Artery-clogging plaque often starts in childhood and stays silent for decades
Autopsies of 300 American soldiers killed in Korea, average age just 22, found visible coronary artery disease in more than three quarters of them. Atherosclerosis begins young, hides for decades because arteries widen to accommodate plaque, and for many people its first symptom is a heart attack.
Atherosclerosis is a form of arteriosclerosis in which fatty plaques build inside artery walls. It is a chronic inflammatory process involving many cell types and driven largely by high blood levels of LDL cholesterol. Plaque itself is a mix of fat, cholesterol, immune cells, calcium and other substances from the blood, and as it narrows vessels it restricts the flow of oxygen-rich blood.
Its silence is a matter of mechanics. Arteries initially expand where plaque forms, so blood keeps flowing, and even most ruptures produce no symptoms until clots narrow or block a vessel. Fatty streaks have been seen in the coronary arteries of juveniles. Almost everyone shows some degree of disease by 65, and it is the leading cause of death and disability in developed countries. United States data from 2004 showed that for about two thirds of men and nearly half of women, the first sign was a heart attack or sudden cardiac death.
What happens next depends on the artery. Narrowed coronary arteries bring angina, breathlessness and abnormal heart rhythms. Blocked carotid arteries, which feed the brain, can cause stroke, with weakness, confused thinking, slurred speech and numbness. Plaque in the limbs produces pain and numbness, and in the kidney arteries it quietly drives chronic kidney disease. Coronary disease is commoner in men, but strokes from brain-artery disease affect the sexes equally.
The cause is thought to be multifactorial, with risks including abnormal cholesterol, high blood pressure, diabetes, smoking, obesity, inflammation markers and family history. Standard prevention guidance centres on diet, exercise, not smoking and healthy weight; established disease may be treated with statins, blood pressure drugs and anticoagulants, then procedures such as bypass grafts. First described in 1575, it may have deep evolutionary roots: some evidence ties it to mutations in the CMAH gene among human ancestors more than two million years ago.
Source: Atherosclerosis
