Harvard Heart Letter

Changing picture of atherosclerosis

New view puts focus on improving artery health, not just fighting blockages.

Atherosclerosis, the accumulation of fatty gunk in the arteries, is the underlying cause of most heart attacks. It's easy to think of it as a plumbing problem caused by an overload of cholesterol. In this scenario, cholesterol-filled blockages pop up in the coronary arteries, the network of blood vessels that nourish the heart muscle. Small ones protrude into the space available for blood flow, making it difficult for the artery to deliver enough oxygen-rich blood during exercise or stress; this causes the chest pain known as angina. Large blockages close off the artery, causing a heart attack.

A flood of new findings makes it time to trade in the plumbing analogy for a better one. The new view paints a picture of atherosclerosis as a chronic condition driven largely by inflammation. Blockages take a back seat to widespread damage to arteries in the heart and beyond, from those nourishing the brain, the feet, and everything in between. This new thinking explains how atherosclerosis advances steadily but can explode in an instant.

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