Coronary artery disease (CAD)

Coronary artery disease (CAD)

Coronary artery disease (CAD) is also called coronary heart disease (CHD) or ischemic heart disease. This is what most people mean when they use the term “heart disease.” CAD is the most common form of heart disease in the U.S. and the leading cause of death.

CAD happens when atherosclerosis affects your coronary arteries. These are the blood vessels that carry blood to your heart. When your heart doesn’t get enough blood, it gets weaker and stops working as it should. CAD can lead to a heart attack or heart failure.

What many people don’t know is that CAD can affect younger people. In fact, about 1 in 5 people who die from CAD are under age 65. That’s why it’s important to get your cholesterol checked starting at a young age. Over time, plaque can silently build up in your coronary arteries. Many people don’t realize it’s happening until they get chest pain (angina) or another sign of a heart attack.

Carotid artery disease

When atherosclerosis affects your carotid arteries, it’s called carotid artery disease. Your carotid arteries carry blood to the large, front part of your brain. When plaque narrows these arteries, your brain can’t get enough oxygen-rich blood.

Carotid artery disease can lead to a transient ischemic attack (TIA or “mini-stroke”) or a stroke.

Peripheral artery disease (PAD)

When atherosclerosis affects the arteries in your legs or arms, it’s called peripheral artery disease (PAD). The arteries in your legs and arms are “peripheral” because they’re away from your heart and the center of your body. PAD is more common in your legs but can also happen in your arms.

PAD is dangerous because it often causes no symptoms. You might finally start to feel symptoms when a peripheral artery is at least 60% blocked. A key symptom is intermittent claudication. This is a leg cramp that starts up when you’re moving around but then stops when you rest. It’s a sign of reduced blood flow caused by the growing plaque in your artery.

PAD can cause major problems in your legs and feet but also elsewhere in your body. That’s because all your blood vessels are connected through your cardiovascular system. So, plaque buildup in one area slows down your whole network of “pipes.”

PAD isn’t the same as coronary artery disease (CAD), but the two conditions are related. People with one condition are likely to have the other one, too. Both PAD and CAD have many of the same risk factors.

High blood pressure

High blood pressure (hypertension) and high cholesterol are linked. Cholesterol plaque and calcium cause your arteries to become hard and narrow. So, your heart has to strain much harder to pump blood through them. As a result, your blood pressure becomes too high.

High blood pressure and high cholesterol are two of the biggest causes of heart disease. In the U.S., about 1 in 3 adults have high blood pressure, and about 1 in 3 adults have high cholesterol. For more than half of the adults in each group, treatment isn’t helping enough or else they’re not using any treatment.

Medications from your healthcare provider can help a lot, but lifestyle changes can help those medications work at their best. Lifestyle changes are important for managing both high cholesterol and high blood pressure. Some changes include:

• Eat less saturated fat and trans fat: Fast food can contain high amounts of both. But even foods at formal restaurants can be high in saturated fat depending on how they’re cooked.
• Eat fewer fried foods and processed foods: These include prepackaged desserts and snacks.
• Eat less sodium (salt): Some foods have hidden salt. It’s important to read labels in the store. Some restaurants may be able to share nutrition information for menu items.
• Stop smoking and using tobacco products: Smoking is a leading risk factor for heart disease and blood vessel problems.

What medical problems affect my cholesterol levels?

Medical problems and cholesterol have a two-way relationship. High cholesterol can cause medical problems like atherosclerosis. But some medical conditions can also put you at a higher risk of having high cholesterol. Here are some conditions that may affect your cholesterol levels.

Chronic kidney disease (CKD)

People with chronic kidney disease (CKD) face a higher risk of developing coronary artery disease. That’s because CKD causes plaque to build up more quickly in their arteries. People with early-stage CKD are more likely to die from heart disease than kidney disease.

CKD causes you to have more triglycerides (a type of fat) in your blood. It also causes you to have more very low-density lipoprotein (VLDL) cholesterol. VLDLs are particles that carry triglycerides. Meanwhile, CKD lowers your “good cholesterol” (HDL) levels and prevents your HDLs from working as they should. CKD also changes the structure of your “bad cholesterol” (LDL) particles so they cause more harm.

HIV

People with HIV are nearly twice as likely as people without HIV to have a heart attack or stroke. Researchers used to think this higher risk came from HIV medications (antiretroviral therapy). They believed those medications raised a person’s cholesterol. But newer research shows the culprit is actually a person’s immune system.

Even if your HIV is managed, your immune system may still be activated. This puts your body in a state of chronic inflammation. This inflammation triggers plaque buildup and atherosclerosis.

The good news is that people with HIV are living longer. But that means more research needs to explore how chronic diseases like heart disease affect them.

Thyroid disease

Having thyroid disease can affect your cholesterol levels. That’s because the thyroid hormone influences how your body processes lipids (fats). The impact depends on what kind of thyroid disease you have.

• Hyperthyroidism: This condition causes your body to make too much thyroid hormone. Medications used to treat this condition can raise your cholesterol levels (total, LDL, and HDL). If you’re being treated for hyperthyroidism, talk with your healthcare provider about how to manage your cholesterol.
• Hypothyroidism: This condition causes your body to make too little thyroid hormone. It also causes you to have higher cholesterol levels. In this case, treatment for thyroid disease lowers your cholesterol levels. But you may still need to take statins to get your cholesterol in the ideal range. Your provider will discuss what’s best for your individual case.

Researchers continue to explore the links between thyroid disease and heart disease. Some studies show that thyroid disease can cause heart problems unrelated to cholesterol or plaque buildup. For example, both hyperthyroidism and hypothyroidism may raise a person’s risk of heart failure.

Lupus

People with lupus usually have higher levels of “bad cholesterol” (LDL, VLDL) and triglycerides. They also have lower levels of “good cholesterol” (HDL). People who have active lupus face a greater risk of high cholesterol compared with those who have well-managed (quiet) lupus.

Lupus raises your risk of developing coronary artery disease. That’s because lupus causes your body to be in a state of chronic inflammation. This inflammation leads to faster plaque buildup in your arteries.

Polycystic ovary syndrome (PCOS)

People with polycystic ovary syndrome (PCOS) face a higher risk of heart disease. This risk goes up more as they age. PCOS raises the risk of many heart disease risk factors, including diabetes and high blood pressure. People with PCOS are more likely to have high “bad cholesterol” (LDL) levels and low “good cholesterol” (HDL) levels.

Diabetes mellitus

Diabetes mellitus (Type 1 diabetes and Type 2 diabetes) doubles your risk for coronary artery disease and peripheral artery disease. Diabetes is linked with lower levels of HDLs and higher levels of triglycerides and LDLs.

About 7 out of 10 people with Type 2 diabetes are diagnosed with diabetes-related dyslipidemia. This means they have high triglyceride levels, high “small dense” LDL levels, and low HDL levels. “Small dense” LDL is a specific type of cholesterol protein that can easily enter your artery wall and cause damage. Having too many small dense LDLs in your blood can cause plaque to grow.

Researchers continue to explore how diabetes and heart disease relate to each other.

How can I lower my cholesterol?

Talk with your healthcare provider about the best way to lower your cholesterol. Some people only need some simple lifestyle changes like eating less saturated fat. Others need lifestyle changes plus medication. People with medical conditions that affect their cholesterol may need a more complex approach. Talk with your provider about your medical history, family history and lifestyle factors. Together, you’ll come up with a plan for lowering your cholesterol numbers.

Remember that even the best plans take time to work. And we all have setbacks. It’s OK to struggle, and it’s also OK to tell your provider when a plan isn’t working. Sometimes even the strictest lifestyle changes don’t lower your cholesterol numbers enough. That’s because most of your body’s cholesterol is produced by your liver. So, many other factors come into play that are out of your control and have nothing to do with what’s on your dinner plate.

Take things one step at a time, and remember that having high cholesterol isn’t a personal failure. It’s a result of many small changes quietly happening inside your body. Take control of what you can, but know that medications and other medical interventions are there to fill in the gaps.