The New Understanding of Heart Disease

In order to learn how you can dramatically reduce your risk of a heart attack, it is important to understand the process of heart disease. Recent large-scale follow-up studies of patients, as well as new scanning technologies that provide an unprecedented clear view of what is actually going on in the coronary arteries, have completely changed our understanding of the disease.

Recent studies of the most popular form of heart surgery have shown that the long-held model of heart disease as basically a plumbing problem in which the coronary arteries that supply blood to the heart become increasingly filled with cholesterol-laden sludge is fatally flawed.

The old model

The old model works like this: Hard, calcified plaque builds up in your arteries, gradually occluding them. Then, when an artery becomes sufficiently locked—75 percent or more—there is a risk that a clot will get stuck in the narrowed opening. When that happens, the artery becomes completely blocked, no blood can get through to the heart muscle—and that’s a heart attack.

We now know that most heart attacks do not result from arteries blocked with the hard calcified deposits, or calcified plaque, that patients are shown by their surgeons. In fact, this type of hard plaque is rarely the cause of heart attacks; rather, it appears to be the result of the body’s attempt to wall off the real culprit, which is soft, non-calcified, or vulnerable, plaque. Soft or vulnerable plaque is flexible and dynamic. It rarely produces symptoms, does not appreciably block arteries, and is difficult to see on angiograms. Yet, vulnerable plaque is the real villain in the story.

The new understanding

The new understanding replaces the old model of heart disease and looks at it instead as a dynamic multistep process in which inflammation (the over-activation of the immune system) works first to create vulnerable plaque and then to lead it through an intricate and insidious cascade of events that ultimately ends in a heart attack.

More Information

Download the full chapter to review the steps in the process that leads up to a heart attack because it guides our thinking on how to thwart this process at every stage.