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Dr. Lloyd's blog has now been retired. We appreciate all the wisdom and support Dr. Lloyd has brought to the WebMD community throughout the years.

Wednesday, July 9, 2008

Heart Attack…Eye Attack?

There are lots of news stories this week regarding the long-term benefits of maintaining normal blood cholesterol levels (HDL, LDL, triglycerides). The lifetime risk of stroke and heart attack may be cut by 36% in the United States over the next 30 years if everyone with elevated lipids is diagnosed and treated. Some pediatricians now advocate prescribing statins for susceptible children.

Most of you know the sequence: a fatty diet plus hereditary tendencies combine to elevate the blood cholesterol. In response to all this circulating cholesterol, the arteries form atherosclerotic plaques that shrink the openings of the arteries. Smaller vessels reduce the amount of fresh blood and fresh oxygen that can be delivered to the tissues. If atherosclerosis compromises the coronary arteries the poorly oxygenated heart muscle will starve (myocardial infarction). Coronary artery occlusion can be reversed with angioplasty (stent placement), laser treatment, and surgical grafting of new vessels that bypass the clogged arteries (coronary artery bypass graft – CABG).

Can atherosclerosis occur inside the eye? Do people ever develop a Retinal Infarct?

Retinal artery occlusion is a true emergency, but it is different than a myocardial infarct. Did you know that there are no true arteries inside the eye – only arterioles and capillaries. Atherosclerosis and cholesterol plaque formation does not occur inside the walls of these tiny vessels.

Having said that, retinal artery occlusion is frequently caused by a dislodged chunk of mineralized cholesterol from the large internal carotid artery in the neck. That chunk of cholesterol becomes an embolus just like a cork flowing downstream. Eventually it gets stuck when the dimensions of the embolus exceeds the opening of the downstream vessel. The results are immediate and catastrophic: sudden, painless loss of vision. Most of the time the vision loss caused by an embolic retinal artery occlusion is permanent and irreversible.

Remember, even if your family history for heart disease is pristine and you carry no risk factors for coronary atherosclerosis, you still need to pay attention to your cholesterol numbers to protect vital structures (like your eyes) from sudden vascular occlusion secondary to atherosclerosis arising elsewhere in your body.

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Posted by: Bill Lloyd MD at 1:08 pm


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