In this Article

• Introduction
• What is atherosclerosis?
• What are coronary heart diseases (CHD)?
• What is angina pectoris?
• What is a heart attack?
• Ventricular fibrillation
• Heart failure
• What is cerebral vascular disease?
• Ischemic stroke
• Hemorrhagic stroke
• Transient ischemic attack (TIA)
• When does the coronary atherosclerosis process begin?
• Have most people done enough to prevent atherosclerosis and heart attacks?
• What are the risk factors for coronary atherosclerosis and heart disease?
• How can coronary atherosclerosis and heart attacks be prevented?
• Heart Attack and Atherosclerosis Prevention Glossary
• Heart Attack and Atherosclerosis Prevention Index
• Find a local Cardiologist in your town

Have most people done enough to prevent atherosclerosis and heart attacks?

Atherosclerosis prevention should start early, preferably during childhood and adolescence. Most scientists believe that preventing atherosclerosis is more effective than trying to reverse established blockages or getting rid of plaques in the arteries. Therefore, children and adolescents should be taught lifetime habits of regular exercise, avoidance of smoking, and good nutrition. Unfortunately, many Americans have not taken adequate steps to prevent atherosclerosis. Reasons for this failure include:

• Lack of awareness that they already have coronary atherosclerosis, and ignorance that coronary atherosclerosis and heart attacks are preventable;
  
  
• Lack of awareness of their blood cholesterol levels and profiles;
  
  
• Unwillingness or inability to quit cigarette smoking;
  
  
• High blood pressure or diabetes mellitus that are either undiagnosed or inadequately controlled;
  
  
• Lack of exercise, an excess of fat and cholesterol in their diet, and an inability to lose excess weight; and
  
  
• Failure to take full advantage of medications that improve cholesterol profiles, usually out of fear of potential side effects.

What are the risk factors for coronary atherosclerosis and heart disease?

Well-known risk factors for coronary atherosclerosis and heart attacks are:

• Elevated levels of LDL cholesterol (the "bad" cholesterol) in the blood;
  
  
• Family history of early coronary heart disease, including a heart attack or sudden death before age 55 in the father or other male first-degree relative, or before age 65 in the mother or other female first-degree relative;
  
  
• Cigarette smoking;
  
  
• Diabetes mellitus;
  
  
• High blood pressure;
  
  
• Low levels of HDL (the "good" cholesterol) in the blood; and
  
  
• Sedentary lifestyle.

Less recognized but just as important risk factors for coronary atherosclerosis are:

• A preponderance of small LDL cholesterol particles in the blood. LDL cholesterol particles come in different sizes. The size of a person's LDL cholesterol particles is predominantly genetically inherited. The smaller LDL cholesterol particles are far more dangerous in causing atherosclerosis than the larger particles. The smaller LDL particles can penetrate the walls of the arteries more easily than the larger LDL particles. A person with an abundance of small LDL cholesterol particles in the blood has a significantly higher risk of heart attack and coronary atherosclerosis than someone with larger LDL cholesterol particles in their blood.
  
  
• Abnormally elevated blood levels of Lipoprotein A, (Lp(a)). Lp(a) is an LDL cholesterol particle that is linked chemically to a protein called apo(a). The level of Lp(a) in the blood is also genetically inherited. Men and women with elevated blood levels of Lp(a) have significantly higher rates of coronary atherosclerosis and heart attacks.
  
  
• Elevated homocysteine levels in the blood. Homocysteine is a metabolic by-product of animal protein. Tests are now available to measure homocysteine levels in the blood. Higher homocysteine levels in the blood are associated with atherosclerosis in coronary arteries and carotid arteries (arteries that supply blood to the brain).