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A recent medical literature review of atherothrombosis in the Journal of the American College of Cardiology by Libby and Ridker of Boston featured the changing understanding of one of the biggest problems of aging, atherosclerosis.

Everyone who reads this column knows that atherosclerosis is a process that begins in adolescence. As we age, it continues to build up in arteries. This build-up can lead to problems with the heart and brain since blood flow to these vital organs is impeded and can be suddenly interrupted, which can cause permanent damage to both. 

What is new in our understanding?
During the past two decades, researchers have learned more about the major problems of myocardial infarction (heart attack) and stroke (brain attack). Heart attack and stroke are precipitated by thrombosis in the arterial vessels that carry life preserving blood to the heart muscle and brain tissue. The final cause of the thrombosis appears to be the clotting of blood at the site of occlusion. This sudden clotting is a result often of the release of thrombus promoting factors from the atherosclerotic plaques in the arteries, which is an inflammatory process. Thus, what has evolved in our understanding of the events leading to heart attack and stroke is that an inflammation in the atherosclerotic buildup in the vessels causes the plaques to rupture and we experience major complications in the heart or brain (not usually both at the same time) that can lead to death. 
    
What does this new information mean?
Traditionally, we have considered blood tests of our cholesterol to be indicative of our risk to develop coronary artery disease. Thus, we measure cholesterol, triglycerides, and high density (HDL) and low density (LDL) lipids. High levels of LDL is consistent with a higher risk of heart attack and ischemic heart disease. High levels of HDL is protective.

The inflammation process is a relatively new blood marker, called high-sensitivity C-reactive protein (hsCRP). It is a predictor of risk for developing coronary events and a predictor of overall outcome in people who experience a cardiac event. Three categories of risk are attributed to blood levels of hsCRP: normal is less than 1, moderate or intermediate risk is 1 to 3, and high risk is over 3. It is very important for physicians to measure hsCRP, as well as lipids, to assess risk of coronary disease and stroke. 
    
Can we treat elevated hsCRP?
Several studies show that certain interventions in people who have elevated hsCRP can lower these values. Not surprisingly, diet and regular exercise would be expected to improve cardiovascular risk and elevated hsCRP. People with diabetes who are treated with insulin and other drugs also can lower their hsCRP. Finally, good control of lipids with "statin" drugs can help lower hsCRP levels.

If your doctor tells you that you have an elevated hsCRP or LDL level, your doctor may suggest treatment with some of the above interventions. 

The bottom line is that we should pay attention to new research and diagnostic tests that can help with healthy aging.

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