Dr. Neil Treister, Medical Director Dr. Treister is President and Medical Director of Salus Heart and Wellness. He has a doctorate of Medicine from Stanford University School of Medicine and is board certified in both Internal Medicine and Cardiovascular Disease.

What is atherosclerosis? (M. Needle; Atlanta, GA)
Atherosclerosis is the “hardening of the arteries” that results from the buildup of cholesterol and other material within plaques along the lining of blood vessels. This process occurs in arteries that carry blood to the various tissues (e.g., heart, brain, legs and kidneys) and not in the veins which carry blood under low pressure back to the heart. Atherosclerosis occurs to some extent in all of us, beginning early in childhood. However, serious blockages of the arteries to the heart (atherosclerotic coronary artery disease or ASCAD) are NOT inevitable and do not occur in most populations living in pre-industrialized conditions. Although not all heart disease is due to atherosclerosis, most heart problems in the United States and other industrialized countries result from this process. ASCAD has reached epidemic proportions in our country and is by no means under control.

What causes a heart attack? (P.Farr; San Diego, CA)
A heart attack or myocardial infarction occurs when the blood supply to an area of the heart muscle is suddenly and profoundly limited such that irreversible cell damage occurs. By definition, some heart muscle dies and is replaced by scar tissue. The closure of the artery generally occurs due to the disruption of a plaque within the artery lining leading to the formation of a blood clot that completely stops blood flow. What makes plaques vulnerable and prone to rupture or disruption is the focus of much research. Factors associated with “vulnerable plaques” include a large fat deposit, inflammation and a thin covering over the plaque material.

What are some of the factors that might lead to a heart attack? (J. Carner; Erie, PA)
Anything that promotes the atherosclerotic process or makes plaques prone to rupture can increase the likelihood of a heart attack. What is becoming increasingly appreciated is the role of the endothelium in atherosclerosis. The endothelium is the layer of cells that comprises the inner lining of the blood vessel. The endothelium produces substances that modulate the interaction of blood components with the blood vessel and how the blood vessel responds to various stimuli. Blood clotting, cholesterol buildup, new blood vessel formation and blood vessel constriction or spasm are affected by the endothelium.

The commonly recognized “causes” of premature or accelerated atherosclerosis are termed “risk factors” and include:

	male gender
	increasing age
	cigarette smoking
	high blood pressure (hypertension)
	high cholesterol (particularly elevated LDL [low density lipoprotein] cholesterol)
	diabetes
	a family history of premature ASCAD
	low HDL cholesterol

Other metabolic and lifestyle factors have been associated with early ASCAD and their roles are the continuing to be explored. A partial list includes:

	elevated levels of homocysteine in the blood
	inflammation as manifest by elevated levels of C-reactive peptide (CRP) in the blood
	insulin resistance syndromes
	diets high in refined carbohydrates
	diets low in naturally occurring anti-oxidants
	sedentary lifestyle
	obesity
	increased intake of saturated fats and “trans-fatty acids”

(Due to large volume, we regret that not all questions can be personally answered by Dr. Treister and staff.)