Something that is not well understood by the general population (except devout readers of my rantings…) is that there is plaquing of the arteries and there is plaquing of the arteries.  None of it is good and it is a sign of poor vascular health.  But without a doubt, the soft, vulnerable plaque is far more dangerous than the hard, stable plaque.

Picture a nice, wide open blood vessel that has some plaquing in it.  The plaque takes up maybe 10% of the opening of the canal.  If it’s a stable plaque this is just fine.  Plenty of blood flow and oxygen are getting the heart.  Your treadmill stress test comes through with shining colors. 

But what if the plaque is unstable?  That mass taking up 10% of the lumen of a large blood vessel, but now it breaks free and works its way into a smaller vessel, taking up most of the canal, starving the heart muscles for oxygen and causing a heart attack.  The stress test on this plaqued artery prior to the mass breaking off?  Again passed with shining colors.

What??  Am I saying that you can drop dead of a massive heart attack leaving a perfectly healthy stress test?  Yup.  And it all boils down to the stability of a plaque.  So how do we know? 

First, this study looks at the ability of CT scan to identify the soft vs hard, stable plaques and finds that it does a pretty good job.  Not too shabby.  Next, we can easily check lipoprotein-associated phospholipase A2 (Lp-PLA2, or PLAC test for short) in the blood.  This test has some pretty strong correlation with being able to predict if any plaques are unstable and ready to rupture.

Even more importantly, what can we do to make sure any plaques were are sporting are the stable type?  Exercise, higher intake of healthy fats (raw nuts, seeds, wild caught fish, avacodos, flax, olive oil, etc..) and lowering our levels of inflammation (see earlier blog postings) all increase the stability of a plaque.

Of course, making sure they’re not there in the first place sounds more preferable to me.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.