Atherosclerosis is responsible for half the deaths in the US today! If you get it in your coronary arteries, you’re at risk for myocardial infarction; if it’s in your carotid arteries, you’re at risk for stroke. And lest you think this is something you don’t need to worry about until you’re old, you should know that this process starts very, very early in life – somewhere during childhood – and you just can’t tell you have it until you suddenly start getting nasty symptoms (doctors call this the “clinical horizon,” which sounds strangely picturesque). Scary.

There are lots of risk factors for getting atherosclerosis. They are divided into two groups: major risk factors (which are known for sure to cause atherosclerosis) and lesser or uncertain risk factors (which have less of an effect, or are as yet unproven). Let’s take a look at both groups.

Major risk factors

Some of the major risk factors for atherosclerosis you are simply stuck with, and there is not a thing you can do about them. These include:

• increasing age (atherosclerosis is more common as people get older)
• gender (At younger ages, males are more at risk. Premenopausal women are relatively protected; after menopause the risk in women increases and eventually exceeds the risk in males.)
• family history
• genetic abnormalities (lots of these probably exist; many aren’t fully understood).

The good news is that there are several major risk factors that you can potentially do something about. These include:

• Hyperlipidemia (best thing to do is have a high level of HDL cholesterol, which actually scavenges lipids and removes them from atherosclerotic plaques, and a low level of LDL, which is the “bad” cholesterol that makes up part of the plaques.
• Hypertension (there’s no one right number, but it should be at least below 140 systolic and 90 diastolic)
• Cigarette smoking (smoking potentiates the other risk factors)
• Diabetes (patients with diabetes mellitus have an increased amount of atherosclerosis at a younger age)
• C-reactive protein level (this is a serum marker of inflammation; the higher the level, the greater the risk for atherosclerosis)

Lesser or uncertain risk factors

Then there are a bunch of other things that may be related to an increased risk, but the data is not yet conclusive. These include:

• Obesity
• Physical inactivity
• Stress
• Postmenopausal estrogen deficiency
• High carbohydrate intake
• Lipoprotein (a) (an altered form of LDL that seems to be independently associated with increased risk of atherosclerosis)
• Trans-fat intake
• Chlamydia pneumoniae infection (Chlamydia pneumoniae and other bugs have been detected in plaques but not in normal arteries, and there are increased antibody titers to C. pneumoniae in patients with more severe atherosclerosis. But a causal link hasn’t been established.)

So: don’t smoke; eat well (not too many carbs, no trans fats), exercise, and maintain a healthy weight; keep your blood pressure and lipids within the normal range; if you have diabetes, work to keep it as controlled as possible; don’t get Chlamydia pneumoniae. Oh, and don’t get all worried about it – stress is another potential risk factor!

Image credit: Hamed Masoumi (http://www.flickr.com/photos/hamedmasoumi/2266654041/), under cc license.