This month I will be continuing with a cardiovascular theme by looking at the phenomenon of vulnerable or unstable arterial plaque.
Arterial disease, leading to heart attacks and strokes, is a significant cause of death and disability in our communities. This is despite all the research advances and the billions of pounds spent by drug companies and universities.
It is certainly an issue where prevention is better than cure. The famous Framingham Heart Study was the first to clearly define the risk factors for arterial disease, factors that could be targeted to help prevent it. As a result, there is currently a big focus in conventional medicine on drugs that lower cholesterol and blood pressure. But as we have read and seen, these issues are very complex and controversial.
Imagine the possibility of achieving a new clarity among this confusion by understanding the latest thinking about what usually triggers a heart attack and stroke.
This becomes particularly powerful when combined with newly discovered properties of dietary supplements, especially how they seem to work in harmony with the cell’s basic metabolism, rather than interfering with it.
What we will be covering in part I and part II of this article will give you a radical new framework for cardiovascular health.
You might be feeling this is a tall agenda, that the whole field is so confused with differing opinions and conflicting studies. Concerns over cholesterol are misplaced, or it’s too hard to treat cardiovascular disease naturally. Or even that we are falling into the same trap as conventional medicine, with an ill-considered focus on risk factors, with the evidence never reaching anything conclusive.
Let’s press on and examine new information about the extreme importance of the role of vulnerable plaque in hard cardiovascular events and what you can do about it.
It’s a radical new concept and a fertile field of discovery for dietary supplements. Currently, it is the elephant in the room of cardiovascular risk assessment, and we are certainly going to mention it here!
Revealing the unstable elephant in the room
Our arteries are subject to a disease known as atherosclerosis, where a build-up of abnormal tissue (known as plaque) occurs in the blood vessel wall. Unstable or vulnerable plaque is an atherosclerotic plaque at a high short-term risk of rupture. If and when rupture does occur, it results in a massive aggregation of platelets (known as a thrombus) which can block the artery. Depending on where this blockage occurs, a heart attack or stroke might follow.
Here’s the interesting thing: only plaque with a very thin fibrous cap is at risk of rupture and even just a small area of such plaque is life threatening. These plaques are essentially unstable because of a deficiency of connective tissue. In a sense, arterial plaque is a type of wound on the blood vessel wall, and vulnerable plaque can be seen as not healing appropriately, somewhat like an ulcer or abscess.
Even in the presence of widespread arterial disease, rarely more than a few plaques appear to be at risk of rupture at any given moment.1
Plaque rupture was described as far back as 1844, but it was only in the late 1980s that its true relevance to heart attacks and strokes was recognized.2
In reality, we can now propose that there are in fact two sets of risk factors for heart attacks and strokes: one set of factors that predicts the risk for development of diseased arteries (arterial plaque), and a second set that predicts the risk for plaque rupture.
Surely if someone already has arterial plaque (and most of us do), the best way to stop an acute event (heart attack or stroke) is to focus on this second set of risk factors.
The research is still ongoing, but the list of risk factors predicting likelihood of plaque rupture contains a few surprises, and also confirms some folk wisdom.
What causes plaque rupture?
One major review of the research found a strong link between acute coronary syndromes and acute respiratory infections.3 Both peak in winter, and acute infections could precede one third of heart attacks.
Large and well-designed retrospective studies consistently find a two- to three-fold increase in risk within one to two weeks after a respiratory infection, especially marked in the first few days (a five-fold increase). Up to half of all deaths during influenza epidemics are attributable to cardiovascular causes.
The review described the detailed and complex mechanisms as to how an infection can trigger plaque rupture.
So, taking a herb like Echinacea root every day to prevent infections might actually lower your risk of a heart attack!
Other factors linked to plaque vulnerability and rupture include:
- Low circulating fibrocytes (maybe indicative of a poor healing capacity)4
- Elevated C-reactive protein (CRP) and other inflammatory markers5,6
- Lower serum eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio (not enough omega-3 fatty acids in your system)7
- Lower plasma glutathione9
- Lower regulatory T cells and serum interleukin-1010
- An elevated low-density lipoprotein to high-density lipoprotein cholesterol ratio
Many of these elements are linked to increased inflammation, a key factor behind vulnerable plaque.
Avoid stress and lower your risk of heart attack or stroke
Remember the wife who pleaded with her husband not to get so stressed and angry, otherwise he might have a heart attack? She was right!
Stress, by increasing the risk of plaque rupture, does indeed cause a heart attack. For example, anger and hostility were linked to an increased incidence of heart attacks in previously healthy people, especially men. They are also linked to poorer outcomes in people with existing heart disease.12
Another recent review found that a variety of mental stressors (anxiety, anger, bereavement, frustration, work stress, sexual activity), physical exertion, community-wide stresses (Monday mornings, winter, blizzards, Christmas, heat waves, sports events, earthquakes, missile attacks, natural disasters) and other miscellaneous stresses (lack of sleep, overeating, air pollution, infection) were all linked to an increased risk of heart attacks.13
In part II of this article I will describe the ways that we can address the risk posed by vulnerable plaque using herbs and other supplements.
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Vol. 8, Issue 4 – April 2014
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.