For all the progress that has been made, heart disease kills nearly one million U.S. citizens yearly, far more than any other disease. About 1.5 million suffer heart attacks. Bypass surgery and artery-opening technology, such as angioplasty balloons and stents – anchors of a $200 billion industry to treat heart disease – are very effective in relieving its chief symptom of angina chest pain. They do almost nothing to arrest the disease itself.
The popular medical view until now has been: when a major artery is closed about 80 percent or greater, a small clot gets stuck in it and shuts off the artery’s blood flow, thus causing a heart attack. According to a new wave of sometimes rebellious doctors, academic, and laboratory cardiac researchers, and many in the field of alternative medicine and nutrition, that idea is wrong.
They have suggested that about 70 percent of heart attacks are caused by much smaller obstructions which narrow the same arteries by only a third or so – too small to cause symptoms or to be detected by an x-ray angiogram. This would explain the patient who receives a good bill of health from his doctor and soon afterward suffers a severe or fatal coronary attack.
The unproven hypotheses from these scientists are startling, none more so than this: the body’s defense system is a key player in the attacks. It can cause small arterial deposits to suddenly rupture like popcorn kernels, choking off the heart’s blood supply. Many of these researchers believe that coronary-artery disease is an inflammation process, which includes a decades-long cycle of irritation, injury, healing, and re-injury to the inside of the blood vessels.
This process alters the biology of the artery wall and can make the plaque susceptible to rupture, according to these
experts. There is even the question of whether an arterial wall that has been stripped of its lining, with nothing but hard tissue to form the clot, leaves the problem with the blood itself. While the research is still in its infancy and does bolster already well-known risk factors, it could also open up tantalizing new approaches to prevention and targets for treatment.
It is important, however, to remember as Dr. Jared Ko, our Wellness Department Medical Director, said: “inflammation in the arteries is a theory – it needs a good study of mortality before [doctors] can say it happens.”
It is important to know that:
1. Statin drugs do not save everyone.
2. Though the cholesterol test is a strong predictor of future cardiac problems, half of the people who suffer heart attacks have “normal cholesterol counts.”
3. Up to one-third of coronary victims, in fact, don’t have any of the accepted risk factors. New research is greatly needed. Some researchers wonder if more benefit might be gained by investigating causes of the arterial injury rather than the body’s response. In addition to cholesterol, smoking, and high blood pressure, other culprits, they say, are certain bacteria, viruses, and high levels of an amino acid called homocysteine. Measuring a marker to detect signs of inflammation in the body is the test for C-Reactive Protein. Dr. Ko adds “CRP tests are unproven. There are detractors among doctors.”
These and many other medical, pharmaceutical, nutritional, and alternative medicine theories are now in the discovery phase of research. There are many questions about inflammation that need answers, as well. Finding answers to cardiac research questions will be the dominant theme for years to come. We have entered the new frontier of cardiology!
Next Edition: Part 5: Pros and cons of statin drugs
