What is vulnerable plaque and what causes it?
What is vulnerable plaque? For many years, doctors have thought that the main cause of a heart attack or stroke was the buildup of fatty plaque within an artery leading to the heart or brain.
What makes a plaque stable?
What makes a plaque stable is the intact and thick fibrous cap that is made up of smooth muscle cells in a matrix rich in type I and III collagen.
What causes plaque to form in arteries?
Plaque forms when cholesterol (above, in yellow) lodges in the wall of the artery. Plaque forms when cholesterol lodges in the wall of the artery. To fight back, the body sends white blood cells to trap the cholesterol, which then turn into foamy cells that ooze more fat and cause more inflammation.
What happens when plaque breaks off?
When soft plaque suddenly breaks loose, it can trigger a clot blockage large enough to cause acute heart attack or stroke.
Why does plaque become unstable?
Plaque instability begins with endothelial activation caused by both the classic cardiac risk factors (elevated cholesterol levels, smoking, and hypertension) and more recently identified factors (homocysteine, immune complexes, and some infectious agents).
What can cause plaque to break loose?
Like magma underneath a volcano, rumblings in the core of a deposit, which contains dead cells, can break open the plaques. Once the plaque ruptures, a blood clot in the lumen of the artery can form.
What is unstable plaque in the heart?
Unstable plaques can rupture and lift off the artery wall, leading to an acute event such as heart attack, stroke or death. Unstable plaques are potentially more dangerous than stable plaques because of their propensity to rupture and cause complete obstruction to blood flow.
What triggers plaque formation?
Atherosclerosis is a hardening of your arteries caused by gradual plaque buildup. Risk factors include high cholesterol, high blood pressure, diabetes, smoking, obesity, lack of exercise and a diet high in saturated fat.
What happens when a piece of plaque breaks off?
A plaque can also break apart. If this happens, a blood clot (thrombus) forms at the break and blocks blood flow. Or the blood clot can move through the bloodstream, blocking blood flow to organs.
Does exercise dislodge plaque?
A. Yes, lifestyle changes, including diet, smoking cessation, stress management and exercise, can decrease the size of atherosclerotic plaques. They can also help to stabilize them so that they are less likely to break off and block blood flow, decreasing your risk of a heart attack.
How long can you live with unstable angina?
It's normal for you to worry about your loved one's health and future, but you should know that most people with unstable angina do not have heart attacks. Usually, angina becomes more stable within eight weeks. In fact, people who are treated for unstable angina can live productive lives for many years.
How can we identify unstable plaque?
Optical Coherence Tomography (OCT) It can clearly identify the thin intimal plaque (as little as 30 microns diameter) above the high risk plaques. It can also define fissuring within the plaque and can generate high contrast between lipid and non lipid tissues, therefore identify lipid collections within the plaque.
Can you get rid of plaque in heart?
High blood levels of cholesterol encourage the formation and growth of vascular plaques that put you at risk for heart attack and stroke. So, can we reduce plaque buildup? "Making plaque disappear is not possible, but we can shrink and stabilize it," says cardiologist Dr.
What foods cause plaque in arteries?
The study, published Aug. 13 in Science, suggests that consuming food rich in saturated fat and choline - a nutrient found in red meat, eggs and dairy products - increases the number of metabolites that build plaques in the arteries.
Does sugar cause plaque in arteries?
LDL cholesterol: Weight gain connected to diets high in sugar can lead to higher levels of LDL cholesterol. LDL — commonly called “bad cholesterol” — causes artery-clogging plaque that can damage blood vessels and your heart.
How do you prevent plaque build up?
To prevent plaque buildup, brush your teeth at least twice a day with a soft, rounded-tip bristled toothbrush. Pay particular attention to the space where the gums and teeth meet. Use a fluoride-containing toothpaste. Floss between teeth at least once a day to remove food particles and bacteria.
What is a vulnerable plaque?
Today’s concept of vulnerable plaque has evolved primarily from the early pioneering work uncovering the pivotal role of plaque rupture and coronary thrombosis as the major cause of acute myocardial infarction and sudden cardiac death. Since the first historical description of plaque rupture in 1844, several key studies by leading researchers and clinicians have lead to the current accepted views on lesion instability. Important to the complex paradigm of plaque destabilization and thrombosis are many discoveries beginning with the earliest descriptions of advanced plaques, reminiscent of abscesses encapsulated by fibrous tissue capable of rupture. It was not until the late 1980s that studies of remodeling provided keen insight into the growth of advanced plaques, beyond the simple accumulation of lipid. The emphasis in the next decade, however, was on a focused shift toward the mechanisms of lesion vulnerability based on the contribution of tissue proteolysis by matrix metalloproteinases as an essential factor responsible for thinning and rupture of the fibrous cap. In an attempt to unify the understanding of what constitutes a vulnerable plaque, morphological studies, mostly from autopsy, suggest the importance of necrotic core size, inflammation, and fibrous cap thickness. Definitive proof of the vulnerable plaque, however, remains elusive because animal or human data supporting a cause-and-effect relationship are lacking. Although emerging imagining technologies involving optical coherence tomography, high-resolution MRI, molecular biomarkers, and other techniques have far surpassed the limits of the early days of angiography, advancing the field will require establishing relevant translational animal models that produce vulnerable plaques at risk for rupture and further testing of these modalities in large prospective clinical trials.
Is plaque rupture a cause of luminal thrombosis?
Plaque rupture is a primary underlying cause of luminal thrombosis responsible for provoking ACS. Although plaque erosion and calcified nodules are also accountable for coronary thrombi, unlike ruptures precursors to these lesions have not been identified. The TCFA is considered an unstable high-risk plaque with a propensity toward rupture. These lesions, however, are morphologically different from ruptures, as they generally exhibit smaller necrotic cores and intact thin fibrous caps less infiltrated by macrophages; the degree of calcification is also less. The current paradigm designating TCFAs as a prelude to ruptures is primarily supported by autopsy findings, where definitive proof does not exist because of a lack of prospective animal or human data confirming a cause-and-effect relationship. Potential morphological and biological processes that may be helpful for the identification of TCFAs recognized by today’s imaging modalities include necrotic core size, intraplaque hemorrhage, and positive remodeling. Advancing the field, however, will require establishing relevant translational animal models that produce vulnerable plaques at risk for rupture and furthering the development of novel imaging and therapeutic modalities.
How does plaque form?
Plaque forms when cholesterol lodges in the wall of the artery. To fight back, the body sends white blood cells to trap the cholesterol, which then turn into foamy cells that ooze more fat and cause more inflammation. That triggers muscle cells in the artery wall to multiply and form a cap over the area.
How to treat a large plaque in the artery?
These are often treated by inserting a wire mesh tube (stent) near the blockage to widen the artery .
Why is LDL bad?
Too much LDL in the blood can cause cholesterol to lodge in the artery walls and form plaques. That's why LDL is known as "bad" cholesterol. Not surprisingly, high levels of cholesterol in the diet raise blood levels of LDL.
Is it dangerous to have a soft plaque under your artery wall?
That triggers muscle cells in the artery wall to multiply and form a cap over the area. But the soft plaque beneath the cap is dangerous. "For example, if your blood pressure spikes, it puts pressure on the thin wall of the plaque, which can break open, form a clot, and cause a heart attack," says Dr. Cannon.
Can high cholesterol cause a heart attack?
High blood levels of cholesterol encourage the formation and growth of vascular plaques that put you at risk for heart attack and stroke. So can we reduce plaque buildup? "Making plaque disappear is not possible, but we can shrink and stabilize it," says cardiologist Dr. Christopher Cannon, a Harvard Medical School professor.
What causes angina to be unstable?
What causes unstable angina? The principal cause of unstable angina is coronary heart disease caused by a buildup of plaque along the walls of your arteries. The plaque causes your arteries to narrow and become rigid. This reduces the blood flow to your heart muscle.
What is unstable angina?
Unstable angina is chest pain that occurs at rest or with exertion or stress. The pain worsens in frequency and severity. Unstable angina means that blockages in the arteries supplying your heart with blood and oxygen have reached a critical level. An attack of unstable angina is an emergency and you should seek immediate medical treatment.
How to prevent unstable angina?
Nonmedical self-care options include taking steps to lose weight, giving up tobacco use, and exercising more regularly. Working toward a healthier lifestyle can improve your heart health and reduce your risk of future unstable angina episodes. Last medically reviewed on May 30, 2017.
What is the procedure to open up an artery that was previously blocked?
If you have a blockage or severe narrowing in an artery, your doctor may recommend more invasive procedures. These include angioplasty, where they open up an artery that was previously blocked. Your doctor also may insert a small tube known as a stent to keep your artery open.
Can angina progress to unstable?
It’s possible for stable angina to progress to unstable angina. If you have stable angina, be aware of any chest pains you feel even when at rest. Also watch for chest pains that last longer than they typically do or that simply feel different to you.
What causes plaque instability?
Plaque instability begins with endothelial activation caused by both the classic cardiac risk factors (elevated cholesterol levels, smoking, and hypertension) and more recently identified factors (homocysteine, immune complexes, and some infectious agents).
What causes angina to be unstable?
Plaque instability is now acknowledged to be the major cause of unstable angina, myocardial infarction, and sudden cardiac death. Unstable lesions (that are not necessarily severely stenotic) with a large lipid core, many inflammatory cells, and a thin fibrous cap are associated with acute coronary syndromes.
What is hard plaque?
Hard (calcified) plaque limits blood flow—but soft (noncalcified) plaque is a ticking time bomb that can suddenly break loose and trigger a clot large enough to cause a fatal heart attack or stroke. Two natural compounds have been identified that target arterial plaque and atherosclerosis.
What is the importance of plaque stability?
Plaque Stability: A Key Factor in Preventing Fatalities. When seeking to reduce atherosclerotic risk, there is more to it than just prevention of plaque formation, as most of the danger posed by plaque occurs when it becomes unstable.
What plant helps to stop plaque buildup?
10,14 This Asian aquatic plant also helps stop the progression of plaque buildup by reducing the adhesion of monocytes, immune system cells that promote atherosclerosis. 15
What are the two compounds that target plaque?
Researchers have identified two natural compounds that target arterial plaque and atherosclerosis . Together, they have been shown to boost stability of deadly soft plaque to help prevent a plaque rupture, while also slowing and even regressing the accumulation of soft and hard arterial plaque. 1.
What are the effects of atherosclerosis?
The effects of atherosclerosis vary, depending on which arteries in the body narrow and become clogged with plaque. If the arteries that bring oxygen-rich blood to the heart are affected, the result can be coronary artery disease, chest pain, or heart attack. If the arteries to the brain are affected, the result can be a transient ischemic attack ...
What does the white component of a plaque mean?
They also experienced a substantial increase in the “white component” of their plaque based on ultrasound imaging, indicating improved plaque density and “a significant reduction in possible events.”. Critically, their plaques were also decreased in length, height, and number.
Can atherosclerosis cause sudden death?
Because soft plaque is unstable and causes no symptoms until it pops without warning, someone with atherosclerosis may feel fine, have a normal EKG, and pass a stress test—and later that same day have a plaque rupture, resulting in sudden death. Researchers have identified two natural compounds that target arterial plaque and atherosclerosis.
History of The Vulnerable Plaque
Pathological Characterization of The Thin-Cap Fibroatheroma Or Vulnerable Plaque
Incidence and Frequency of The TCFA
Mechanical Stress, Lesion Vulnerability, and Rupture
Limitations to The Vulnerable Plaque Paradigm
Proteolysis and Plaque Imaging
Catheter-Based Near-Infrared Spectroscopy and Assessment of Lipid Burden
What to Look For When Imaging The Vulnerable Plaque
Summary and Perspectives
- Plaque rupture is a primary underlying cause of luminal thrombosis responsible for provoking ACS. Although plaque erosion and calcified nodules are also accountable for coronary thrombi, unlike ruptures precursors to these lesions have not been identified. The TCFA is considered an unstable high-risk plaque with a propensity toward rupture. These l...