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Invisible bombs in blood vessels: How to identify the dangerous characteristics of vulnerable plaques?
With the increasing incidence of cardiovascular disease worldwide, it is particularly important to understand the formation of vulnerable plaques and their dangerous characteristics. Vulnerable plaque refers to the accumulation of white blood cells (mainly macrophages) and lipids (including cholesterol) in the artery wall. This type of plaque is particularly unstable and can easily lead to sudden problems such as heart attack or stroke.
Characteristics of vulnerable plaques include a thin fibrous cap, rich lipid necrotic core, enhanced plaque inflammation, and vascular remodeling, which make plaques susceptible to rupture.
According to research, as plaque grows, artery walls gradually thicken, a process that helps reduce the risk of plaque rupture. However, certain factors, especially elevated blood pressure and increased activity, can increase the risk of vulnerable plaque. When these factors combine, the fibrous cap of vulnerable plaques can rupture, causing the contents of the plaque to be released into the bloodstream.
Formation of vulnerable plaque
The formation of vulnerable plaques is the result of a combination of factors. Research shows that chronic endothelial damage and local inflammation are key to plaque development. Factors such as hyperlipidemia, hypertension, smoking, and elevated homocysteine may accelerate endothelial damage and increased permeability.
Once low-density lipoprotein (LDL) particles enter the arterial intima, the oxidized LDL will attract macrophages to phagocytose them and form foam cells. This process will cause inflammation and continue to promote the growth of plaques.
When macrophages accumulate excessively, they release large amounts of lipids and cholesterol, which further causes damage to the endothelium and forms fragile plaques. The mechanical stress of each heartbeat affects these weak fibrous caps, eventually causing them to rupture. The complexity of this process makes vulnerable plaques difficult to identify early, but is an important cause of heart attacks.
Identification and detection of vulnerable plaques
Currently, the detection of vulnerable plaques remains a challenge. Traditional testing methods, such as cardiac stress testing and angiography, are not effective in identifying unruptured plaques because these plaques typically do not cause significant vessel narrowing.
Cardiac CT angiography can help observe blood vessel walls and plaque composition, and certain CT-derived plaque characteristics can help predict the risk of acute coronary heart disease.
In current medical research, efforts using techniques such as interventional ultrasound and thermal imaging aim to better predict such plaques and possible future cardiac events. However, these are still in the research stage and have not been actually used in clinical practice.
The impact of vulnerable plaque on heart health
Rupture of vulnerable plaque is often accompanied by the formation of blood clots, a process that can quickly block blood vessels supplying the heart or brain, leading to a heart attack or stroke. After plaque ruptures, activity within the arterial lumen can also cause embolization of small blood vessels, affecting the blood supply to tissues and possibly causing related organ necrosis.
Rupture of vulnerable plaques and subsequent thrombosis are the most common causes of cardiac events, which is why their identification and prevention are critical.
With the development of science and technology and medical research, the industry is still exploring ways to identify the characteristics of these plaques. Understanding the biological characteristics of these vulnerable plaques may help doctors take effective preventive measures before heart disease events occur.
How to prevent vulnerable plaque
Maintaining a healthy lifestyle is important to reduce the risk of vulnerable plaque rupture. The risk of heart attack can be reduced by optimizing lipoprotein levels, controlling blood sugar, maintaining an appropriate weight, eating a healthy diet, and being moderately active.
At present, it seems that obesity and diabetes may also be related to high levels of C-reactive protein, which is also worthy of attention. As more research continues on how to identify and manage vulnerable plaques in the population, look forward to better ways to protect heart health in the future.
How can we more effectively identify and prevent these dangerous vulnerable plaques?
