The Role of Lipids in Atherosclerosis

The Role of Lipids in Atherosclerosis

Last time we spoke of the various factors that play a part in plaque buildup and rupture causing a heart attack/stroke. We discussed the role of inflammation. This time, we will discuss the role of lipids. We know these are important and these numbers can be impacted by various treatments. So the question to be answered is who needs to be treated and how. Clearly, those who have had a prior heart attack, stents, bypass or stroke need aggressive treatment. What about people who have never had any vascular disease? Who amongst them should be treated and how?

To start off, all adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed meats, refined carbohydrates, and sugar-sweetened beverages. For adults with overweight/obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. In addition, adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 

Potential barriers to adhering to a heart-healthy diet should be assessed, including food access and economic factors; these factors may be particularly relevant to persons from vulnerable populations, such as individuals residing in either inner-city or rural environments, those at socioeconomic disadvantage, and those of advanced age. Adults who are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on therapy.

People with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion should be treated with statins. In patients who are at risk but not quite at the numbers I have quoted, tests like coronary calcium scores can guide the need for aggressive treatment. Coronary calcium scores are a surrogate for plaque in the coronary arteries, and can identify patients who may need medications.  In the next issues I will discuss all the current treatments available.

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