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Why did my plaque double and how to stop it
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Why did my plaque double and how to stop it

Two years ago I had a heart scan that indicated I had heart score of 18.67 in my left main.  I underwent an angiogram and the doctor said I had 10% luminal irregularities there, no significant coronary disease.  Now 2 years later I have another heart scan that shows the plaque in my left main has more than doubled to 38.06 and there are other smaller numbers on my RCA and LAD.  I was thinking I was doing everything right, diet(I am 10 lbs overweight), vitamins, Crestor,(20mg) fish oil, aspirin.  My lipids are Chol(143), LDL(50), HDL(95), Trig(59).  My real size pattern is A. My TSH is 1.37, My CRP is zero.  I just found out my vitamin D was borderline low.(I have stated to fix that)  What am I missing?  My father died at 54 of heart disease and I am 57.  How do I stop the plaque from multiplying and what do you think the cardiologist should be asked.  Thank you so much
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Thats a great question. It sounds like you have held up your side of the bargain in making the lifestyle changes that were necessary to improve your risk profile. You also sound very compliant. What we are increasingly discovering is that the factors that we have focused on in the past ie the degree of narrowing in the arteries of the heart, while important may not be the most important factor that correlates with a patients risk of stroke. And the presence of calcium may not be a great predictor either. It is clear that it is not a good thing to have blockages in blood vessels. And it is not a good thing to have severe blockages which interfere with flow of blood. However for mild blockages like yours appear to be, it is becoming clear that some of these mild blockages are less prone to problems than others. The problem is that some mild blockages are "vulnerable" to rupture and when this happens the blood vessel can block off and cause heart attack like symptoms.  What we know is that the traditional cholesterol panel may not be the most sensitive way to predict which blockages are vulnerable.  

Inflammation is one of the key factors that increases the risk of plaque rupture. Laboratories like CRP may be hetter indicators of inflammation but there are even better labs that are not routinely performed. these include interleukin 6. Also refer to www.optimalhealthtoday.com and click on "cardiac risk profile". There are a number of labs which go beyond the standared lipid profile to assess any genetic abnormalities in production and breakdown of cholesterol. With your father having an early heart attack (I dont know what his risk factors or lifestyle was) you may have a cholesterol production or breakdown problem. this problems can be present even when the cholesterol is normal by traditional parameters

Finally, investigate berkley heart panel. You may benefit by asking your heart doctor about this lab. Good luck
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Thank you for this information.  I have been using the VAP testing.  I will see about changing that.  I have always been curious and concerned about "vulnerable" plaque.  Last month Abbott put out its results from its "PROSPECT" study on vulnerable plaque. Would you say that from that study I should be taking an IVUS instead of the $99 heart scans I currently use.  Even if I know I have vulnerable plaque is there anything to be done about it?
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I would say that the biggest yield on your invested efforts is in determining your subfractionation results and your genetic predisposition. If it can be determined that your cholesterol is being managed appropriately, at this point, thats really all there is to offer in terms of preventing progression or conversion to a vulnerable plaque.  IVUS is merely another diagnostic modality, not a treatment solution
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It is very disheartening to hear that if my lipids are fine there is nothing out there that will prevent this plaque from doubling every year.  Surely there must be some treatment, perhaps a study on the horizon?
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