If cholesterol can only attach to the inner lining of the artery once if it has been damaged, how does the lining of an artery get damaged?

Free radicals are the primary source of arterial wall damage. Free radicals are highly reactive substances like polluted air, radiation, tobacco smoke, or herbicides. They are found naturally within our own bodies as a byproduct of regular metabolic processes. 

Free radicals change normal cell activity and damage cells. An example you may recognize happens in every day life when metal starts to rust (oxidize) or fruit begins to spoil. For that reason we take   anti-oxidants like vitamins C, E, beta-carotene or selenium, to resist attacks from free radicals.

Heredity influences your chances of having high cholesterol.  Your genes influence your LDL by affecting how fast it is made and removed from your blood.  One form of inherited high cholesterol often leads to early heart disease.  That is familial “hypercholesterolemia”. It may affect 1 in 500 people.

Weight also influences your LDL levels.  If you have a high LDL level and are overweight, weight loss may help you lower your LDL cholesterol.  Losing weight also helps lower triglycerides and raises your HDL levels.

Your age and sex are also contributing factors.  Before menopause, women generally have total cholesterol levels lower than men.  This shifts as men and women age.  Levels rise until reaching age 60 to 65.  Menopause can cause an increase in LDL (bad) and a decrease in HDL (good).  After the age of 50, many women have higher total cholesterol levels than men of the same age.

Alcohol has peculiar affects on cholesterol levels.  It increases HDL (good) but does not lower LDL (bad).    This is one reason healthcare professionals do not really know whether alcohol reduces the risk of heart disease or not.  Too much alcohol can damage the liver and heart muscle. It can lead to high blood pressure and raise triglycerides.  The number of risks to consider regarding alcohol use suggests it is not wise to use alcoholic beverages as a way to prevent heart disease simply because it increases HDL levels.

Personality and how people handle stress may also be factors contributing to heart disease.  For many years people have suggested that particular personality types are more prone to heart disease.  The first “Type A” and “Type B” personality studies were performed in 1959.  Type A people drive themselves to meet specific deadlines which are often self-imposed. Type A behavior shows itself in a person who has a chronic sense of time, urgency, aggressiveness and striving for achievement.

Type A individuals often feel constant pressure and multi-task, doing two or three things at the same time, to achieve more.  Type A people are driven.  They may consider themselves indispensable.    These personality traits contribute to a state of stress.

Stress responses tend to raise blood cholesterol levels in the long run. One way it does this is by affecting habits.  One example is when people under stress over indulging in fatty foods as comfort foods.  The saturated fat and cholesterol in these foods contribute to high levels of blood cholesterol.   Further dietary factors will be discussed in a later chapter.

Type B behavior seems to be comprised of the opposite set of traits.  Type B people are less rushed; less preoccupied with achievement, and often more relaxed people. Deadlines do not yield any special pressure and they prefer not to be rushed. They are less prone to angry outbursts. Type B individuals seem to be making clear distinctions between work and play.

Different studies show that Type A participants have a 31% increased risk of developing heart disease.  These studies ranged from a period of eighteen months to two years with groups of both Type A and Type B individuals.
The discovery of more deposits of plaque in the coronary arteries of Type A people is further affirmation of their greater health risk.  Type A behavior is also associated with other risk factors like smoking, higher fat levels, and increased adrenaline.  All of these factors increase the amount of oxygen the heart muscles need and they contribute to releasing fatty acids from body fat into the bloodstream.

 Keep in mind these are behaviors being discussed. These are not actually two different classes of people.  Sorting people into categories does not adequately identify the individual differences between each person. Nor does it adequately recognize the common ground among all people.

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