Coronary plaque undergoes a specific transformation that ends up causing a blockage of the vessel and eventual ischemia. In this article, I will discuss the basics of how atherosclerosis and inflammation play a role in heart health.

Atherosclerosis

Plaque is the buildup inside an artery, leading to decreased blood flow and sometimes complete lack of blood flow – obstruction. It begins far deeper in the vessel wall before you see anything protruding through into the lumen of the artery.

With obstruction comes ischemia – lack of oxygen to the nearby tissue, not just muscle but the vessels themselves, the nerves, and connective tissue.

You need cholesterol to form this plaque. With a total cholesterol value below 150, achieved naturally without medications, it’s rare to see someone develop much plaque in their arteries.

Another ingredient for plaque buildup is hardened vessels and increased pressures or turbulent blood flow through those vessels. Hypertension can cause this; lack of exercise or inflammation can also contribute.

Unstable Plaque

Let’s lay the cards flat on the table – we know little about inflammation. Astute clinicians can recognize inflammation when they see it. There are specific biomarkers that are helpful as well.

Inflammation adds to the problem of atherosclerotic and negatively affects heart health because it leads to unstable plaques.

A plaque is like a scab on a wound. If it’s the right time for it to come off, it’ll fall off without any bleeding. Rip it off prematurely, and you’ll get fresh blood.

Fresh blood will clot in the artery and create an unstable plaque that is prone to rupturing and exposing those raw surfaces. Suddenly you go from a tiny plaque to a massive clot that halts all blood flow in that artery.

Measuring Inflammation

Several biomarkers can tell us there is inflammation. But it’s not biomarkers alone we use in our risk stratification.

Some people with inflammation in their bodies may never develop unstable plaque. And some with inflammation may not have much plaque to begin with.

If someone has atherosclerosis, the goal is to increase their exercise capacity – both cardiovascular and anaerobic. Next, we want their systemic inflammation to be as low as possible.

Examples of inflammatory biomarkers are below. Some are nonspecific markers, and others are specific to the atherosclerotic cardiovascular disease.

hs-CRP
ferritin
ESR
homocysteine
uric acid
triglycerides
HDL
platelets
neutrophils or leukocytes
insulin
fibrinogen
oxidized LDL
Lp-PLA2
myeloperoxidase
interleukin 1
interleukin 6
F2-Isoprostanes
ADMA/SDMA

Atherosclerosis and Inflammation

In regards to heart health, atherosclerosis isn’t a death sentence. Most of us will develop it, and less than half of us will suffer heart attacks or other complications because of it.

Preventing atherosclerosis is what we encourage in our Heart Health program. But most of those who come to us already have atherosclerosis.

Plaque and inflammation have an essential relationship in Heart Health which we address with this second group. We want to decrease their total body inflammation to allow newly formed plaques or old plaques to stabilize.

Statins lower inflammatory markers independent of their lipid-lowering effects. Perhaps this is another reason why they are effective and reducing cardiovascular death.

In a meta-analysis of 26 randomized controlled trials involving over 160,000 participants, statins were shown to reduce the risk of all-cause mortality by 10% and the risk of cardiovascular mortality by 15%.

Other Inflammatory Markers

Even without serology, we can tell if someone has inflammation. More importantly, how much more actionable information do we get beyond the basic inflammatory markers?

The following are inflammatory markers I use based on signs and symptoms:

obesity
acne
rosacea
seborrheic dermatitis
joint pain
fatigue
sleep disturbance
agitation
sound sensitivity
GI changes
heavy menses
concentration issue

As you can imagine, these are rather subjective. Even if you have a little bit of all of this, it doesn’t mean there is inflammation.

We use these data points as a guide. With them, we change our diet and lifestyle and reevaluate. If these markers decrease, then inflammation is likely.

Interventional Steps to Consider

First, where’s the fire? What we mean by this is that the person likely isn’t about to have a heart attack or die from their inflammation.

Let’s figure out why the inflammation is there; stress, insomnia, too much exercise, dairy, wheat, or environmental exposures.

Next, we recommend testing those values, which are the most sensitive markers of inflammation, and see if there was any change.

Nattokinase or curcumin decreases inflammatory markers such as the commonly tested hs-CRP and fibrinogen.

Normal LDL Levels?

Imagine the LDL-C levels of a person are normal. How could we predict what their heart attack and death from heart attack risk would be?

Paul Ridker et al. did a wonderful study highlighting this relationship and showed that hs-CRP would be a bigger predictor of a heart attack or death when a person has normal or even high LDL-C levels.