What Causes Vulnerable Plaque?

By Dr Harold Gunatillake Health Writer

This would be the million dollar question. The fat droplets floating in the blood stream are absorbed by the arterial inner lining causing release of proteins (called cytokines) that lead to inflammation.

These cytokines make the artery wall sticky, which attracts immune-system cells, called monocytes present in the blood. The monocytes creep into the arterial wall and turn into larger cells called macrophages. These scavenging large cells begin to soak up fat droplets. It is these fat filled macrophages, it is believed, that form plaque with a thin covering.

When this inflammation is combined with other stresses, such as high blood pressure, the thin covering over the plaque can rupture and bleed. The blood cells, mainly platelets get stuck to the sticky cytokines and clumping of these cellular materials forms a clot large enough to block the artery.

Dr Dwight Lundell past Chief of Staff and Chief Surgery at Banner Heart Hospital has this to say:
"The only accepted therapy was prescribing statin medication to lower cholesterol and a diet that severely restricted fat intake. These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

"The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences. Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

"Statistics from the 'American Heart Association' show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

"Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes.

Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped". It is bringing to light that diets low in fat is not what the doctors should recommend when the culprits are polyunsaturated fats and carbohydrates causing repeated injury to our blood vessels, resulting in heart disease, stroke, diabetes and obesity.

Overload of simple, highly processed carbohydrates (sugar, foods cooked with rice and wheat flour) and the excess consumption of omega-6 vegetable oils like corn, sunflower, and soybean found in many of our processed foods, are today considered as creating such chronic inflammatory changes in the inner lining of arteries.

Colombo is becoming a refuge for many food outlets for starchy processed foods cooked in Omega-6 type of polyunsaturated oils.

Look around the main and side streets; what you see are small unclean food outlets feeding people with food such as hoppers, pittu, indiappams, thosais' and wadeis'.

These are all processed starchy foods prepared with oils like sunflower, vegetable and corn. The more heart healthy oils – the omega-3 types like canola, monounsaturated oils like peanut, olive oil, and saturated coconut oils are far too expensive to be utilized in these cost cutting food outlets, and furthermore not available freely in our markets.

The elite patronize cleaner food outlets for their pastries and cakes, and rice packets, all using similar oils. Most of these omega 6 types of oil are trans-fat sold in supermarkets to increase the shelf life of the oils.

An overload of highly processed carbohydrates and excess consumption of omega-6 vegetable oils are the biggest culprits of chronic inflammation and not beneficial cholesterol manufactured in the liver (90%) and found in foods such as eggs, and sea foods, and dairy products.

C Reactive Protein
Assessing the degree of chronic inflammation by C Reactive Protein (CRP) cardiologists can today measure the extent of chronic inflammation of blood vessels and the risk of heart attack or stroke, by performing a simple blood test to measure the level of a substance called C-reactive protein manufactured in the liver that increases with systemic inflammation.

C reactive protein is a marker that doctors use to measure inflammatory activity in the body. Studies show that the higher the C-reactive protein levels in the blood, the greater the risk of a heart attack.

There is a more sensitive test called highly selective (hs) C-reactive protein assay to determine the risk of heart disease, available in most countries, including Sri Lanka.

Medicines like ACE inhibitors (high blood pressure medication) and aspirin appear to reduce inflammation in the body, which may prevent heart attacks in people who already have high C-reactive protein levels.

Cholesterol lowering drugs called statins also have been found to lower C-reactive protein levels.Ask your doctor to do a CRP level in your blood on your annual check-up.

That test may reveal whether an inflammatory process is brewing in your body, which requires further investigation and early preventive measures.

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