Atherosclerosis is a chronic condition characterised by the build-up of plaque, a combination of cholesterol, fatty substances, calcium and other cellular debris within the walls of arteries. Over time, this plaque accumulation leads to the narrowing and hardening of the arteries, impairing blood flow to vital organs such as the heart and brain. While atherosclerosis typically progresses silently, its consequences can be severe, potentially resulting in heart attacks, strokes or peripheral artery disease.

Several factors contribute to the development and progression of atherosclerosis, including:

	High cholesterol Elevated levels of low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, increase the risk of plaque formation within the arteries. Conversely, high levels of high-density lipoprotein (HDL) cholesterol, or "good" cholesterol, may offer protection against atherosclerosis.
	Hypertension (High blood pressure) High blood pressure places increased stress on the arterial walls, promoting the development of atherosclerotic plaques. Uncontrolled hypertension is a significant risk factor for heart disease and stroke.
	Diabetes Individuals with diabetes are at a heightened risk of atherosclerosis due to elevated blood sugar levels, which can damage the arteries and promote plaque formation. Proper management of diabetes through medication, diet and lifestyle modifications is essential for minimising cardiovascular complications.
	Smoking Tobacco smoke contains numerous harmful chemicals that damage the inner lining of blood vessels, facilitating plaque deposition and accelerating the progression of atherosclerosis.
	Obesity and physical inactivity Excess body weight and sedentary lifestyles contribute to atherosclerosis by promoting inflammation, insulin resistance, and dyslipidaemia.
	Poor diet Diets high in saturated fats, trans fats and refined carbohydrates can exacerbate atherosclerosis by raising LDL cholesterol levels and promoting inflammation.
	Family history A family history of heart disease or atherosclerosis increases an individual's susceptibility to these conditions. Genetic factors play a significant role in determining cardiovascular risk, underscoring the importance of early screening and proactive prevention strategies.

While certain risk factors for atherosclerosis, such as age and genetic predisposition, cannot be modified, many others are within our control. By adopting a heart-healthy lifestyle and addressing modifiable risk factors, individuals can significantly reduce their risk of atherosclerosis and its associated complications. Key strategies for prevention and management include:^1,2

• Cholesterol management: Keep cholesterol levels in check through dietary modifications, regular exercise, and, if needed, medication prescribed by a healthcare provider.
• Blood sugar control: Maintain healthy blood sugar levels through proper management of diabetes, including medication adherence, blood glucose monitoring and lifestyle adjustments.
• Blood pressure control: Monitor blood pressure regularly and work with healthcare providers to achieve and maintain optimal blood pressure levels through lifestyle modifications and, if necessary, medication.
• Healthy eating: Emphasise a diet rich in fruits, vegetables, whole grains, and lean proteins while minimising intake of saturated fats, trans fats and added sugar.
• Regular exercise: Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity per week, as recommended by health guidelines.
• Smoking cessation: Quit smoking and avoid exposure to second-hand smoke to reduce cardiovascular risk and improve overall health.
• Regular screening: Undergo routine health screenings, including cholesterol tests, blood pressure measurements and blood glucose monitoring, to detect and manage risk factors for atherosclerosis early.

In conclusion, atherosclerosis poses a significant threat to cardiovascular health, but armed with knowledge and proactive measures, individuals can mitigate their risk and safeguard their hearts. By understanding the factors that contribute to atherosclerosis and adopting a heart-healthy lifestyle, we can pave the way toward a future free from the burden of this silent but formidable foe.

References

1. Ghodeshwar GK, Dube A, Khobragade D. Impact of Lifestyle Modifications on Cardiovascular Health: A Narrative Review. Cureus. 2023;15(7):e42616.
2. Jiang X, Alnoud MAH, Ali H, et al. Heartfelt living: Deciphering the link between lifestyle choices and cardiovascular vitality. Curr Probl Cardiol. 2024;49(3):102397.