Discussions that mention luminal

High Cholesterol board


liverock,

I'm having a problem alas. Damn slides require RealPlayer and I use WindowsMediaPlayer...thus for me, it's all reading and NO video...so I'm missing the boat.
Some thoughts:
[QUOTE]Glagov was right on target. We now know that between 95% and 99% of this disease, which kills one-third to one-half the population, occurs at sites without luminal narrowing. That is to say, only 1 in 20 to 1 in 100 plaques actually cause luminal narrowing. Thus, the angiograms we perform so commonly have really misled us.
Okay, what does this say:
1. that plaque problems are FAR worse than one sees on an angiogram and that a clean one may not be so clean.
2. IF the plaques that show up represent only 1 in 20 or 1 in 100, then we'd expect heart attacks in people with failed angiograms at the same rate as those who passed with flying colors (give or take a couple percent.) I don't think this is what we actually see in fact. I think he is vastly overstating the case.
IF 1/2 to 2/3 of the peope are killed by sites WITH shrunken lumina, then that alone is a very good argument FOR angiography...if ony 1-5% of plaques shrink the lumen but kill 60%, it is STILL this kind of plaque that we must find.

[QUOTE]Should we not intervene at all? No, of course not. We should intervene to relieve angina, but we should not expect that intervention to treat the underlying arterial plaque. The intervention is going to treat the 1% of the plaque that the angiographer can see; it's not going to treat the 99% of the plaque that the angiographer can't see.
That seem quite obvious to me. Of course somebody who has been laying down plaque for decades and decades of fat coursing through his blood vessels is goint to show a distribution from tiny to humongous. THe humongous plaque will close down the lumen, and HURT. Such a plaque should be opened for pain relief. THat's not to say that the hundreds of others that don't hurt won't kill.
If anything, the presence of disease that cannot be surgically treated seems the very best reason for plaque reducing statin drugs since removing the fat is the only resasonable way to shrink a couple hundred plaques in the heart...certainly can't stent them.

If I had to summarize the results of the lecture, vis a vie, statins, it would be with this statement:
[QUOTE]Now what about the lumen, did it get any bigger? It did not. There was no change in the hole. There was only change in the disease. At follow-up, the plaque was about half the size it was at baseline.
For me and most people with proven heart disease who are agressively lowering LDL with agents like Crestor the appproach is angiography to find closing or nonexistent lumens and force them open...and then assume there are MANY MANY partial blockages, the disease, that must be treated to maintain status quo or regression.

The lecture is quite good (I did 2/3 of the 32 pages.) It is probably the best summary of why one should stating drugs that I've seen. I didn't get the same negative view of angiography that you did. It painted angiography for what it is, a way to ascertain areas that are causing ischemia by closing off the lumen of a major artery. What it DOES indicate is that one shouldn't take an angiographic clean bill of health to the bank...there may be LOTS going on.
(oops I seem to have gone seamlessly from Dr. Nissen's article to Dr. Jones'...but they are related.)

I look forwward to revisiting the lecture when I can more fully appreciate it (if I ever load RealPlayer) alas my one attemp to run both media players was a disaster of overcompetition between them! :D) I would have liked to view th video presentations...maybe I'll sneak over to friend.