forming what is called a foam cell. When multiple foam cells
coalesce, they create a characteristic fatty streak, marking
the beginning of what, over time, might become a plaque, as
other immune cells, platelets, and dysfunction of the artery
wall compounds.
The process of LDL oxidation clearly plays a major role
in the development of atherosclerosis. Interestingly,
atherosclerosis is only found in arteries, as opposed to veins.
Arteries, unlike veins, carry oxygenated blood in a high-
pressure environment, providing fertile ground for those
small, dense LDL particles to become damaged and stick to
the vessel wall. And while a heart attack (due to plaque
build-up in the arteries surrounding the heart) is what many
would consider a worst-case scenario, atherosclerosis can
happen anywhere, including the microvasculature supplying
oxygen to the brain. This is what vascular dementia is: lots
and lots of tiny little strokes in the brain.^13 And it is the
second most common form of dementia after Alzheimer’s.
But what if you’re young and healthy, decades away
from that brain disease “only old people get”? Can this
elegant plumbing system really affect your cognitive
function? My friend and colleague Dr. Richard Isaacson,
who heads up the Alzheimer’s Prevention Clinic at Weill
Cornell Medicine and NewYork-Presbyterian, has seen
countless patients whose elevated levels of small, dense
LDL particles have correlated with lower-than-expected
executive function on cognitive tests (this includes the
ability to think clearly, focus, and be mentally flexible).
While the exact mechanism is unclear plausible that the
underlying processes described above are contributing in