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Old 12-30-2005, 03:26 AM   #1
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Is cholesteral different from "plaque"? (newbie's question)

A stent was recently put in for a 90% blockage. I have high cholesteral and have been taking Lipitor for at least 8 yrs. with great lab reports all along. I've never thought twice about my heart over the years and made no effort to follow a low-fat diet. BECAUSE I thought since my labs were good that meant no problems, I thought my arteries were fine and Lipitor was keeping things OK.

The thing is, I just don't understand the difference (or relationship) between cholesteral and whatever it is that clogs your arteries. I thought cholesteral clogs your arteries but my reading materials seem to say it's "plaque." Are cholesteral and plaque the same things or are two different things?

 
Old 12-30-2005, 04:33 AM   #2
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Re: Is cholesteral different from "plaque"? (newbie's question)

Basically, cholesterol is fat in your blood. There is lots of discussion about whether or not, or how much, cholesterol contributes to the build-up of plaque in the arteries. Plaque consists of a lot more than just fat.
Some people have high cholesterol but barely any plaque, some people have good cholesterol but lots of plaque. I'd recommend looking at the "high cholesterol" section of these boards, the people there could probably give you more answers.

 
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Old 12-30-2005, 04:39 AM   #3
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Re: Is cholesteral different from "plaque"? (newbie's question)

onstack,

They are RELATED but not the same thing. Cholesterol and protein carry fats around bundled as lipoproteins. Depending on the carrier protein and the amount of fat you can have different types of things called cholesterol. Plaque is basically a reaction to an injury that the body tries and tries to fix and the injury gets more and more low density lipoproteins (LDL bad cholesterol) laid down...they stick to the injury and the body continues to force the removal of the LDL with macrophage (white cell attack). This creates "foam cells" added to the mess. The mix of dead white cells, foam cells, cholesterol, protein and fats then gets walled off by smooth muscle and scar tissue when they body realized that removal is impossible. What the body can't remove, it tries to wall off.
Then it can be further sealed over time with a calcium rich layer that hardend making a stable plaque that is hard to reduce but also hard to break into. They are usually not the ones that break and cause a heart attack but they do diminish the diameter of the artery where they are located and compromise blood flow.

Thus cholesterol and other blood fats are a necessary part of plaque formation but plaque itself is a complicted and variable entity. Once the hardened old plaques have formed, it is unlikely much dietary or drug intervention can be done to get rid of them, they must be ignored, pushed back, ground off or bypassed, The goal of tight cholesterol management is to keep the old ones from growing and, very important, to keep from making any newer, high fat, fragile, medium aged ones that can break open readily, discharging the fats, scar tissue and "necrotic core" (like a gangrenous center) that the body attacks immediately and forms a clot that is the killer of a heart attack or ischemic stroke.

I WISH Lipitor did ALL the work. But even with Lipitor (I've taken it for 7 years) it's a wise idea to lower the fat content of our diets as much as humanly possible or at least as much as we can without moving mountains and also make sure that we aren't making too much fat from food excess. So getting lean, howerver it's done, is wise.

Let that stent be your warning. I'm gonna guess it was in your RCA (right coronary artery.) Do I get a point for a correct guess?
I'll go for a second point and guess your HDL is very low.

(If my lingo was a bit clumsy, it's because this was my first post while waiting for my first tank of coffee! )

Last edited by Lenin; 12-30-2005 at 04:52 AM.

 
Old 12-30-2005, 08:08 AM   #4
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Re: Is cholesteral different from "plaque"? (newbie's question)

Thank you both. I'm so new to this that I don't even know which artery it was! Don't know enough info to even think of that question in the first place. I was not given a report about the procedure (which artery, what kind of stent). I would have liked to have something to refer to.
Yes HDL is low, how did you know that would be the case?

 
Old 12-31-2005, 05:44 AM   #5
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Re: Is cholesteral different from "plaque"? (newbie's question)

ranaj,
It seems a good guess for people who have a nearly complete or complete blockage and are still able to function tolerably well.
Those who present to the E/R with chest pains and a heart attack seem to be the ones with Left heart involvelment.
Whether it's because the right heart circulation is more redundant, or whether there's something about the RCA blockage that allows for collateral vessel formation, or whether RCA's form more stable plaques or have a slower blood flow, I don't know.

Also, from what I've seen, people who have only ONE stent (me included) usuallly have it in the RCA.

onstack,
Call your cardiologist or the hospital where your procedure was done. You are entitled to all this info, after all, YOU paid for it.

Last edited by Lenin; 12-31-2005 at 05:48 AM.

 
Old 12-31-2005, 07:56 AM   #6
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Re: Is cholesteral different from "plaque"? (newbie's question)

Yes, you're right! I'll do exactly that, first thing next week.

 
Old 01-03-2006, 08:54 AM   #7
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Re: Is cholesteral different from "plaque"? (newbie's question)

QUOTE: Those who present to the E/R with chest pains and a heart attack seem to be the ones with Left heart involvelment.
Whether it's because the right heart circulation is more redundant, or whether there's something about the RCA blockage that allows for collateral vessel formation, or whether RCA's form more stable plaques or have a slower blood flow, I don't know.

I have a totally blocked left decending artery and and some blockage in the branch; I never have had any pain, nor shortness of breath (except CHF and edema). My right artery provides some blood supply to the distal portion of my heart providing some relief in the area not supplied by the LAD blockage as well as collaterals around the blockage.

I haven't seen any scientific studies that support the thesis the RCA is more vulnerable for blockage than other arteries for blockage. But IF within the population there are more stents placed in the RCA that may support that interesting propostion.

 
Old 01-03-2006, 11:30 AM   #8
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Re: Is cholesteral different from "plaque"? (newbie's question)

I guess we'll have to wait til onstack gets his/her results to see if my RCA guess was on the money.

 
Old 01-04-2006, 08:50 AM   #9
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Re: Is cholesteral different from "plaque"? (newbie's question)

Right side ischemia symptoms would/could be different from left side eschemia. The blockage of left main's branches or the left main will cause heart failure as well as damage the mitral valve...There are approximately 25% of the population that have left-side eschemia with heart failure and are unaware. Undoubtly there are deaths before any dx and are not counted for stent treatment.

Right side ischemia would give early symptoms, a dx, and stents. Right side failure can go for a considerable amount of time before there is heart failure or impaired EF.

Early detection for RCA blockage is more probable than that for the left side. Can you accept that!

Last edited by started04; 01-05-2006 at 08:01 AM.

 
Old 01-06-2006, 06:58 AM   #10
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Re: Is cholesteral different from "plaque"? (newbie's question)

Yeah,

I like that...
After all, I suffered from ischemic heartburn for a decade before discovering the main trunk of my RCA was completely blocked.
All that time also allows for extensive growth of microcirculation (collaterals) so I can definitely accept the generalization left side blockage is the heart attack killer and that right side blockage is the achy-breaky stenter.

I also think that the left side is most apt to be inappropriate to stenting because of all the branching. The RCA in comparison flows more like a backwards Mississippi...stenting seems easier!

And of course, the left ventricle is the most important workhorse in the operation and left ventricular fibrillation the biggest killer 5 minutes after the heart attack.

 
Old 01-06-2006, 11:28 AM   #11
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Re: Is cholesteral different from "plaque"? (newbie's question)

Also, a bypass may be the recommended treatment on the left side. If there is blockage near the junction of the branching LAD and the circumflex artery, it requires a bypass. Stents are not appropriate.

 
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