Under-40 heart attacks: Understanding the hidden threat of plaque rupture

So less severe blockages, which do not seem to be a threat when they hold good, become life-threatening when they are dislodged and blood cells clump around them to form bigger clots. This is borne out by data. A 2012 study by researchers in Denmark, which looked at survival rates in 4,711 women and 6,512 men after analysing the severity of blocked arteries through coronary angiography, found that people with less than 50 percent blockage of their heart’s arteries were at just about the same risk of death due to heart attack, stroke or heart failure (congestive heart disease) as people with a bigger plaque deposit in their arteries with a 50 per cent or greater blockage. Then a 2013 review from the UK collected angiography data from 41,960 patients, who were evaluated for suspected heart disease, and found that those with a non-obstructive heart disease accounted for an estimated third of people who visit their physician complaining of chest pain.

What causes plaque rupture? Of course, by now most Indians know the risk factors for heart disease — diabetes, obesity, high blood pressure, cholesterol, poor lifestyle management, sedentary living, erratic diet and lack of sleep and exercise. Sometimes, we top up these risk factors with additional stressors like smoking, over-worrying, overworking and over-indulging ourselves. At other times, we exhaust our body a bit too much by taxing it with our bad lifestyle choices and then subjecting it to the rigours of a gym routine without actually letting it rest or be prepared for a session. That’s what makes these lesser stable plaques prone to rupture. Once we reduce these aggravating factors, we reduce the risk of more plaque forming and stabilising those that exist.

How can this be done? This can be done by calculating your risk factor. If high risk, then your cardiologist will prescribe statins. At one time, they were just used as cholesterol-lowering drugs and were, therefore, only administered to those with high cholesterol. But by taking out the bad or low-density lipoprotein (LDL) out of the plaque, they also stabilise it. So, now we prescribe them to even those who may have lower cholesterol but score high on other risk factors of heart disease.

So how do you assess my plaque threat? Over the past week, most cardiologists have discussed a calcium scoring test, which is a non-invasive, simple CT scan that shows plaque deposits. Of course, it maps the older calcified plaque more accurately. A score above 100 is non-negotiable for statins. Then there’s the high-sensitivity C-reactive protein (hsCRP), a blood component indicator of inflammation. Higher levels of this marker mean you are more prone to heart attacks and strokes. An LDL level higher than 190 automatically qualifies you for statin use as does a family history of heart disease and an age category upwards of 40. Then there is the treadmill test or TMT to map heart stress. Often invasive tests may not work in unstable plaque and potential rupture scenarios because anyway they would not find significant arterial obstructions. Every diabetic should take a ten-year risk score. Of course, research is ongoing for more plaque-stabilising drugs and injectables but at the moment we have to measure high risk versus low risk categories for any kind of treatment protocol. But above all, Indians should begin lifestyle correction rather early.

(As told to Rinku Ghosh)