You Can Reverse Atherosclerosis and Prevent Heart Attacks If Your ‘Bad Cholesterol’ Is Below This Level

An image showing functional red blood cells. Sickle cell anaemia (SCA) and Beta thalassemia (BTHAL) are caused by mutations in the adult genes that carry instructions for the creation of red blood cells and cause them to change shape. (Lightspring/Shutterstock)

It is generally believed that myocardial infarction is a disease of the middle-aged and elderly. However, in recent years, the age of onset for myocardial infarction is becoming younger and younger. How can we prevent myocardial infarction? First, we need to know what causes a myocardial infarction.

Let’s start with some basic knowledge about myocardial infarction.

A coronary artery is an artery that supplies blood to the heart, and a myocardial infarction is a failure of blood flow to reach a part of the coronary artery, causing necrosis of the heart muscle.

The main cause for the blood flow to decrease or stop is the narrowing and blockage of blood vessels. And the hardening and narrowing of blood vessels is a long-term process, so patients with myocardial infarction are mostly people over 50 years old.

In the picture below, the raised part of the blood vessel wall is hardened and fibrotic due to cholesterol accumulation. Inside the blood vessel is cholesterol and some cellular fragments, and this causes the blood vessel to become narrow and the blood flow to become not so smooth, which is medically known as “arteriosclerotic plaque,” or “plaque” for short.

Our heart is only about the size of our fist, and the coronary arteries are about the same thickness as the veins on the back of our hands, with a diameter of only 0.3 to 0.5 centimeters. Therefore, even very tiny plaque can cause the blockage of a coronary artery.

Why a Young Person Might Suddenly Die of a Heart Attack, While Someone Elderly Would Survive

There are often news reports of seemingly healthy young people, who suddenly die of myocardial infarction. However, some elderly people with a bad heart conditions have angina pectoris repeatedly, but they recover after taking a rest. Why is that?

There are two types of arteriosclerotic plaques: one is stable and the other is unstable.

• Stable arteriosclerotic plaques

This type of plaque has a thick outer layer of fibrotic and calcified tissues and proliferating smooth muscle cells, with a relatively small cholesterol core inside.

A stable arteriosclerotic plaque blocks blood vessels, leaving only a narrow pathway for blood flow. Whenever the burden on the heart increases, such as emotional stress, heavy lifting, and stair climbing, as the blood supply is relatively insufficient, the myocardium becomes ischemic, and angina will occur.

However, after taking a rest, the burden on the heart is reduced, and the balance between oxygen demand and blood supply is regained, and the patient will then recover. In such patients, the blood vessels become increasingly narrow over time, but there are signs before they become completely blocked. This type of stable arteriosclerotic plaques are usually seen among the elderly.

• Unstable arteriosclerotic plaques

An unstable arteriosclerotic plaque has a lid-like thin shell, and there is a “lipid pool” inside it. However, this type of plaque doesn’t block the blood vessels as severely as stable ones.

In arteries blocked by unstable arteriosclerotic plaques, the blood flow pathways are usually still adequate, and the diameter of the vessels is relatively thick.

Therefore, patients usually do not have any symptoms, and their athletic performance is still decent.

However, at a certain point, the plaques will suddenly rupture and the cholesterol inside them will flow out, triggering a sudden and complete blockage of the coronary arteries. At this moment, a seemingly healthy person would abruptly have a myocardial infarction.

Such patients may not be very old. They are usually energetic, and work at a fast pace. Since their coronary arteries are wide enough and not severely calcified, and have sufficient elasticity, when the patients carry out activities such as hiking and golfing, they may not experience angina pectoris caused by insufficient blood flow to the myocardium.

Low Bad Cholesterol Level Reverses Atherosclerosis and Prevents Heart Attacks

Unstable atherosclerotic plaques are relatively complex in composition. There is cholesterol inside a plaque, mixed with some immune cell fragments, and surrounded by an accumulation of various immune cells, smooth muscle cells, and fibroblasts.

The process of atherosclerotic plaque formation is also relatively complex.

In the blood vessels, the part closest to the blood circulation is called the endothelium. Endothelial cells are important for maintaining vascular tone, regulating immune responses and inhibiting vascular smooth muscle proliferation.

They also inhibit platelet aggregation and prevent thrombus formation. As we age, the elasticity of our blood vessels deteriorates, and if blood pressure rises, the endothelium may break down.

At this time, some monocytes will be attracted to where the endothelium is damaged, enter into the arterial walls, and change into macrophages.

After the macrophages become filled with cholesterol, they will become foam cells and accumulate in the blood vessel walls. They would slowly accumulate into cholesterol plaques. They would also cause inflammatory reactions, fibrosis, and calcification.

When the body’s immune system is well coordinated, this condition will not worsen.

In addition, the atherosclerosis plaques can be reduced in size, when the “bad cholesterol” level in your body is low enough.

Bad cholesterol is low-density lipoprotein cholesterol (LDL). Eugene Braunwald, known as the “father of modern American cardiology,” once said that bad cholesterol should ideally be no higher than 50 mg/dL.

A 2017 study published in the World Journal of Cardiovascular Diseases pointed out that the cardiovascular burden brought by atherosclerosis begins to decline when bad cholesterol dropped to 55–70 mg/dL.

And a 2018 study published in the Journal of Lipids further suggests that a bad cholesterol level below 45 mg/dL can lead to a reduction in the size of atherosclerotic plaques.

Conditions that Cause Atherosclerosis and Trigger a Myocardial Infarction

So, under what circumstances can a sclerotic plaque suddenly rupture and cause an acute myocardial infarction?

The force of blood flow that is parallel to the inner wall of a blood vessel is called shear force; the blood pressure that we normally measure is the pressure acting vertically on the vessel wall. Both pressure and shear force may trigger plaque rupture. So a sudden exertion of force, violent exercises, hot and cold temperature changes, emotional agitation, and other situations that cause a sudden increase in blood flow rate and pressure may cause plaque rupture.

When the outer layer of a plaque ruptures, the cholesterol, cell fragments and inflammatory cells inside will escape and have an agglutination reaction with the red blood cells and platelets in the flowing blood, and they will solidify the ruptured plaque into a large piece, thus completely blocking the blood vessel and causing myocardial ischemia and hypoxia, and resulting in myocardial cell death.

Furthermore, since many immune cells have been involved in plaque formation, factors such as inflammation and protease degradation of the plaque shell from within are associated with plaque rupture.

Different factors can turn a plaque into a firm and stable one or a fragile and unstable one. The immune system’s worsening coordination may also make the plaques fragile and unstable. In addition to smoking and diabetes, psychological stress and emotional changes are associated with the sudden onset of myocardial infarction in young people.

Changing Lifestyle and Habits Can Reduce the Risk of Myocardial Infarction

Therefore, the factors that can cause the accumulation of atherosclerotic plaques and make them unstable and/or rupture are all risk factors for myocardial infarction. However, as long as you start making changes to your unhealthy lifestyle and habits, you can prevent myocardial infarction from occurring.

In summary, the risk factors that influence the occurrence of myocardial infarction are:

• Risk factors that cannot be changed: Age, gender (men are at a higher risk), and family health history
• Risk factors that can be controlled: Blood pressure, blood cholesterol level, body weight, smoking, stress, exercise, diet, and kidney function

In order to avoid these high risk factors, we can adjust our diet and exercise habits to balance our body and mind. A lifestyle that protects coronary arteries can also protect blood vessels throughout the body, especially vascular endothelial cell function and metabolic capacity, to avoid myocardial infarction, while also help the individual stay away from cerebrovascular diseases, kidney diseases, diabetes, and even cancers.

However, some elderly patients have difficulty changing their habits. Their motor function may already be very poor, while weight problems also make these patients’ backs and knees degenerate, further inhibiting their ability to exercise. These patients need to take medication to control their blood pressure, blood sugar, and blood cholesterol levels, as well as aspirin. So many end up needing to take a large amount of drugs every day to reduce the risk of myocardial infarction and stroke in the immediate future.

Many people in their 40s and 50s have relatively minor health problems and may not have a strong motivation to change their lifestyle and/or habits.

However, when in their 50s and 60s, some people will start thinking about taking care of their bodies. If you can seize the opportunity at this stage, when your physical and mental strengths are still strong, you will still have a chance to improve your health. Of course, if you can start taking care of your body earlier, it will be less difficult to improve your habits, and you will get more long-term benefits.

So, for young people, are there different risk factors for myocardial infarction?

Young People can Prevent Myocardial Infarction by Avoiding 7 Risk Factors

Young people are a minority of myocardial infarction patients, but now their proportion is increasing. Atherosclerotic plaques are starting to accumulate earlier–even in children as young as 8 to 9 years old–and their rate of accumulation is also increasing, perhaps due to a diet based on trans-fats and processed foods and an increasingly stressful and high-pressure lifestyle.

A recent study published in the Journal of the American Medical Association showed that the top seven risk factors for myocardial infarction in young adults between the ages of 18 and 55 include diabetes, depression, high blood pressure, smoking, family history of early-onset myocardial infarction, low household income, and high cholesterol.

These risk factors cover about 85 percent of patients in this age group and are similar to those of other age groups.

Two risk factors, depression and low household income, statistically have a greater impact on young myocardial infarction patients than the rest. This suggests that psychological and social stresses have a significant impact on coronary artery health.

Curiously, low household income was not associated with acute myocardial infarction in men, but only in women. In addition, the most significant risk factors are diabetes and smoking for women, and smoking and a family history of early-onset myocardial infarction for men. Early-onset myocardial infarction is a congenital condition, for which we need to take greater care of our health.

Proper fitness methods are also important.

In the 1970s, the long-distance running movement emerged in the United States. At that time, there was a well-known long-distance running promoter, Jim Fixx, who had written a best-selling book to promote the benefits of long-distance running, and he also often appeared on television. However, he suddenly died of myocardial infarction at the age of 52, which caused a lot of controversy at the time.

The subsequent investigation found that Fixx had smoked two packs of cigarettes a day for a period of time and was under great pressure at work. His father passed away suddenly of heart disease at the age of 35, and Fixx himself had a congenital abnormal enlargement of his heart. At the time, it was thought that long-distance running would have helped Fixx’s health, or he might have died of heart disease even earlier. However, we now have many medical studies proving that excessive exercise can damage the cells of the heart–and there are many cases of athletes dying young.

As the saying goes, “going too far is as bad as not going far enough”–we need to strike a balance in order to better protect our health.