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It is not the value on one day that counts but the sum across the years — and lipoprotein(a) is worth measuring once in a lifetime.
Also known as: atherosclerosis · arteriosclerosis · hardening of the arteries
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Atherosclerosis begins decades before the first symptom. Cholesterol particles deposited in the vessel wall set off a silent inflammation there; from that come plaques that grow for years without causing anything. Two insights make the subject graspable. First: the vessels are a single system. Anyone with calcified leg arteries usually has them at the heart as well — a finding in one place is therefore always a statement about the whole body. Second: it is not the value on a single day that decides but the sum across the years. Which is why lying a little lower early and permanently works far more strongly than intervening hard late. What is dangerous, moreover, is not primarily the narrowing but the make-up of the plaque: a heart attack usually arises where an inconspicuous plaque tears open, not at the tightest place. That explains why widening a vessel can relieve complaints without solving the underlying problem. One value is worth measuring once in a lifetime: lipoprotein(a). It is inherited, hardly changes with diet, and explains many family histories in which slim, sporty people had an early heart attack.
A single time is enough for a whole life. If it is high, that shifts the reading of every other value — and it is information that counts for siblings and children too.
Because the sum across the years counts, a modest but lasting reduction works more than a late, large one. That holds for diet, movement and medicines alike.
Pressure and plaque reinforce each other: the pressure damages the inner lining, the damaged lining takes up more particles. The two together weigh more than either alone.
Oats, barley, pulses, apples and psyllium husk bind bile acids in the gut and measurably lower LDL. It is the part of the diet with the best basis.
Not leaving fat out but swapping it: olive oil, rapeseed oil, nuts and fish in place of butter, sausage and fried food. The exchange works, mere omission hardly does.
Anyone with a narrowed leg artery, a calcification in the neck artery or erectile trouble has received information about the heart. That is the moment to look at the overall risk, not only the one place.
A raised homocysteine is often discussed as a vessel risk. More useful in practice is what it almost always indicates: a real shortage of B12 or folate, which belongs treated in its own right.
Statins lower LDL and stabilise the deposit — the cap over it becomes firmer, and that is exactly what prevents the tear from which a heart attack arises. The calcium on a heart CT does not fall, it rather rises; that is a sign of stabilisation, not of progression. A deposit cannot be dissolved. What did lead to a small fall in volume in imaging studies was very low LDL levels over eighteen to twenty-four months.
The first fatty streaks in vessel walls are found already in adolescents; decades pass before symptoms. A narrowing usually becomes noticeable only from about seventy per cent of the cross-section — which is why a heart attack often comes without warning, and usually arises at a spot with less than fifty per cent narrowing that tears. The calcium score on heart CT gives a number for risk; at zero it is very low over ten years.
That is atherosclerosis of the legs. It is at the same time one of the strongest indications that the coronary arteries are affected as well.
Tightness, pressure or burning that comes on walking uphill and goes on stopping. Newly appeared, or occurring at rest, it is an emergency.
Before fifty-five in a father or brother, before sixty-five in a mother or sister. That is the occasion to measure lipoprotein(a) and the lipid values once — even in healthy people.
Calcifications noticed during an examination done for another reason are a real piece of information and not a footnote. They belong taken into the risk assessment.
No other single factor speeds the process so strongly — and none improves so quickly after stopping.
Counts the number of particles that can lodge in the wall, rather than only the amount carried. With raised triglycerides or diabetes it reflects the risk better than LDL alone.
The best known value and the one with the clearest cause-and-effect link. What decides, though, is not the height on one day but how long it has been there.
Measure once in a lifetime. The value is ninety per cent inherited, hardly changes, and explains early heart attacks in families where everything else looks unremarkable.
Sugar speeds the process at the vessel wall considerably. Diabetes shifts the whole calculation and therefore belongs in every risk estimate.
Describes the inflammatory side. It is not a value one treats to, but it helps to place things when the lipid values alone do not explain the situation.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Plant-forward, minimally processed: the best-documented measure for the vessels there is.
Works on blood pressure, sugar and fats at once — no preparation does that.
Discussed in connection with vascular calcification; solid outcome data are still missing.
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