Over the past few years, our understanding of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease has greatly evolved.
The introduction of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that bypass surgery and percutaneous interventions with stent implantation has significantly transformed the treatment of this condition.
For a time, these advances created the impression that a lasting solution had been found.
However, the reality is different.
People who have undergone these treatments remain at risk of experiencing another coronary event. In fact, their risk is higher than that of someone of the same age who has never had heart disease.
The disease remains present
These interventions correct specific areas of narrowing in the arteries. They improve symptoms and may reduce certain short-term risks.
However, they do not eliminate the disease.
Atherosclerosis — the process responsible for the buildup of deposits in the arteries — remains present throughout the coronary network. It can progress silently, sometimes in areas away from those already treated.
It can be unexpected
In some individuals, the first event occurs without warning.
No prior symptoms, no clear signal.
These situations can affect people who appear to be in good health, reinforcing the sense of unpredictability.
Tests can be reassuring… but incomplete
Another important point deserves attention.
It is possible for tests to suggest the absence of significant coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that narrowing. Yet, these same individuals may shortly afterward experience an acute coronary syndrome, such as unstable angina (NSTEMI) or a myocardial infarction (STEMI).
Back to the root of the problem
To better understand this disease, we must return to its origin: the atherosclerotic plaque, commonly referred to as a cholesterol plaque.
Read more: Atherosclerotic plaque
An invisible threat
The story of the Trojan Horse illustrates this reality well.
After years of conflict, the Spartans left a massive wooden horse on the shore. King Priam decided to claim this “gift,” believing it to be a divine offering of peace following the supposed departure of the Greeks, one that would ensure the protection of the goddess Athena, despite Cassandra’s warnings. The Trojans then brought it into the city.
This act, seemingly reassuring, actually marked the beginning of the city’s downfall.
The danger was not visible. It was already inside.
At the heart of the problem
To better understand the danger posed by cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaque, we must look back at the work of Russell Ross.
A graduate of Columbia University in the United States in 1955, he initially focused on the mechanisms of tissue repair. His research later led him to study atherosclerotic plaque.
He observed that the cells involved in the “cleanup” and repair of cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> deposits within the arterial wall also trigger an inflammatory process.
In trying to help, these cells can become harmful. They release enzymes—substances capable of breaking down surrounding tissues—including the thin layer that covers the plaque.
Similar to the story of the Trojan Horse, atherosclerotic plaque can be present within the arteries without causing symptoms or significant narrowing. However, once weakened, it can suddenly trigger a cardiovascular event.
An example to better understand
Let’s take a simple example to better understand this process responsible for the unpredictable rupture of plaques, regardless of their size.
The skin of the face “breathes” through small openings called pores. Through these tiny openings, sebum—an oily substance—is released. When one of these pores becomes blocked, sebum accumulates.
Quickly, defense cells are called to the area to try to correct the situation. An inflammatory reaction develops: redness appears, accompanied by increasing sensitivity, followed by localized firmness.
What happens next is well known.
When a plaque ruptures
In a similar way, when an atherosclerotic plaque ruptures, its contents are exposed to the bloodstream.
This exposure triggers a defense mechanism: bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clotting. A clot (thrombus) forms on the surface of the plaque.
If this clot completely blocks the artery, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow is interrupted. The heart muscle, deprived of oxygen, begins to suffer and then becomes damaged.
This is what is known as a heart attack.
Read more: Myocardial Infarction
Even the smallest plaques are vulnerable
All plaques, whether small or larger, can rupture.
This is why bypass surgery or the placement of coronary stents does not cure the disease. These interventions treat specific areas, but the disease itself remains present.
New plaques can develop, while others, initially considered insignificant, may progress over time.
Once again, the activity of a plaque—regardless of its size—can lead to rupture, with the consequences we know.
Staying vigilant
For the same reasons, a cardiovascular event can occur even if, not long before, a test was completely normal.
It is therefore important to keep in mind the presence of the disease, even when it is not showing any signs.
Who is at higher risk?
The National Heart Institute launched a study in 1948 involving residents of Framingham.
The goal was to identify factors associated with the risk of cardiovascular events over the following years.
This study identified several major risk factors:
- Age
- male sex
- high bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure
- diabetes
- high cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> levels
- smoking
- obesity
It also showed that these factors do not simply add up: when present together, their effect is multiplied.
Read more: Assessing cardiovascular risk
Prevention is better than cure
People identified as being at risk have every reason to take action.
Some factors, such as age or sex, cannot be modified. Others, however, can be improved.
Quitting smoking, adopting a balanced diet, and engaging in regular physical activity are essential steps in reducing risk.
The same applies to better control of diabetes, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure, and cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> levels.
Revisiting lifestyle habits
For individuals with coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease—whether or not they have undergone revascularization (bypass surgery or stent placement)—adopting healthy lifestyle habits is even more important.
These changes are what most positively influence long-term outcomes.
Read more: Healthy lifestyle habits
An active role in one’s health
Interventions such as stents or bypass surgery address certain consequences of the disease but do not eliminate it.
What happens next largely depends on the individual’s level of involvement.
Certain medications also help reduce the risk of future cardiovascular events, including aspirin and statins.
Conclusion – Understanding the Unpredictable
Coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease is not limited to visible narrowing of the arteries. It is diffuse, progressive, and often silent.
Even in the absence of symptoms, even after reassuring tests or effective treatments, the risk does not completely disappear. A plaque may be present, evolve silently, become unstable, and suddenly trigger an event.
Understanding this reality means accepting that a degree of unpredictability remains, without it necessarily being a fatal outcome.
Risk factors are well known. Lifestyle habits have a real impact. Medical treatments help reduce risk.
And when an event occurs, rapid intervention becomes critical. The earlier the treatment, the greater the chances of limiting damage to the heart muscle.
Beyond technical interventions, it is the combination of prevention, treatment, and rapid response that helps reduce risk and influence the course of the disease.
In cardiology, as in many areas, better understanding is already a step toward better protection.
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