When some one gets a heart attack, it is often told to be because of “Blocks”. What exactly are these blocks and how do you get them?? In medical terms, these are Atherosclerotic Cardiovascular diseases (ASCVD). These don’t just cause heart attacks or strokes! It is a process that can happen throughout the body, often silently, for years.
Most cardiovascular problems begin with atherosclerosis, a condition where cholesterol builds up inside blood vessels, forming plaques that narrow and stiffen them. Think of your blood vessels like plumbing pipes. When the water (blood) is full of minerals (cholesterol and other particles), it leaves behind deposits that clog the system over time. The narrower the pipes, the easier they are to block and the most vulnerable pipes are the ones supplying your heart, brain, and kidneys.
As plaques grow, they not only restrict blood flow, but also make the inner walls of the arteries rough. This makes it easier for clots to form, which can suddenly cut off blood supply. That’s when heart attacks and strokes happen. The good news? These risks are manageable. Like using a water filter to protect your plumbing, managing your health can prevent dangerous blockages in your arteries.
Most of the cholesterol that shows up in your blood tests are actually made by your liver. The liver takes the fat, and even carbohydrates and proteins in your food and makes different types of cholesterol containing particles (Chylomicrons and VLDL). These circulate in our blood stream and get’s transformed in to other types of cholesterols. There are also some proteins that carry these cholesterols, called lipoproteins. Let’s break down what actually puts you at risk:
LDL is the main contributor to plaque buildup. LDL levels above 190 mg/dL signal high risk and typically require immediate treatment, usually with statins. These medications are quite effective and every 1 mg/dL drop in LDL can reduces ASCVD risk by about 1%. What should be the target LDL level??
For high-risk individuals: Aim for LDL below 50 mg/dL
For most people: LDL Below 100 mg/dL is a good target
If you have other risk factors like diabetes: LDL Below 70 mg/dL is recommended
ApoB is the protein that carries LDL in the blood. It can be a better indicator of your heart attack risk that just LDL. The LDL/ApoB ratio can reveal how dangerous your LDL level realy is. Smaller, denser particles (LDL/Apo B <1.2) are more likely to sneak into artery walls and form plaques.
Lp(a) is a genetic variant of LDL with an added molecule called apolipoprotein(a). It’s highly atherogenic (plaque-forming) and more common in South Asians like Indians. This is one reason why heart disease often strikes earlier in this population. It can be inherited from your parents. High levels of LP(a) is seen in at least one in five people worldwide.
HDL is the “good” cholesterol that transports cholesterol from the bloodstream back to the liver, thus preventing atherosclerosis. Low HDL levels therefore increase heart disease risk. Triglycerides are yet another component of cholesterol that is absorbed directly from our diet. Unfortunately, many South Asians naturally have low HDL and high triglyceride levels. This raises your TG/HDL ratio, which is a strong predictor of heart risk.
Beyond cholesterol, there are several lifestyle and metabolic factors that increases your risk for heart attack, stroke and other cardiovascular diseases:
Increased Visceral fat (fat around your organs)
Insulin resistance or prediabetes
Sedentary habits
High blood pressure
High blood sugar levels
This is why a basic ECG or standard lipid profile doesn’t tell the whole story. Your cardiovascular risk is shaped by your genes, medical history, lifestyle, and more. A personalized approach is key to understand how to reduce your risks and improve long term health.
Understanding and lowering your cardiovascular risk starts with the right information. It’s not just about numbers, it’s about context. Get a full picture of your health, know your specific risks, and take steps to manage them before they become life-threatening.
