How does plaque build up in the arteries?

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Delmar M. Rogers, MD
Cardiology (Cardiovascular Disease)
We're often times asked how one can prevent the buildup of plaque within blood vessels. There are several risk factors that are involved, but I would have to say, far and away, the most common risk factor that vascular surgeons see on a day-to-day basis is smoking.

For many years, this was not realized, and I'm sure many people will remember the old commercials back in the 1950s where the doctor recommended a certain type of cigarette. But over the years, it's been proven that smoking is probably the number one health problem, at least from a vascular standpoint, in the whole country.

Just about all of the people I see in my practice are smokers. If you're not a smoker, you rarely have significant buildup of plaque in the vessels. The only exceptions to that would probably be the people with poor diabetes control or those who have a severe hyperlipidemia or hypercholesterolemia problem.

In terms of other risk factors, certainly diabetes is a risk factor. Hypertension is a risk factor. A high blood pressure that is untreated can certainly lead to a buildup of plaque over a period of several years.
Kelly Traver
Internal Medicine

First, the cells of the inner layer of the arteries become injured, creating small nicks in the inner lining. These nicks may occur as a result of oxidized low-density lipoprotein (LDL), smoking, high blood sugar, or high blood pressure. Once the nicks occur, it is much easier for LDL to slip past the inner lining of the arteries into the middle layer. When LDL slips past the "front line," a chemical "alarm bell" goes off, announcing the presence of a foreign invader. The inflammatory system, acting as the "police," becomes activated and rushes in to save the day.

Although the inflammatory system is designed to help, it ends up making a bit of a mess. It forms a soft, mushy plaque right over the area where the LDL has invaded. This does help to contain the problem, but the area becomes a hotbed of inflammation. Sticky platelets are part of that inflammation. Over time, the soft, unstable plaque forms a hard, fibrous cap. In the early stages, when the plaque is soft and unstable, there is a high possibility of plaque rupture. This is the cause of 75 percent of heart attacks. When plaque ruptures, the area of rupture attracts even more inflammatory cells and sticky platelets. This can then trigger the formation of a clot that can suddenly and completely cut off the blood supply downstream. This process can be acute, or it can go on for years. When the latter happens, new plaque is laid down on old plaque until the arteries allow only a trickle of blood to pass.

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