. They do this so efficiently that the white blood cells rapidly become filled with cholesterol until they look under the microscope like they are filled with foam.  For this reason we call them “foam cells.” These foam cells then migrate through the lining of the artery to a position over the muscular layer that forms the arterial wall, gradually growing in thickness. This build-up is called plaque.

Plaque progressively narrows the opening on the interior of the artery so that there is less and less room for blood to pass through. As the arteries have less and less capacity to carry blood to the heart muscle our ability to exercise begins to decline and we start feeling a bit tired. Most of the time we simply pass this fatigue off as a normal consequence of aging – but it is not. It is in fact an early sign of heart disease. Often those in the beginning stages of heart disease experience few obvious symptoms: for example, chest pain during exercise will usually not develop until more than 90% of the opening within the artery has been narrowed.

The plaque lining the artery underneath the intima (the innermost layer inside the artery) is a thick, inflammatory mass, which causes a great deal of irritation along the inside of the artery. Sometimes this plaque will cause so much irritation that it actually erodes through the artery and bursts through into the blood stream. This massive inflammatory discharge triggers the almost instantaneous formation of a clot, which will completely block off the blood flow through that artery. This is a heart attack. All of the heart muscle that depends on the blood flow from that now clogged artery is in risk of dying. If the amount of heart muscle deprived of blood is too large the patient may suddenly die without warning. If the area is small enough the patient will suffer symptoms we’ve heard of, and many have experienced: chest pain, shortness of breath, nausea, and sweating. The next step is a quick trip to the hospital for emergency care. Fortunately the ER doctors now have clot buster drugs available in the emergency room to dissolve the clot rapidly and resume the flow of blood to the heart muscle, minimizing the amount of damage. But that assumes the patient gets treatment in time.

Interestingly, about one third of heart attacks are small enough that the patient never recognizes they’ve occurred. We often find evidence of these on routine EKGs done during physical examinations. These people are often shocked to discover that they have had a heart attack at some time in the past. On careful questioning we often discover a time in which they suddenly felt fatigued, lethargic and under the weather for a few days. This was probably when the blood supply to a small piece of heart muscle was actually shut off without the patient knowing it.

At Longevity Medical Clinic, we want our patients to learn that problems like heart disease are both preventable and reversible. That’s why it’s important to know what’s going on inside your body. In the next heart disease blog I will explain more about heart attacks – and how to prevent them.

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