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Understand how coronary arteries get blocked.

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It is due to lipid rich plaque. Process of deposition of such plaque is known as Athrosclerosis . Indians are prone to enhanced Atherosclerosis.

It has been due to combined effect of Nature & Nurture. Nature is responsible one of the very important risk factor for accelerated Atheroscleosis is a Factor known as "Lipoprotien 'A' "; which is genetically acquired.

The Nurture is contributed by affluence, mechanisation and urbanisation. Affluence leads to consumption of foods rich in calories and fat, where as the latter results in lower obligatory energy expenditure associated with daily living [due to lack of exercise, sedentary habits]. These life style changes leads to abdominal obesity, Insulin resistance (insulin is not physiologically active), High Serum Triglycerides, boderline high LDL and Low HDL, the good protective cholesterol.

As coronary arteries gets narrowed, there is less supply of blood to the heart muscle. Then patients get chest pain while walking. If the narrowing is abruptly blocked due to bleeding or thrombus formation, heart attack ensues.

Angiogram is done to know the blocked areas of coronary artery. In bypass surgery blocked portion is bypassed by a graft.

   
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Human coronary atheroscleroticplaque. The lipid rich core is separated from the lumen by a fibrous cap

Coronary atherosclerotic plaque disruption. The fibrous cap is torn and projects into the arterial lumen and thrombus is present in the plaque core

Reversal Therapy aims at stabilization of lipid rich plaque, which is the most important factor to prevent heart attack. Also, in many cases there is regression of the lesion. So we make a vulnerable lesion less vulnerable, thin fibrous cap is made thick that protects against contact with blood.

Bypass surgery does not prevent myocardial infarction.
10 year follow up of shows (Muhlabaier et al)
In bypass group incidence of heart attack-49%
In medically treated group- 41%

Another research worker Wiseman showed
Incidence of heart attack in bypass group- 40%
Incidence of heart attack in medically treated group- 23%

Even Angioplasty is not successful in reducing heart attack in comparison with medical therapy.
   
It is very recently known that heart attack can occur even on those parts where angiogram does not show significant block. Process of deposition of lipid plaque is a diffuse process. it can occur anywhere in the coronary artery. Moreover, it is not the degree of block but composition of the lipid plaque which is responsible for total block of the artery, ie. Heart attack. Also some important endothelial mediated vasomotor abnormalities are many times responsible.
Very Importantly .....................
It is now established . .. Vigorous cholesterol lowering by a low fat diet & Statin group of cholesterol lowering drugs or intensive lifestyle change can stop further blockage in coronary artery ; even many times blockage regresses and risk of rupture of vulnerable plaque markedly becomes less !! So naturally chances of getting heart attack lessens.....
 
IMPLICATIONS OF THESE NEW FINDINGS
1. Only by seeing block in angiogram there is no need of submitting the patient for Bypass, Stenting or Angioplasty

2. Bypass is not useless, but it should be done in selected restricted cases (with 3 vessel disease) with reduced ejection fraction. Benefits of bypass on survival have not been convincingly documented in cases with good ejection fraction.

3. FOR MAJORITY OF PATIENTS EVEN IN HIGH RISK GROUP MEDICAL TREATMENT WITH REVERSAL THERAPY  IS ALL THAT IS NEEDED.  IT REQUIRES STRONG SUPPORT BY A KNOWLEDGEABLE PHYSICIAN

CLICK HERE TO KNOW ABOUT REVERSAL THERAPY  (THE REVOLUTION)
   
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