Cardiovascular Disease : Clogged Arteries could be Debilitating and Fatal

Uday Saxena | PhD (The author has spent the last 25 years researching cardiovascular and metabolic disease therapies. He was associated with the Team at Pfizer which discovered “Lipitor/Atorvastatin” the largest selling statin with peak sales of over seventeen billion dollars annually)

Introduction

Cardiovascular disease, which is manifested as a collection of outcomes such as heart attack, stroke and hypertension, is still the world’s largest killer of humans – twice as many people die of this disease relative to cancer. Several effective drugs in the late 1980s and early 1990 called statins were introduced. The statins did dramatically reduce death due to this disease by lowering blood cholesterol levels. But we still need newer therapies.

What causes cardiovascular disease?

Simply put, it is the clogging of critical arteries which stops blood supply to the organs such as heart, brain or kidneys which results in devastating outcomes. Let us understand how the arteries get clogged. The artery can get blocked due to build-up of fat and cholesterol in the form of a plaque, a physical lump, which then can block blood supply (see picture below of an artery which is clogged). Imagine a waterpipe supplying water in your home, and the pipe gets choked, then water supply is stopped. This is pretty much what happens when the artery clogs. If the artery supplying blood to the heart is blocked, it can cause a heart attack, if it is in the brain, it results in stroke, or if in the kidney artery, then it may cause high blood pressure or hypertension.

Causes

There are several risk factors for the build-up of plaque in your arteries. Let us split them into two buckets

Non-Modifiable

• Age – The clogging increases dramatically in later ages after about 40 years.
• Male gender is more prone than female although after menopause the risk is similar for females.
• Family history, meaning if your grandparents, parents, siblings or uncle or aunts had premature cardiovascular disease before 50 years, the risk is more.

Modifiable

• Smoking
• Sedentary lifestyle
• Obesity
• Diabetes
• High fat and cholesterol diet

Obviously, nothing can be done about non-modifiable risk factors, but the focus of treatment is on modifiable factors.

Treatment

Low cholesterol, low-fat diet, and physical exercise are the first set of interventions for people at risk. The main preventive focus is on lowering your blood cholesterol levels. This is done using statins which are quite powerful at lowering your cholesterol. This alone can cut your risk of cardiovascular disease by 50%. Besides cholesterol, blood triglyceride (fat) levels and blood pressure are also lowered which cuts the risk even more. Similarly, diabetes is also controlled. To treat existing clogged arteries, interventional cardiology is used in the form of balloon angioplasty. In this, a fine tubing attached to an inflatable balloon, is inserted into the artery and then the balloon is inflated which literally blows the block away.

What’s coming?

Statins predispose patients to type 2 diabetes; so, a new set of non-statin drugs are being introduced called PCSK9 inhibitors. These are injectable drugs that lower cholesterol through a new mechanism of action and may not promote diabetes. From interventional cardiology perspective, robotic angioplasty is being used for precision; biodegradable and drug coated inert stents (tiny pieces of thimble-like structures) that keep arteries open and free of plaque build-up are also being used. 3D bioprinted lab grown patches of heart muscles are being tested to replace dead heart tissue and improve blood flow. An individual above 50 should get their blood cholesterol and triglyceride levels tested annually and take a tread mill test (TMT) to stay on top of cardiovascular disease, especially if there is family history.