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What is atherosclerosis?

Atherosclerosis is a chronic, cardiovascular inflammatory disease that can lead to the development of cardiovascular conditions such as heart attacks and strokes. Atherosclerosis is a leading cause of death all over the world.1,2

Atherosclerosis occurs when an injury to the lining of the arterial walls results in inflammation and an abnormal accumulation of plaques (fats and cells) in the artery.3 These plaques lead to the formation of calcium deposits, causing the artery wall to become more rigid. The rigid walls and narrowing of the artery prevent oxygen-rich blood from moving smoothly to organs in the body.

What are common symptoms?

Atherosclerosis can begin in childhood and slowly progress throughout adulthood. It can go undetected because it is largely asymptomatic.4 Atherosclerosis is often diagnosed when a myocardial infarction, heart failure, stroke, or diminished blood flow has already occurred.5 However, high cholesterol can indicate risk of future heart problems from plaque accumulation.6

What are the causes?

Atherosclerosis is often caused by high LDL (low-density lipoprotein) cholesterol. LDL cholesterol is considered the ‘bad’ cholesterol since it can contribute to plaque formation in arteries. HDL cholesterol (high-density lipoprotein cholesterol), however, can actually clear the blood of LDL cholesterol by carrying it to the liver, where it can be processed and eliminated from the body. High levels of HDL cholesterol and low levels of LDL cholesterol are considered healthy. Exercise and a healthy diet can improve the balance of cholesterol in your blood.

Other risk factors that encourage the development of atherosclerosis include4:

  • Diabetes
  • Hypertension
  • Lack of physical activity
  • Obesity
  • Smoking habits
  • Unhealthy diet, particularly one high in saturated/trans fats

How does this topic relate to my microbiome?

When certain gut microbes are present in large amounts, they may influence the development of atherosclerosis. Those influential microbes include species like Escherichia coli, Enterobacter aerogenes, and members of Klebsiella spp. genus. Bacterial organisms commonly found in the mouth – such as Lactobacillus salivarius, Solobacterium moorei, Atopobium parvulum, and species belonging to Streptococcus spp. genus – are also positively correlated with atherosclerosis when found in the gut. Interestingly, bacterial species such as Roseburia intestinalis and Faecalibacterium prausnitzii, which are associated with the production of short chain fatty acids (a major source of fuel for cells in the large intestine), are almost depleted in atherosclerosis patients.7

Which diseases/topics are related to atherosclerosis?

One of the most notable signs of atherosclerosis is chronic inflammation in the arterial walls due to plaque accumulating inside them.6 This inflammation, combined with risk factors for atherosclerosis, is associated with these comorbidities6,8:

  • Acute coronary syndrome
  • Coronary calcification
  • Heart failure
  • Stroke
  • Stenosis and distal ischemia
  • Thrombosis in major conduit arteries to the heart, brain, legs, and organs
occurs when the blood vessels gradually and abnormally narrow, which can reduce blood flow through them.
occurs when blood flow to tissues away from the heart diminishes. Those tissues can include the limbs. Ischemia reduces oxygen supply, leading to tissue damage.

How can people take action?

Common treatments for atherosclerosis aim to reduce levels of LDL cholesterol and triglycerides, whether through medications or changes in lifestyle. Lifestyle interventions may also help increase HDL cholesterol levels. These interventions include9:

  • Reducing alcohol intake
  • Reducing dietary cholesterol
  • Reducing excessive body weight
  • Reducing dietary saturated fat
  • Reducing dietary trans fat
  • Reducing total amount of dietary carbohydrates
  • Increasing dietary fiber
  • Increasing regular physical activity
  • Eating foods enriched with phytosterols, which are compounds similar to cholesterol. Phytosterols are found in vegetable oils and berries. They can help lower LDL cholesterol and reduce the risk of cardiovascular diseases.

References

1. Libby P., Lichtman A.H., Hansson G.K. (2013). Mechanisms Implicated in Atherosclerosis: From Mice to Humans. Immunity, 38, 1092–1104.

2. Yamashita, T., Kasahara, K., Emoto, T., Matsumoto, T., Mizoguchi, T., Kitano, N., … Hirata, K. (2015). Intestinal Immunity and Gut Microbiota as Therapeutic Targets for Preventing Atherosclerotic Cardiovascular Diseases. Circulation Journal, 79(9), 1882–1890.

3. Shah, P., Bajaj, S., Virk, H., Bikkina, M., & Shamoon, F. (2015). Rapid Progression of Coronary Atherosclerosis: A Review. Thrombosis, 2015, 1–6.

4. Lewis, S. J. (2009). Prevention and Treatment of Atherosclerosis: A Practitioner’s Guide for 2008. The American Journal of Medicine, 122(1), S38–S50.

5. Frostegård, J. (2013). Immunity, atherosclerosis and cardiovascular disease. BMC Medicine, 11(1), 117.

6. Insull, W. (2009). The Pathology of Atherosclerosis: Plaque Development and Plaque Responses to Medical Treatment. The American Journal of Medicine, 122(1), S3–S14.

7. Jie, Z., Xia, H., Zhong, S.-L., Feng, Q., Li, S., Liang, S., … Kristiansen, K. (2017). The gut microbiome in atherosclerotic cardiovascular disease. Nature Communications, 8(1), 845.

8. Charniot, J. C., Khani-Bittar, R., Albertini, J. P., Giral, P., Cherfils, C., Cosson, C., … Bonnefont-Rousselot, D. (2013). Interpretation of lipoprotein-associated phospholipase A2 levels is influenced by cardiac disease, comorbidities, extension of atherosclerosis and treatments. International Journal of Cardiology, 168(1), 132–138.

9. Reiner, Z., Catapano, A. L., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., … Zamorano, J. L. (2011). ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal, 32(14), 1769–1818.