Plaque on the heart is a buildup of cholesterol, fats, and cells in artery walls, called atherosclerosis. It is driven by high LDL cholesterol, smoking, high blood pressure, and diabetes.
What it is
Atherosclerosis: plaque made of cholesterol, fat, calcium and cells builds in artery walls and narrows them. In the heart, it’s coronary artery disease.
Causes
- High LDL cholesterol.
- High blood pressure.
- Smoking.
- Diabetes.
- Obesity and inactivity.
- Family history.
Risks
Angina, heart attack.
Prevention
Healthy diet, exercise, no smoking and statins when needed.
Tests
Coronary calcium scan.
How plaque forms
Atherosclerotic plaque is a buildup of cholesterol, fat, calcium, cells and fibrous tissue in artery walls. It begins when LDL cholesterol enters damaged artery lining, gets oxidized, and triggers inflammation. Plaque can narrow the artery or rupture, causing a clot and heart attack. Coronary artery disease is the leading cause of death in the US, causing roughly 375,000 deaths per year.
- Risk factors include high LDL cholesterol, high blood pressure, smoking, diabetes, obesity, inactivity, family history and age.
- Plaque starts in youth: autopsy studies of young adults who died of trauma show early lesions.
- A coronary artery calcium (CAC) scan scores calcified plaque.
Prevention and testing
Statins lower LDL by 30 to 50 percent or more and reduce events. Lifestyle steps include not smoking, a Mediterranean-style diet, 150 minutes of exercise weekly and keeping blood pressure under 130/80. Tests include lipid panel, CAC scan, CT angiography and stress testing. Talk to a doctor about risk calculators such as the pooled cohort equations or PREVENT.
How plaque forms
Coronary plaque (atherosclerosis) builds when LDL cholesterol enters the artery wall at sites of injury, triggering inflammation, immune cells and a fatty core covered by a fibrous cap. Risk factors include high LDL cholesterol, high blood pressure, smoking, diabetes, obesity and family history. Heart disease is the leading cause of death in the US, with about 700,000 deaths a year, according to the CDC.
Prevention and testing
Healthy diet, exercise, not smoking and controlling blood pressure and lipids help. Statins reduce events. A coronary artery calcium score by CT measures plaque burden. Seek emergency care for chest pain, shortness of breath or pain spreading to the arm or jaw.
Risk numbers and diagnosis
Coronary artery disease affects about 20.5 million US adults, per CDC. Plaque risk accelerates with LDL cholesterol above 160 mg/dL, systolic blood pressure above 140 and smoking. Lp(a) is a genetic risk factor present in about 20 percent of people. A coronary calcium score of 0 gives low short term risk, while over 400 indicates extensive plaque.
Prevention and treatment
Statins lower LDL by 30 to 50 percent. Aim for LDL below 100 mg/dL in many, and below 70 in high risk patients. Mediterranean diet reduced cardiovascular events by 30 percent in the PREDIMED trial. Exercise of 150 minutes a week, quitting smoking and controlling diabetes matter. Seek emergency care for chest pressure, shortness of breath or pain in arm and jaw.
Based on data from the CDC, the American Heart Association and the PREDIMED trial
