Blocks in the coronary arteries are due to lifestyle habits. Amazingly, the body can repair blood clots and function in a healthy manner, through a process called reverse modelling. To achieve this, it is important to identify the percentage of blockages and make the necessary changes for a healthy living. In a landmark study called Mount Abu Open Heart Trial (MAOHTrial) 123, patients with angiographically proven, moderate to severe, coronary artery blocks were given a low fat, high fibre diet, and were asked to do moderate aerobic exercises and stress management. They were also asked to carry out raja yoga meditation for 7 days through an in-house sojourn and were offered a six-month program. These patients were monitored for two years. The coronary angiogram showed significant decrease in coronary artery blocks and cardiac events among those who followed the healthy life style (HLS) adherence.
Dr Nekkanti Venkat Rayudu, senior consultant cardiologist at Apollo Hospitals, explains the importance of reverse modelling and how it can be achieved.
What is reverse remodelling?
When tissues are injured or damaged they become non-functional. The body repairs it to make them functional and healthy. This process is called reverse remodelling. It can be achieved by decreasing blood cholesterol and inflammatory cells, by controlling diabetes and hypertension.
What are active and in-active blocks and how do they differ? Can inactive blocks become active ones?
An active block has more cholesterol (lipid core) and the covering layer of the block is fragile. They easily break, exposing the components of the vessel wall to flowing blood, resulting in further or complete block. Inactive blocks have less pool of cholesterol (lipid core) and the cap is stable. By modifying risk factors, active blocks can become inactive. If risk factors are not controlled inactive blocks can become active. Viruses and bacteria are suspected to make blocks active and antibiotics were tried to prevent heart attacks. But, an infection anywhere in the body makes the blocks active. People with dental sepsis and pyuria have more chances of heart blocks.
Why are some blocks called vulnerable plaques? Does it make the chances of getting a heart attack higher?
Vulnerable blocks are active blocks which contain large amount of cholesterol and the cap is thin, fragile and easily disturbed with blood flow. Vulnerable plaques are more prone for rupture causing heart attacks and brain strokes.
Why are blocks caused due to calcium deposits? Why does calcium narrow the arteries severely?
Normal vessels are soft tissues and free of calcium. Arteries are continuously under stress of blood flow. The rush of blood causes wear and tear and gets repaired with deposition of calcium. More the injury more the calcification. With the control of risk factors, the calcium deposition is less, but with ageing and uncontrolled cardiac risk factors, calcium deposition increases. Calcium deposition leads to loss of elasticity in arteries, due to which blood supply to the tissues decreases.
Orthopaedic doctors prescribe 1 gm of calcium as it can cause narrowing of arteries.
The calcium is needed for bone health. Bones are hard tissues and act as support to soft tissues (muscles, skin and other organs). The calcium through food and medication gets deposited in the bone, but if calcium is diverted and deposited in arteries, the tissues harden. This is known as pathological calcification due to abnormal metabolism. The calcium, instead of finding the right place, sticks in the wrong place, due to wear and tear of ageing, hypertension, and diabetes mellitus, as well as bad habits and life styles.
How can blocks be diagnosed? Currently, a patient with either 60 to 80 per cent blocks is asked for stenting. How can one identify blocks before reaching 60 per cent?
A good history and regular clinical examination is the first step for proper diagnosing. Basic clinical tests are ECG, 2dECho for LV Function, Tread mill ECG (TMT). To know the blocks in the tube-like arteries, CT Coronary Angiography, Coronary Angiogram and advanced procedures like IVUS (Intravascular Ultrasound), OCT (Optical Coherence Tomography) are available in many centres. Many people with mild blocks may not have any symptoms. To detect the blocks in early stages, CT Coronary Angiogram and Invasive Coronary Angiogram are available.
How does maintenance of good vascular health help the body?
Blood vessels are tube-like structures that carry oxygen, glucose and other essential nutrients to the tissues and cells. Every tissue cell needs oxygen and glucose for its function. If vessels are diseased, the tissues become unhealthy, non-functional and ultimately die. Also, vessels are not just tubes, but they are considered as organs. So, vascular health is essential for a healthy body.
What exactly does life style modification mean?
- Maintaining ideal body weight: BMI 18 to 24.
- Regular physical activity and exercise.
- Control of hypertension, diabetes mellitus and high cholesterol.
- Avoiding active and passive smoking.
- No tobacco chewing.
- Eating healthy food like fruits, vegetables, whole cereals, fish and a balanced diet.
- Avoiding trans fats, deep fried foods, junk and fast foods.
- Avoiding or limiting alcohol intake (2 pegs for men and 1 peg for women).
