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What Causes Heart Disease? | The Peter Attia Drive Podcast (Ep 203, AMA 34)
The data presented in the beginning discusses how a little less than half of all first heart attacks are fatal, and they can frequently happen in your 50s, and can be asymptomatic. Of note, heart disease is the leading cause of death in the US and the world, but it is believed to be strongly preventable. My own family has a very strong history of heart disease, and for about a year I worked as a medical scribe within a cardiology clinic. So this topic is of special interest to me.
The process of atherosclerosis, which is the narrowing of your arteries largely influenced by plaque and other risk factors discussed below, begin as early as your teens, so the name of the game is preventing plaque buildup and reducing the risk factors that damage your arteries.
Generally there are two types of issues with the heart: obstructions in blood flow, and electrical abnormalities. Electrical issues tend to manifest as arrhythmias, and while still something to be concerned above, are not nearly as prevalent or deadly as blood flow obstructions. The first term to be familiar with regarding blood flow obstruction is stenosis. Coronary stenosis is the narrowing of a heart artery due to the buildup of plaque or other factors that reduce the diameter of the artery. Coronary stenosis can reduce the blood flow to the organs and tissues that depend on that artery, causing symptoms such as chest pain, dizziness, shortness of breath. Stenosis can increase the risk of a heart attack or a stroke if the plaque ruptures and forms a clot that blocks the blood flow completely. Therefore, stenosis is often considered a risk factor for cardiovascular events.
Plaque, in the context of heart disease, refers to the accumulation of fatty deposits, cholesterol, calcium, cellular waste, and other substances within the walls of the arteries. Plaque buildup can also be called atherosclerosis. Plaque formation begins with damage to the inner lining (endothelium) of the artery, often due to factors like high blood pressure, smoking, high cholesterol levels, or inflammation. In response to the damage, immune cells and platelets migrate to the site and initiate an inflammatory response. Apolipoprotein B tagged cholesterol particles like low-density lipoprotein (LDL cholesterol-the ‘bad’ cholesterol), starts to accumulate within the damaged area. Over time, the accumulated cholesterol, along with cellular waste and other substances, forms a plaque that narrows the artery and restricts blood flow. Some types of cholesterol are more atherogenic, which means they have different levels of ‘stickiness’ to the arterial walls.