This is the sixth in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.
Archive to All Aging Gracefully Diaries
Cardiovascular problems is a broad term that takes in a lot of territory. The human circulatory system is a complex arrangement that has lots of parts to it. Coronary disease is the leading cause of death in the US and cerebrovascular disease in the third thing on the list. This is clearly a major concern of the ageing process.
Cardiovascular problems are grouped into three broad categories.
Heart disease
Cerebrovascular disease
Peripheral vascular disease
This division is based on the parts of the body affected rather than the underlying causes of the problems. This is an enormously complex subject. There are some relatively rare conditions such as rheumatic fever and congenital defects that can cause heart disease, the majority of cardiovascular problems are part of an inherent process of ageing. This can be slowed down with good management.
There are two interlocking problems that are major factors in this process. They are hypertension (high blood pressure) and atherosclerosis (hardening and blocking of arteries). Both of these problems can be managed with various forms of intervention. I am going to focus on the details of atherosclerosis in this diary.
Atherosclerosis
Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is a specific form of arteriosclerosis in which an artery wall thickens as a result of invasion and accumulation of white blood cells (termed "fatty streaks" early on because of appearance being similar to that of marbled steak) and containing both living active WBCs (called inflammation) and remnants of dead cells, including cholesterol and triglycerides, eventually calcium and other crystallized materials, within the outer-most and oldest plaque. These changes reduce the elasticity of the artery walls but do not affect blood flow for decades because the artery muscular wall enlarges at the locations of plaque.
I have practical personal involvement with this. Seven years ago I had to have vascular surgery to clean out my left carotid artery which was close to being blocked. The right artery was 50% blocked and they left it alone. I have been getting regular ultra sound exams since and the whole situation has happily remained very stable. I am compulsively following the medical advice I have been given about medication, diet and exercise. To what extent my good results are directly related to the things that I have been doing is a matter of some controversy. Personally I prefer to take the conservative approach and I am not complaining about it. However, I'm going to explore some of the different perspectives on the matter.
Hypercholesterolemia is the medical term for having higher than normal levels of cholesterol in the blood. When you get routine lab work as part of physical one of the reports that is usually included is a lipid panel. This includes values for four substances.
Total cholesterol
LDL (low-density lipoprotein), the "bad cholesterol"
HDL (high-density lipoprotein), the "good cholesterol"
Triglycerides, another form of fat in the blood
This is considered to be important information in evaluating people's risk level for cardiovascular problems in general and atherosclerosis in particular. These values are influenced by multiple factors. It seems pretty clear that one of those is genetics. There have been some specific genetic anomalies identified. Others are implied by a family history of related problems. Obesity and diet are considered to also be major factors. Diabetes is an added risk factor. Statistical studies that try to relate diet to outcomes like heart attack and stroke often don't come up with particularly strong correlations. One thing to look for when reviewing them is the extent to which they were able to control for other risk factors such as family history.
If diet and exercise are not sufficient to lower lipid values to desirable levels then medication in the form of statin drugs are typically prescribed. I have been taking them for years without any problems. They generally have strong medical backing for use with people who have multiple risk factors. Like most any medication that is strong enough to have an impact on medical problems they have the potential for side effects in some individuals. There is controversy over the latest guidelines for determining who should be advised to take statins. It is a basic risk vs benefits issue. I have enough risk factors to make the decision easy.
The dietary advice given to people with high cardiovascular risk runs along the lines of avoiding food with cholesterol, saturated fat and trans fat. There are also indications that foods with high fiber content play a beneficial role. I've managed to work out a diet that meets these recommendations and is effective at managing my diabetes. The use of low glycemic, complex, high fiber carbohydrates plays a significant role in it. Since I like to cook, I have found ways to make the whole thing pleasant and gastronomically satisfying.