CORONARY ARTERIES

As you might expect of such a hardworking muscle, the heart requires a great deal
of oxygen and nutrients to fuel its own operations. The myocardium is too thick to
be served by diffusion of oxygen and nutrients from the blood passing through.
Thus, the heart has its own set of blood vessels called the CORONARY
ARTERIES that supply the heart muscle.
The coronary arteries branch from the aorta just above the aortic semilunar valve
and encircle the heart’s surface (the word coronary comes from the Latin corona,
meaning “encircling like a crown”). From the surface, they send branches inward
to supply the myocardium. Cardiac veins collect the blood from the capillaries in
the heart muscle and channel it back to the right atrium.
The coronary arteries are relatively small in diameter. If they become partially or
completely blocked, perhaps as a result of atherosclerosis, serious health problems
can result.

CHOLESTEROL & ATHEROSCLEROSIS

As you probably already know, cholesterol is a key
component of all cell membranes and the precursor molecule for
several hormones. All cells require a certain amount of it for normal
functioning. However, too much cholesterol in the blood can lead to a
condition called atherosclerosis—a thickening of an arte-rial vessel
wall due to the buildup of fatty materials containing cholesterol. Left
untreated, atherosclerosis contributes to heart attacks, strokes,
aneurysms, and peripheral vascular disease.
Most of the cholesterol in the blood is bound to certain carrier
proteins. Together, the cholesterol and the protein are called a
lipoprotein. There are two types of lipoproteins, based on their
densities: In terms of atherosclerosis, low-density lipoprotein (LDL) is considered “bad” and high-density lipoprotein
(HDL) is considered “good.” When present in normal amounts, LDL transports cholesterol throughout the body and
makes it available to cells. However, when there is too much LDL, it begins to attach to the cells lining the arterial blood
vessel wall and then makes its way into the cells.
Once inside cell, LDL triggers an inflammatory response that ultimately results in the buildup of fatty deposits
called atherosclerotic plaques within the blood vessel wall. Eventually, these plaques may rupture, causing blood clots to
form that can occlude arteries and cause heart attacks and strokes. Conversely, HDL targets cholesterol for removal. HDL
picks up free cholesterol and carries it to the liver, where it is detached from the protein, mixed with bile, and secreted into
the small intestine. Some of the cholesterol in bile is excreted from the body with the feces, although some is reabsorbed,
to be used again.
Risk factors for atherosclerosis include factors that raise blood choles-terol (obesity, sedentary lifestyle, and a
high-fat diet), smoking, diabetes, hypertension, and a family history of ath-erosclerosis. Before age 45, men have a 10
times greater risk of atherosclerosis than women; however, women’s risk rises after menopause. According to the
American Heart Association, a total cholesterol of under 200 mg/dl is considered desirable. Ideally, HDL should be
greater than 60 mg/dl and LDL should be less than 100 mg/dl. A total cholesterol of greater than 240 mg/dl along with a
high LDL and/or low HDL would be cause for concern. If you’re having trouble remember-ing which lipoprotein is bad
for you and which is good, just remember that cholesterol is a lipid, and lipids are less dense than protein or water. So
low-density means more cholesterol, and, therefore, low-density lipoprotein (LDL) is the “bad” one. Some degree of
atherosclerosis is common with advancing age. However, lifestyle can make a big difference in how rapidly
atherosclerosis develops and whether it becomes severe. At the end of this chapter, we look at what you can do to lower
your risk of atherosclerosis and other cardiovascular conditions.