Introduction

If you have been following "Aging of the Heart and Blood Vessels is Risky" you have learned a lot about the heart. I've designed this series differently from what you may find in books, magazines, and on other sites. A lot of information out there is too technical or too terse, too specific for a broad audience or not at all relevant to the interactive and inquisitive older persons who now surf the web for health and aging information. I try not to preach, but rather teach. By first educating you about how the heart functions and how aging plays its part, I hope to have given you a solid foundation on which to view and analyze health information.

You have learned how to determine if you are in shape for your age and why aging causes your exercise ability to deteriorate (Articles #1 and #2). You saw how the older heart pumps blood and why older people feel short of breath (Articles #3 and #4). You read about changes in the older heart's ability to pump blood and about changes in the heartbeat and brain-heart communication with aging (Articles #5, #6, #7, and #8). Then you were introduced to the concept of why normal aging is a risk factor for heart disease (Article #9). Next, you learned about arterial stiffening and how the inner layer of your blood vessels, the endothelium, plays a part in this process (Articles #10 and #11). The next two articles helped identify risk factors and explained the importance of blood pressure as a risk factor and how blood pressure medications work (Articles #12 and #13). Most recently you read about arrhythmias (Article #14).

Since we began this series, questions related to each of the articles have poured in. Recurrent inquiries are related to deterring atherosclerosis. This shows that people are becoming more serious about the importance of prevention.

This issue may be an eye opener to you. In this article I will advise you not only about strategies to prevent coronary heart disease, or atherosclerosis, but also how to regress, or roll back, the process. Yes, if you already have atherosclerosis you can improve the condition of your cardiovascular system. Did you just reread that last sentence? Good....you are paying attention. Read and take the information in this article to HEART for a longer and healthier life.

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The Key To Combating Atherosclerosis Lies In The Endothelium

Please refer to Article 11, "The Inner Layer of Your Aging Blood Vessels Is a Battlefield" , for previous information on endothelial function and atherosclerosis, and the effects of aging on these.

Individuals who maintain endothelial and vascular health and those who take steps to restore damaged endothelium can prevent heart attacks and strokes caused by atherosclerosis. There are four components to the prevention and regression of atherosclerosis which relate to endothelial cell function and vascular conditioning. These are: reduction of modifiable risk factors, a heart-healthy diet, medications and supplements (when necessary), and exercise.

These interventions work, in part, because they operate both independently and in unison to promote vitality of endothelial cells. The endothelium, the innermost lining of the blood vessel, has direct contact with the blood and serves as an interface between the blood and the vessel wall. The cardiac endothelium is not a passive barrier between blood and myocardium (heart muscle), as we once thought. It has a regulatory function on blood vessels and the myocardium and thus can modulate the function of the ventricles (pumping chambers) of the heart and of the blood vessels. The endothelium is like a factory which produces substances that maintain the health of the blood vessels. Thus, damage or dysfunction to it is a major factor in the development of cardiovascular disease.

The most serious consequence of an unhealthy endothelium is that it causes the blood vessels to constrict and thicken over time. This facilitates the sticking and accumulation of blood cells on the vessels walls and leads to the formation of blood clots and development of atherosclerotic plaques. A healthy endothelium has been described as being like a Teflon coating on the vessels' inner walls, its non-stick quality enhancing the flow of blood. An unhealthy endothelium, by contrast, acts like Velcro, grabbing white blood cells and platelets and packing them against the inner wall of the blood vessel. An unhealthy endothelium is also a breeding ground for free radicals.¹

A healthy endothelium has the ability to release many beneficial substances. One, in particular, nitric oxide or NO, helps prevents atherosclerotic plaque development because of its ability to relax and dilate blood vessels and it will be discussed in detail. A sister molecule of NO, called prostacycline (PG12) also causes vessel relaxation. Relaxation is important because dilated vessels enhance the speed of blood flow, and the ability of blood cells to attach to vessels' walls decreases when they pass through swiftly. Another effect of these substances is to quench free radicals.

Progression of atherosclerosis is one reason why large arteries lose normal flexibility and become thickened and stiff, so they can't expand as they should when the heart pumps blood through them. In a recent article you learned that pumping blood into stiff arteries makes the heart work harder (Article #10 "How Badly are Your Arteries Hardening with Aging?"). When blood is forced into stiff arteries, the systolic pressure increases more than it would in softer, more expandable vessels. The effect of this higher blood pressure is one eventual cause of blood vessel deterioration. This is one reason why reducing your blood pressure reduces your risk for heart disease (Article #9 "What Was Once Believed To Be Normal aging is Now Considered To Be Dangerous!" and Article #13 "What's Your Blood Pressure and How Do Blood Pressure Medications Work?").

In summary, inappropriate constriction of blood vessels is bad and relaxation is good, because relaxed vessels reduce the work on the heart. A healthy endothelium can in effect prevent the formation of blood clots and atherosclerotic plaque because it produces substances which have a beneficial effect of the endothelium.

Part Two of this article will show how nitric oxide works to combat atherosclerosis and promote a healthy endothelium.

Footnotes
1. Free radicals are unstable atoms or molecules with at least one unpaired electron. These unpaired electrons want and need a partner. Consequently, the unstable free radicals, which have the ability to attract electrons from other atoms or molecules, go about swiping electrons from other stable atoms. This taking of an electron from another atom means that the free radical is now balanced and is no longer a free radical. But the atom or molecule from which the electron was taken is now damaged, and it additionally becomes a free radical. This sets off a chain reaction of damage within the body. In their reckless search for electrons, free radicals do a lot of structural damage to healthy cells.

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