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Why LDL C Consider As Bad For Heart Disease & What Precautions Need To Take At The Age Of 40 To Prevent The Event
Cholesterol is a lipid molecule that is vital for various bodily functions. It is a structural component of cell membranes, serves as a precursor for the synthesis of steroid hormones, bile acids, and vitamin D. Cholesterol travels through the bloodstream in lipoproteins, which are classified based on their density: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).Atherosclerosis is a condition characteri sed by the buildup of fatty deposits, or plaques, within the walls of arteries. This process begins when LDL cholesterol particles penetrate the arterial wall and undergo oxidation. The oxidised LDL (oxLDL) triggers an inflammatory response, leading to the recruitment of immune cells called macrophages. These macrophages engulf the oxLDL, transforming into foam cells and contributing to the formation of atherosclerotic plaques. Over time, these plaques can narrow the arteries and restrict blood flow, potentially leading to heart attacks and strokes.
LDL cholesterol is often referred to as "bad" cholesterol because of its atherogenic properties. LDL particles are smaller in size compared to other lipoproteins, allowing them to easily penetrate the endothelial lining of arteries. Once inside the arterial wall, LDL particles are prone to oxidation, which enhances their ability to cause inflammation and plaque formation. This process is particularly detrimental in the coronary arteries, which supply blood to the heart muscle. Blockages in these arteries can result in coronary artery disease (CAD) and increase the risk of heart attacks.As individuals reach the age of 40, it becomes increasingly important to monitor lipid parameters, including LDL cholesterol levels. This period is critical because the risk of developing cardiovascular diseases (CVD) begins to rise significantly. Setting the tone at 40 involves adopting a proactive approach to heart health by making lifestyle changes and, if necessary, taking medication to manage cholesterol levels. Regular lipid panel screenings help identify elevated LDL cholesterol early, allowing for timely interventions to prevent the progression of atherosclerosis.
Research shows that the risk of cardiovascular disease escalates with age, particularly from 40 years onward. Factors such as sedentary lifestyle, poor dietary habits, smoking, and genetic predispositions contribute to this increased risk. By age 40, many individuals may already exhibit early signs of atherosclerosis without noticeable symptoms. Hence, it's crucial to Prioritise heart health through regular medical check-ups, lifestyle modifications, and adherence to recommended treatments."Setting the tone at 40" underscores the necessity for individuals to take control of their cardiovascular health as they approach midlife. This initiative involves a multifaceted approach that includes:
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.Com does not necessarily subscribe to it. ETHealthworld.Com shall not be responsible for any damage caused to any person/organisation directly or indirectly).
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Incidental CAC Tied To Worse Outcomes In Systemic Inflammatory Diseases
WASHINGTON, DC—Incidental coronary artery calcium (CAC) is often seen on chest CTs in patients with immune-mediated inflammatory diseases who don't have atherosclerotic cardiovascular disease (ASCVD), with the finding indicating a greater risk of poor outcomes, researchers report.
An artificial intelligence (AI) algorithm picked up CAC in more than half of patients with psoriasis, systemic lupus erythematosus (SLE), or rheumatoid arthritis who had undergone a prior noncardiac chest CT scan, Brittany Weber, MD, PhD (Brigham and Women's Hospital and Harvard Medical School, Boston, MA), told attendees here at the 2024 Society of Cardiovascular Computed Tomography (SCCT) meeting.
Any amount of calcium was associated with greater risks of all-cause death and MACE (death, MI, stroke, or revascularization), with the relationships strengthening at higher CAC scores. In fact, Weber said, patients with a CAC-AI score of 100 or more carried a CV risk similar to what has been seen in secondary prevention cohorts.
"These data demonstrate that AI-based calcium scoring could offer additional prognostic information, which could better guide the initiation or the intensification of our prevention therapies," she said. She noted that ASCVD risk scores can underestimate risk in patients with systemic inflammatory diseases, a population in whom chest CTs are commonly ordered for noncardiac indications.
Leveraging AI
Prior studies have shown that patients with systemic immune-mediated inflammatory diseases have greater risks of CVD, Weber said, noting that the subspecialty of cardio-rheumatology is emerging to improve recognition of heart disease in these patients. There are no clear guidelines on how to assess cardiovascular risks in these patients, however. "This requires multidisciplinary care models and that's just, unfortunately, not available at the majority of academic medical centers—hence the need for innovative solutions," Weber said.
The detection of coronary plaque can enhance CVD prevention, and this can be done in multiple ways, she said, pointing to coronary CT angiography, calcium scoring, or the evaluation of prior chest CTs obtained for other indications.
Ultimately what we're all trying to achieve here is prevention. Brittany Weber
The current study explored that last option, with investigators using a US Food and Drug Administration-cleared AI algorithm from Nanox to look for CAC on previously obtained noncardiac, nongated chest CTs from 2,528 patients (median age 59 years; 66.6% women) with psoriasis, SLE, or rheumatoid arthritis and no known ASCVD who were scanned between 2010 and 2020.
In this cohort, the most common CV risk factors were hypertension (32%), hyperlipidemia (21%), and active tobacco use (17%). The heaviest risk factor burden was in patients with psoriasis, though those with SLE had the highest rate of chronic kidney disease. Lipid profiles tended to be better in patients with SLE versus the other two inflammatory conditions.
Using the AI algorithm, the researchers found that more than half of patients had some degree of CAC, with only 46.6% having a CAC-AI score of 0. Scores of 1-99, 100-299, and 300 or more were found in 30.3%, 10.1%, and 13.0%, respectively. CAC severity was greater in patients with psoriasis than in those with the other two conditions.
Through a median follow-up of 7.4 years, the presence of CAC was associated with adverse outcomes. Risks were greater with increasing levels of CAC, but the increases were significant even for those with CAC-AI scores of 1-99: HR 1.4 (95% CI 1.1-1.9) for all-cause mortality and HR 1.5 (95% CI 1.2-1.9) for MACE. The HRs for both of those outcomes were 2.5 in patients with a CAC-AI score of 300 or higher.
Unanswered Questions
Commenting for TCTMD, Jonathan Weir-McCall, MBChB, PhD (University of Cambridge, England), pointed to several open questions. He said that in a future study he'd like to see a control group of patients without systemic inflammatory diseases, which would allow for a better assessment of the impact of incidental CAC in these patients versus the general population.
In addition, a real difference in the risk of adverse outcomes between the two highest categories of CAC-AI score did not emerge until after 10 years, at which point patient numbers were very small, he said. And that's difficult to explain, he added.
Finally, Weir-McCall said, the interplay between immune-mediated inflammatory diseases, standard CV prevention therapies, CAC, and risk of adverse outcomes remains unclear.
The study "speaks really well to AI-automated extraction of this information from scans and hopefully using it to better guide patient care," he said, noting that all the scans in this study were already performed for other indications.
But there's a need to understand how therapies like statins interact with immune-mediated inflammatory diseases in terms of reduced CV risk, according to Weir-McCall. "Because of course it's inflammatory-driven, so will our standard preventative therapies work or do we need to look at alternate approaches to mitigate this risk?"
Weber said in the future she hopes to do a prospective randomized clinical trial to understand the impact of notifying patients with immune-mediated inflammatory diseases and the clinicians—often rheumatologists—caring for them about incidental CAC findings, including any effects on recommendations for primary prevention therapies.
"Because ultimately what we're all trying to achieve here is prevention," Weber stressed.
Common Causes Of Peripheral Artery Disease: What You Need To Know
Peripheral artery disease (PAD) is a condition where the arteries, particularly those in the legs, become narrowed or blocked due to a build-up of fatty deposits, called plaques.
This restriction in blood flow can lead to pain, difficulty walking, and even serious complications like sores that won't heal or, in severe cases, amputation. Understanding the causes of PAD can help in managing and preventing this condition.
One of the primary causes of PAD is atherosclerosis. Atherosclerosis is a process where plaques made of cholesterol, fat, calcium, and other substances build up in the walls of arteries.
This build-up makes the arteries narrower and stiffer, reducing the blood flow to various parts of the body, including the limbs. Research has shown that atherosclerosis is often a result of a combination of lifestyle choices and genetic factors.
Smoking is a major risk factor for PAD. Studies have consistently shown that smoking significantly increases the risk of developing PAD.
The chemicals in cigarettes can damage the lining of the arteries, making it easier for plaques to form. Additionally, smoking causes the blood to thicken and clot more easily, further complicating blood flow.
Diabetes is another significant contributor to PAD. People with diabetes are at a higher risk because high blood sugar levels can damage the arteries and lead to atherosclerosis.
Research indicates that diabetic individuals are more likely to develop PAD and tend to experience more severe symptoms compared to those without diabetes. Managing blood sugar levels through diet, exercise, and medication is crucial in reducing this risk.
High blood pressure, or hypertension, also plays a critical role in the development of PAD. When blood pressure is consistently high, it exerts extra force against the artery walls, which can cause damage and make them more susceptible to atherosclerosis.
Studies suggest that individuals with hypertension are more likely to develop PAD and experience faster progression of the disease.
High cholesterol levels contribute to the formation of plaques in the arteries. Cholesterol is a fatty substance that can build up in the walls of arteries, leading to atherosclerosis.
Research has shown that individuals with high levels of low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, are at an increased risk of developing PAD.
Conversely, high levels of high-density lipoprotein (HDL) cholesterol, or "good" cholesterol, can help protect against atherosclerosis.
Obesity is another factor that increases the risk of PAD. Carrying excess weight can lead to a range of health issues, including diabetes, high blood pressure, and high cholesterol, all of which contribute to the development of atherosclerosis and PAD.
Studies have found that obese individuals are more likely to develop PAD and experience more severe symptoms.
Physical inactivity is also linked to PAD. Regular exercise helps maintain healthy blood vessels and promotes good circulation. Research indicates that people who are inactive are more likely to develop atherosclerosis and PAD.
Exercise helps control weight, reduce blood pressure, improve cholesterol levels, and manage diabetes, all of which are important in preventing PAD.
Age is another factor to consider. As people get older, their risk of developing PAD increases. This is partly because the arteries naturally become stiffer and narrower with age.
However, lifestyle choices made earlier in life, such as smoking, diet, and exercise habits, also play a significant role in the development of PAD later in life.
Family history can also influence the risk of PAD. If a close family member has had PAD or other cardiovascular diseases, the risk of developing the condition increases.
This suggests that genetic factors, combined with shared lifestyle habits, contribute to the likelihood of developing PAD.
Understanding these risk factors is crucial for preventing and managing PAD. Lifestyle changes such as quitting smoking, managing diabetes and high blood pressure, maintaining a healthy weight, eating a balanced diet, and staying physically active can significantly reduce the risk of developing PAD.
Regular check-ups and working with healthcare providers to monitor and manage these risk factors are essential steps in preventing PAD and maintaining overall vascular health.
If you care about heart health, please read studies about top foods to love for a stronger heart, and why oranges may help fight obesity, diabetes, and heart disease.
For more health information, please see recent studies about simple guide to a 7-day diabetes meal plan, and why you should add black beans to your plate.
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