In order to help readers understand what causes heart disease here is another in my Monday series of selected Khan Academy Health related videos will focus on coronary artery disease and heart attacks. This video is quite helpful in laying out the basics of heart disease, and should answer most of the answers as to what causes heart disease. A few clarifying points may make it a bit more helpful. First when they talk about an atherosclerotic plaque rupturing and leading to a clot that causes a heart attack they don’t mention that the mechanism of the clot’s initial formation is the aggregation of platelets at the site of the ruptured plaque. That’s why we often recommend taking low dose aspirin to inhibit platelet aggregation, so that if a plaque ruptures platelets are less effective at aggregating at the site and causing complete coronary artery blockage. In addition medications like the statins and possibly the ACE inhibitors or ARB medications probably function at least in part by stabilizing the lining cells of arteries and reducing the chances of plaque rupture.
One other comment is that the video implies that only if a large heart attack occurs is cardiac arrest likely. Actually even small heart attacks, and likely even episodes of coronary ischemia not severe enough to cause actual death of cardiac tissue can lead to cardiac rhythm disturbances, a.k.a. cardiac arrhythmias that may cause cardiac arrest and sudden death.
The key to preventing coronary artery disease, heart attacks, heart failure and cardiac arrest is to lower your risk of developing atherosclerosis. The primary risk factors are tobacco use, high blood pressure, diabetes, lipid abnormalities like high LDL cholesterol and low HDL cholesterol, obesity and sedentary lifestyle. In some cases other familial factors play a role, but most often a strong family history of heart disease is because of a hereditary tendency to one or more of these risk factors.
So what do you do? In order of importance in my opinion:
- Don’t smoke. If you do smoke quit now.
- If you have high blood pressure be sure it is well controlled.
- If you have diabetes do everything you can to control your blood sugars.
- If you have high LDL cholesterol and other risk factors discuss use of a statin or other lipid lowering medications with your doctor.
- Stay fit. Exercise regularly, reduce your dietary animal fat intake, and lose weight if you are overweight or obese.
- If you already have atherosclerotic vascular disease, i.e. if you have had a heart attack, stroke, or peripheral artery disease even more aggressive treatment of risk factors like high cholesterol, high blood pressure, obesity, and diabetes is important. Ask your doctor about how to accomplish these things.
- Ask your doctor about taking an aspirin daily.