The high mortality rate of cardiovascular disease is largely due to the "plaque" in the blood vessels. If there is no plaque, the risk of myocardial infarction and cerebral infarction will be greatly reduced.
The good news: plaques can shrink or even disappear completely.
Recently, Guo Yifang, chief physician of the Department of Cardiology at Hebei Provincial People's Hospital, said that one of his patients reversed the plaque in the carotid artery to disappear in just one year. How did this patient do it?
Experts interviewed
Ding Rongjing, Chief Physician, Department of Cardiology, Peking University People's Hospital
Li Jian, Chief Physician, Department of Cardiology, Huashan Hospital, Fudan University
Clinical case: The plaque is really reversible
Professor Guo Yifang wrote in her personal public account that a woman in her 50s found a atheroplaque in her left carotid artery during a physical examination in the spring of 2022. This year, her plaque disappeared, and she was examined by the same specialist and using the same equipment.
The carotid artery is superficial and easy to examine, and it is a window into the condition of the arteries throughout the body. The presence of atherosclerotic plaque in the carotid arteries often indicates that arteries throughout the body may also be narrowed.
When the carotid plaque was detected, the woman's blood pressure, blood sugar, and weight were normal, but her "bad cholesterol" levels were high. To prevent the plaque from growing further, Guo Yifang prescribed cholesterol-lowering drugs and asked her to adhere to a healthy lifestyle.
Why did her plaques disappear? Guo Yifang believes that the key is that she successfully controlled "bad cholesterol". Her "bad cholesterol" level dropped to 2.01mmol/L, a drop of 52%.
Ding Rongjing, chief physician of the Department of Cardiology at Peking University People's Hospital, said she had treated many patients with vascular stenosis of more than 70% (stent placement is generally recommended), and because patients were very afraid of stent fits, she developed a comprehensive plan. Patients strictly control "bad cholesterol", blood sugar, blood pressure, aerobic exercise for 1 hour a day, eat a balanced diet, and quit smoking according to requirements.
One year later, the patient's review of coronary CT found that the degree of narrowing of the blood vessels was reduced to less than 60%, the plaque had been significantly reversed, and there was no need for a stent placement.
The key to reversing plaque is cholesterol
In life, many people can't tell the relationship between plaque, blood clots, cholesterol and blood lipids.
In simple terms, blood lipids include cholesterol and triglycerides (the scientific name of the oil), of which cholesterol is the main raw material for plaque formation.
When the plaque slowly grows on the blood vessel wall, more than 50% of the lumen, blood flow will be significantly blocked, and the chance of the plaque falling off is greatly increased. Rupture of the plaque triggers a clotting mechanism that forms a blood clot.
The thrombus drifts with the blood, blocking the blood vessel in a certain place, and there are events such as myocardial infarction and cerebral infarction.
From left to right: normal arteries, fibrous plaques, atherosclerotic plaques, plaque rupture, thrombosis.
That is to say, without cholesterol, there is no arterial plaque, it is difficult for arterial thrombosis, and it is naturally difficult to occur myocardial infarction and cerebral infarction.
Soft plaques are easier to reverse
As long as they are old enough, anyone can develop plaques. 70% of people over the age of 60 have plaque. With the normalization of bad lifestyles, more and more young people are also beginning to develop plaques.
Long plaque is not terrible, what we have to do is to control the size and stability of the plaque to prevent it from becoming larger and cracked.
Experts say most plaques are reversible, but not all are reversible:
If the plaque surface is not smooth, irregular in shape, and has low echo, it is a lipid-rich soft spot, which is easy to break, but the treatment value is higher, and this soft spot is reversed relatively often.
If the plaque is found on ultrasonography with a smooth surface, regular shape, and strong echo, it is calcified plaque, which is dense, has little space for reduction, and requires more intensive treatment.
Shrinking plaque, what exactly to do
Strategies to reverse plaque mainly include "lifestyle modification" and "drug treatment".
Lifestyle adjustments
1
Reduce excessive calorie intake
Actively adjust your diet and stick to low oil, salt and sugar. Eat more vegetables and deep-sea fish, replace animal oil with rapeseed oil, eat less red meat and its products, and limit refined carbs.
Eat enough 1 kilogram of vegetables and half a kilogram of fruits every day. Whole grains, oats, and legumes are rich in soluble dietary fiber, which helps reduce the amount of cholesterol absorbed by the blood.
2
Exercise is essential
Exercise requirements are "active exercise", commuting to work is not counted, it is best to achieve about 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, jogging.
The study found that those who walked more than 7,000 steps per day had a more pronounced reversal of plaque compared to those who walked less than 7,000 steps per day.
3
Control your weight
BMI = square of body weight / height (international unit kg/㎡), should be controlled below 24, the elderly can be appropriately relaxed, controlled below 26.
4
Quit smoking and alcohol
Smoking is a risk factor for ischaemic events and coronary calcification. The atherosclerotic index decreases with the duration of smoking cessation.
drug therapy
Drug treatments include statins, drugs that lower lipoprotein(a) and triglycerides, antiplatelet drugs, and so on.
The medication plan should be considered in combination with the degree of stenosis of the patient's blood vessels, the presence or absence of hypertension and diabetes, and the level of "bad cholesterol". Generally, "bad cholesterol" is strictly controlled below 1.8mmol/L or even 1.4mmol/L, and the plaque may be reversed.
Plaque reversal is a dynamic process and it is important to maintain a healthy lifestyle for a long time to avoid rebound of the disease. ▲
Editor of this issue: Zheng Ronghua