High cholesterol is a major risk factor for heart disease, which is the leading cause of death worldwide. This is because high cholesterol levels can lead to a buildup of plaque in the arteries, a condition known as atherosclerosis or “clogged arteries.” However, not everyone with high cholesterol will develop clogged arteries. Here’s a closer look at the link between high cholesterol and clogged arteries.
What is cholesterol?
Cholesterol is a waxy, fat-like substance found in all of the cells in your body. Your body needs cholesterol to build cell membranes, make hormones like estrogen and testosterone, and create compounds that help you digest food. The body produces all the cholesterol it needs, but you also get cholesterol from foods that come from animals, like meat, eggs, and dairy.
There are two main types of cholesterol:
– LDL cholesterol – Known as “bad” cholesterol, LDL cholesterol builds up on the walls of arteries and causes plaque formation.
– HDL cholesterol – Called “good” cholesterol, HDL cholesterol carries cholesterol from other parts of your body back to your liver where it is removed. Higher levels of HDL can lower your risk for heart disease.
What causes high cholesterol?
High cholesterol is usually caused by:
– Diet – Eating foods high in saturated fat and trans fats can raise LDL cholesterol levels. Foods high in cholesterol like meat, eggs, and dairy can also contribute.
– Weight and physical activity level – Being overweight and not exercising can lower HDL and raise LDL cholesterol.
– Genetics – Your genes can affect how your body regulates and produces cholesterol. Familial hypercholesterolemia is an inherited condition that causes extremely high cholesterol.
– Age and sex – LDL cholesterol levels tend to rise as we age. Before menopause, women tend to have lower total cholesterol levels than men.
– Certain medical conditions and medications – Hypothyroidism, chronic kidney disease, pregnancy, and many drugs can impact cholesterol levels.
When is cholesterol considered high?
Here are the general cholesterol level guidelines:
– Total cholesterol: Desirable is less than 200 mg/dL. Borderline high is 200-239 mg/dL. High is 240 mg/dL and above.
– LDL cholesterol: Optimal is less than 100 mg/dL. Near optimal is 100-129 mg/dL. Borderline high is 130-159 mg/dL. High is 160-189 mg/dL. Very high is 190 mg/dL and above.
– HDL cholesterol: Low is less than 40 mg/dL (men) or 50 mg/dL (women). High is 60 mg/dL and above. This is considered protective against heart disease.
– Triglycerides: Normal is less than 150 mg/dL. Borderline high is 150-199 mg/dL. High is 200-499 mg/dL. Very high is 500 mg/dL and above.
Can You Have High Cholesterol Without Clogged Arteries?
Yes, it is possible to have high cholesterol without having clogged arteries or atherosclerosis. Here’s why:
High cholesterol alone doesn’t always lead to plaque buildup
Cholesterol levels alone do not give the full picture when it comes to heart disease risk. While high LDL is a major contributor to plaque formation in the arteries, other factors also play a role, including:
– Inflammation
– Oxidative stress
– High blood pressure
– Smoking
– Insulin resistance
– Diabetes
– Obesity
– Physical inactivity
– Genetics
Some people can tolerate high levels of LDL cholesterol and not develop arterial plaque and heart disease. For others, even moderately elevated cholesterol drives atherosclerosis.
Plaque buildup develops over many years
For most people, clogged arteries do not happen overnight. The plaque accumulation process generally occurs over decades.
At a young age, even if you have elevated cholesterol, you are less likely to have substantial plaque buildup compared to an older adult whose high cholesterol has persisted for many years.
HDL cholesterol may offset LDL’s effects
HDL cholesterol has antioxidant and anti-inflammatory properties that are protective to your arteries. Higher HDL levels may offset some of the damaging effects of LDL cholesterol.
If your HDL is high enough, even very high LDL may not immediately lead to clogged arteries. Raising HDL is important for people with high cholesterol.
Arterial plaque is not evenly distributed
The buildup of plaque in the arteries, called atherosclerosis, does not occur evenly throughout the arteries. Some areas tend to have more plaque than others.
It is possible to have a high cholesterol level that has not yet led to a dangerous buildup of plaque that could block critical arteries and lead to a heart attack or stroke. However, the risk rises over time.
Will High Cholesterol Eventually Lead to Clogged Arteries?
For most people, if high cholesterol goes untreated for many years, it will eventually lead to some degree of clogged arteries and atherosclerotic cardiovascular disease. Here’s why:
Persistent high LDL adds to plaque over time
LDL cholesterol does not simply disappear if it stays in your bloodstream. Over months and years, your arteries are exposed to more LDL than they can handle, which gradually builds up plaque. Even small dense LDL particles that squeeze into the artery walls can accumulate.
According to the American Heart Association, someone with total cholesterol levels above 200 mg/dL has roughly twice the risk of heart disease as someone with ideal levels below 200 mg/dL. The higher your cholesterol, the more hazardous the plaque buildup tends to be.
Inflammation accelerates plaque buildup
High LDL cholesterol triggers inflammation in the arteries. Inflammation destabilizes plaque, making it more prone to rupturing and causing blood clots. Ruptured plaque is the main cause of heart attacks and strokes.
Ongoing inflammation and oxidative stress in someone with elevated LDL can speed up the atherosclerotic process over time.
Plaque buildup worsens with age
Aging affects cholesterol metabolism and how your arteries respond to LDL cholesterol. As you get older, your arteries stiffen and lose their elasticity, becoming more susceptible to plaque buildup.
A person with high cholesterol will generally have more rapid atherosclerosis progression as they move through middle age and beyond.
Genetics can accelerate plaque development
Your genetics influence how high cholesterol impacts your cardiovascular health. People with familial hypercholesterolemia have very high LDL from birth due to genetic factors. Without treatment, LDL this extreme often leads to premature heart disease.
Even more moderate genetic susceptibility can speed up harmful plaque formation in response to high cholesterol.
Can You Reverse Clogged Arteries?
Once plaque buildup is present in the arteries, can it be reversed? Research shows that atherosclerosis can be reversed through lifestyle changes and medical treatment, especially when intervention starts early.
Aggressive LDL cholesterol lowering stops further plaque buildup
Strong evidence shows that lowering LDL cholesterol can reduce plaque and stop the progression of atherosclerosis.
Powerful statin drugs are the first-line treatment for lowering LDL cholesterol and protecting the arteries. Lifestyle measures like diet, exercise and avoiding smoking are also critical.
One major study found that patients who lowered their LDL cholesterol to an average of 50 mg/dL had plaque reduction and stabilization, with less risk of heart attack and stroke.
Raising HDL may help reverse plaque buildup
Some emerging research indicates increasing levels of HDL cholesterol may help shrink plaque volume through several mechanisms:
– Removing excess cholesterol from plaque in artery walls
– Reducing inflammation
– Improving endothelial function
However, more evidence is still needed to confirm whether raising HDL effectively reverses atherosclerosis in humans.
Artery plaque can begin dissolving within months
A researcher named Dr. Caldwell Esselstyn conducted a trial where patients with heart disease ate a strict whole-foods, plant-based diet without added oils or nuts. Within months, follow-up tests showed commencement of plaque volume reduction as patients lowered their cholesterol levels.
However, severe atherosclerotic blockages may require other procedures like stents or bypass surgery for reversal, in addition to lifestyle changes.
Key Takeaways
– It is possible to have high cholesterol but no artery blockages, especially if you are younger or have protective factors like high HDL. However, prolonged high cholesterol typically leads to plaque buildup over time.
– Aggressive cholesterol treatment targeting LDL levels below 70 or 50 mg/dL can stop and reverse the progression of arterial plaque.
– Lifestyle changes involving diet, exercise, and avoiding smoking are critical both to prevent clogged arteries and help reverse atherosclerosis when it develops.
– Early intervention provides the best opportunity to dissolve arterial plaque before it causes a heart attack or stroke.
Conclusion
High cholesterol is a major contributor to the plaque buildup and clogged arteries that can lead to heart attacks and strokes. However, high cholesterol does not automatically mean you have severe blockages. Especially when you are younger, it is possible to have high cholesterol but minimal atherosclerosis if you have protective factors.
Yet for most people, leaving high cholesterol untreated for many years allows dangerous plaque accumulation in the arteries. By making aggressive lifestyle changes and getting cholesterol levels down, preferably below 70 mg/dL through medication and diet, you may stop and reverse some of the built-up plaque and damage to your arteries before it is too late. The key is not waiting once you discover high cholesterol, but taking immediate steps to address it through healthy lifestyle habits and medical care.