Question: How do arteries continue to plaque if a person stopped smoking over 20 years ago and does not have chronically high cholesterol?
Dr. Hibberd's Answer:
Plaque forms over many years. Once formed, it often calcifies. The danger of heart attack and stroke occurs when the plaque becomes unstable and falls away from the vessel surface in the form of an inflammatory platelet-rich plug that will cause sudden blockage without much warning.
Long-term smoking causes plaque buildup (which causes narrowing), and stopping smoking definitely reduces its acceleration. No regression can be expected with elevated blood lipids, but regression is seen when blood lipids are managed aggressively. This usually requires prescription lipid medications to reach LDL goal of 80, to elevate HDL to targets of 60 or more, to and reduce triglycerides to under 150.
While diet has a role, it probably impacts lipid values in most people by only 10 to 20 percent. By itself, it is definitely not enough to lower risk in patients who are at higher risk. I recommend you set up a visit with your cardiologist or your primary care physician to discuss this further.