What is atherosclerosis?

Atherosclerosis is the narrowing of small- to medium-sized arteries from atherosclerotic plaque formation.

What causes atherosclerosis?

Atherosclerosis has many different causes. Western societies, including the United States, have the highest rates of atherosclerosis. This suggests that dietary and lifestyle factors play a part in the development of the disease. Dietary and lifestyle risk factors for developing atherosclerosis include diets high saturated fats, lack of physical activity, smoking, stress and having a "type-A" or aggressive personality. Chronic disease risk factors include obesity, hypertension (high blood pressure), hypercholesterolemia (high cholesterol) and increased blood insulin levels (such as in diabetes mellitus type II). In addition, males and post-menopausal females are more likely to develop atherosclerosis. Research has also discovered that people with high C-reactive protein levels (CRP) have a greater risk for developing atherosclerosis. CRP is a general inflammation marker that can be measured through a blood test, suggesting that chronic inflammation could be a risk factor. Interestingly, researchers have found traces of bovine xanthine oxidase in atherosclerotic plaques. Bovine (cow) xanthine oxidase is substance produced from homogenized cow milk, which suggests that consuming homogenized milk, including dairy products, may also be a cause.

How does an atherosclerotic plaque form?

There is still some debate over how and why atherosclerotic plaques form. Rubin's Pathology provides a "unifying hypothesis" which combines different theories of atherosclerotic plaque formation (see Figure 1 on page 3). First, an area of the artery must be predisposed to plaque formation. Then lipid (fat) accumulation occurs at the site. Over time, inflammation at the site leads to arterial wall damage. The body attempts to heal the area with white blood cells from the immune system. During the healing process the white blood cells, muscles cells from the artery wall, cholesterol and other materials become trapped in the newly formed "plug." This "plug" eventually turns into an atherosclerotic plaque. The plaque extends into the lumen (opening) of the artery which causes narrowing. This leads to decreased blood flow through that section of the artery. Having a plaque in your artery is like having a clog on the inside of a pipe—in addition to reduced flow, turbulence occurs around the clogged area. Turbulence then causes increased damage to other parts of the artery wall, which leads to inflammation and atherosclerotic plaque formation at other sites. In extreme cases, an atherosclerotic plaque can become so large that parts of the plaque cannot receive nutrients. These parts become necrotic and calcify, which can lead to plaque rupture, hemorrhage and thrombosis.

You can think of this process as similar to a cut on your hand. If you get a cut then your body heals the cut by sending white blood cells and other products of inflammation. White blood cells fix the cut and die off, swelling occurs and a scab forms. Eventually your body carries away the white blood cells, reduces the swelling and the scab falls off. In the case of atherosclerotic plaque formation, you body does not carry away the white blood cells or reduce the swelling. The "scab" does not come off and instead becomes a permanent part of the artery wall, keeping all of the products of inflammation trapped underneath.

How can I treat and even prevent atherosclerosis?

Knowledge is power

You can get simple tests to check for atherosclerosis risk factors. First, find out if heart disease or cardiovascular disease runs in your family. Make sure to have your blood pressure taken regularly and your body mass index (BMI) checked by your healthcare provider. Blood tests you can ask your primary care doctor to order are: 1) fasting blood glucose to screen for insulin-regulating problems, 2) LDL, HDL and total cholesterol to screen for hypercholesterolemia and 3) hs-CRP (heart specific C-reactive protein) to check systemic inflammation levels. For more advanced studies, you can get a CT scan of the arteries around your heart or an angiogram (imaging of arteries) of other arteries. Ask your doctor what would be appropriate most for you.

Natural treatments you can do on your own

Aerobic "cardio" exercise

Aerobic exercise can decrease many risk factors for atherosclerosis including obesity, hypertension, hypercholesterolemia, high blood insulin and stress. Different types of aerobic exercise include walking briskly, running, swimming, bicycling, competitive sports, elliptical or other gym machines, dancing, gardening and even cleaning—anything that raises your heart rate for at least 20 minutes. The recommended aerobic exercise amount is 150 minutes per week, which is 30 minutes five days per week if done daily.

Sleep

Getting the sleep your body requires can decrease obesity and help regulate blood insulin levels, decrease high blood pressure and decrease stress. The recommended amount of sleep is six to nine hours each night, although this varies from person to person. Consistently getting enough sleep is the more important than "catching up" on sleep on the weekends.

Stress management

Managing stress can be one of the most difficult changes a person can make. We live in a society where we have too much to do and too little time to accomplish everything. First you can list your stressors, which can include work, home life, extracurricular activities, etc. Then see if you can reduce any of the stressors such as any unnecessary extracurricular activities. Then look at the "necessary" stressors and think about different ways to approach them or different ways to react to them so they are not as stressful. As mentioned previously, getting enough sleep and exercising can also reduce stress.

Stop or reduce cigarette smoking

Cigarette smoke causes oxidative stress and chronic inflammation. Reducing cigarette intake, or even better stopping cigarette intake altogether, can greatly reduce both oxidative stress and chronic inflammation in the body.

Decrease saturated fat intake

Saturated fats are found in high levels in meat (beef, chicken, pork, fish, other animals) and especially in the skin, whole-milk dairy products, lard and some vegetable oils including coconut, palm kernel and palm oils. You can greatly decrease your saturated fat intake by eating a more vegetarian-based diet and reducing your animal and animal-product intake.

Decrease omega-6 fat intake and increase omega-3 fat intake

Omega-6 fatty acids promote chronic inflammation whereas omega-3 fatty acids are anti-inflammatory. Omega-6 fats are found in high levels in most animals including beef, chicken, pork and farmed fish, and in animal products including dairy. High levels of omega-3 fatty acids are found in wild-caught fish and lower levels are found in nuts and seeds. Also, grass-fed meats have fewer omega-6 fats and more omega-3 fats than conventionally-fed meats.

Increase antioxidant intake

Antioxidants can quell damage caused by oxidation in the body, leading to less chronic inflammation. Antioxidants are found in fruits, vegetables, nuts, sea vegetables and other sources. Dark-pigmented fruits such as blueberries, blackberries, raspberries and acai berries have high amounts of antioxidants.

In addition to dietary and lifestyle changes, naturopathic medicine can provide natural therapies that can decrease your need to be on prescriptive medications for any chronic disease risk factors such as hypertension, hypercholesterolemia, diabetes and obesity. Naturopathic medicine can also provide support for side effects that can occur from these medications.