Cardiovascular Disease (Atherosclerotic)

What it is

Atherosclerotic cardiovascular disease (ASCVD) is the build-up of lipid-rich plaque in arterial walls, leading to coronary heart disease, ischaemic stroke, peripheral arterial disease, and abdominal aortic aneurysm. The two endpoints that matter most are myocardial infarction and ischaemic stroke.

What causes it

Plaque starts forming in adolescence and progresses over decades. The dominant causal driver is cumulative arterial wall exposure to apoB-containing lipoproteins, modified by inflammation, endothelial dysfunction, and shear stress. Other major contributors:

• High blood pressure.
• Smoking.
• Diabetes / insulin resistance.
• Genetic risk (FH, Lp(a)).
• Chronic inflammation.

Primary prevention works

Almost all ASCVD events in middle-aged adults are preventable with sufficient long-term apoB lowering, blood-pressure control, and no smoking. The earlier you start, the larger the lifetime benefit (the “cumulative LDL years” concept).

Tools

• Risk calculators: pooled cohort equations, SCORE2, QRISK.
• CAC scoring (coronary artery calcium) for reclassification in middle-aged adults.
• Lifestyle: Mediterranean diet, regular exercise, weight management.
• Drugs: statins + ezetimibe (and PCSK9 inhibitors if needed), antihypertensives, GLP-1 / SGLT2 in diabetes, selective use of aspirin.

Related entries

ApoB, Lp(a), Statins, CAC score, Peter Attia.