CHAPTER 9

Managing Risk

PART 1 What Are Risk Factors?

Certain lifestyle habits, traits, and conditions may increase the probability that you’ll develop atherosclerosis. These conditions are known as risk factors. The more risk factors you have, the greater your chances of developing atherosclerosis. Fortunately, most of these risk factors are within your control.

PART 2 Major Risk Factors You Can Control

Hypertension (high blood pressure). When your blood pressure is chronically high, your arteries protect themselves against the added pressure by thickening and stiffening their walls. You’re considered to have high blood pressure if it stays at or above 140/90 mmHg over time (or 130/80 mmHg, if you have diabetes or chronic kidney disease).

Overweight or obesity. Fat tissue is metabolically active and releases numerous substances into your bloodstream, including cytokines (immune system messenger molecules) and hormones. Some of these substances act as toxins and create low-level, chronic inflammation throughout your body, including inside your blood vessels. This sets the stage for atherosclerosis.

Smoking or using tobacco in any form. The toxins in tobacco enter into your bloodstream, constricting your blood vessels and damaging their endothelium (lining), creating inflammation. Smoking constricts your blood vessels as well and prevents your tissues from getting enough oxygen. It’s also been found to raise levels of LDL-cholesterol (the “bad” cholesterol) and to raise blood pressure.

Insulin resistance and diabetes. Glucose (blood sugar), when present at high levels in your blood, acts as a toxin on your blood vessels’ endothelium and leads to atherosclerosis. If you have high blood sugar or diabetes, take steps to lower your blood sugar level.

Lack of physical activity. A sedentary (inactive) lifestyle is a major risk factor because it can worsen other risk factors, such as high blood pressure, diabetes, being overweight, and abnormal cholesterol levels.

Unmanaged response to stress. Feeling chronically stressed has been shown to be a high risk factor for atherosclerosis, although scientists are not sure exactly how stress damages your arteries. If you experience stress on an ongoing basis, find ways to manage and relieve it.

Abnormal blood cholesterol levels. Too-high levels of LDL-cholesterol, and especially VLDL, can put you at risk for atherosclerosis. Levels of HDL-cholesterol that are too low put you at risk, too, because HDL-cholesterol removes excess cholesterol from your body.

Unhealthy diet. Evidence is mounting that a diet high in refined carbohydrates (such as foods made with white flour or white sugar) may be worse for you than a diet high in fats—even saturated fats—but low in carbs. (Trans fats, though, are highly inflammatory and definitely unhealthy.) Eating a diet high in refined carbohydrates creates an ongoing cycle in which your blood sugar levels swing from too high to too low, over and over again. High levels of blood sugar are toxic to the sensitive cells lining your arteries. This type of damage leads to atherosclerosis.

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PART 3 Major Risk Factors You Can’t Control

Genetics. You’re at higher risk for atherosclerosis if your father or brother was diagnosed with heart disease before 55 years of age, or if your mother or sister was diagnosed with heart disease before 65 years of age.

Older age. Everyone builds up a certain amount of plaque in their arteries as they get older. Due to genetics or lifestyle factors, however, some people accumulate more than others. For women, risk increases after age 55; for men, risk increases after age 45.