Is serious arterial blockage 2 years after a good report plausable?

Question

Is it plausable that a 65 year old person with diabetes could have two seriously blocked coronary arteries that both required stents - one 95% and the other 85% blocked - only 18 montns after a nuclear stress test was done and the doctor said there were not arterial blockage issues whatsoever?  Also, over that period, reasonable efforts were made to live a healthy lifestyle and cholesteral levels were low?  My impression is that it would be highly unlikely for such levels of arterial blockage to take place so quickly.  Am I correct?

Flycaster305 · Accepted Answer

From personal experience, blocks to heart arteries can occur in a New York Minute, especially with those of us with Diabetes. Ed gives a good perspective.  Inflamation of our arteries is considered a big reason for blockages to occur.  I went through a very aggressive period of blockages, but it wasn't until I agreed to a very strict diet to control diabetes, took all the drugs, exercised daily that the blockages stopped.  I agreed to lose a pound a month as the process of losing weight changes the metabolism and reduces inflamation of the arteries.  I quit adding salt at the table, added good quality fish oil and quit eating beef and fatty pork.  I also agreed to work out daily, and I lost 45 pounds.  My blockages stopped. This may be what Kenkeith was alluding to, very tight control of diet, taking the good drugs, losing weight slows the CAD symptoms, at least they did in my case.  I work as a volunteer at a Cardiac ICU unit, I can say from experience that most Cardiac patients in the ICU are diabetic.  

I'd suggest that your conclusion was incorrect, blockages can and do occur quickly.

kenkeith · Answer

I differentiate CAD as a disease that has its own etiology and pathology.  Arterial stenosis can have many causes for narrowing of the vessel and that includes a buildup of plaque.  It seems to me CAD is the disease and stenosis is the effect.  My response and question to flycaster was/is related to the pathology of CAD and the significance of diabetes to the pathology of CAD as a disease not withstanding possible causes of vascular stenosis.

kenkeith · Answer

My interest is a general question?.  We all know from numerous posts about blockages, and soft plaque and hard plaque, etc.  There is no need to explain that issue...I can site my response to the thread if you need a refresher?

Please control yourself, as my post indicates I am asking about the etiology of diabetes and CAD, if known? I would be interested to hear what Flycaster has to say as I know he has a history of diabetes and CAD as well. And it appears he has researched the issues.

ed34 · Answer

There is insufficient information in the original post to give any accurate reply. This is because there are different reasons for restrictions in coronary arteries. Atherosclerosis starts at a very young age, before teen years. Restrictions in coronary arteries are not only caused by plaque build up, there are other reasons. If a section of hard plaque (the cap) ruptures, exposing the softer material below, then a clot will form. Clots are not always 100% and some even break up and disappear on their own. This is what I believed must have happened in a recent post by someone who said they had a recent test which showed the blockage was gone. The endothelium can become irritated by plaque or a clot and fail to function properly. This means the artery may refuse to dilate, or may even constrict inappropriately. Clots take a matter of minutes to form, if they took years we would all bleed to death from a simple cut.

kenkeith · Answer

I had diabetes in mind and the probability of its deleterious effect concomitant with CAD and knowing the implication I researched  throughly looking for some objective evidence regarding diabetes and the etiology of CAD progression. I found nothing and very little information regarding progression other than reference it takes years. 

You say you abided by the general and accepted view for heart health and happ states the same. It stopped progression for you but not for happ?.  Happ has diabetes under control as well. Have you ever researched contolled diabetes and CAD progression?  If it is genetic, and that is the underlying cause, then that is somewhat against my understanding regarding risk control and the genetic proprensity for CAD.

kenkeith · Answer

Quote:"...Is it plausable that a 65 year old person with diabetes could have two seriously blocked coronary arteries that both required stents - one 95% and the other 85% blocked - only 18 montns after a nuclear stress test was done and the doctor said there were not arterial blockage issues whatsoever?"

>>>>Usually it takes years to have blockage in the therapy range (>70%)  It is possible that the no blockage  report indicated there were not blockage in the theraputic range. 

It seems the care you have taken would stop or at least slow any progression of CAD.  If your diabetes is under control that shouldn't be an issue, and your age should not be a factor although older persons are more vulnerable...probably they don't exercise nor have a good heart healthy diet. I would question the rapid occlusion as well.  It doesn't sound reasonable.  Sorry there is no definitive answer...but it is unusual.

ed34 · Answer

I believe blockages can form quite quickly in an artery, but it depends on how the blockage was formed. For example, it is obvious that a rupture can occur, even quite a small one which will form a clot in a matter of minutes. If you eat healthily, keep your cholesterol under control, there are still other factors which can cause a blockage. For example, you don't mention your blood pressure. If this is high, then you are more likely to form occlusions. Even if you have medication to keep pressure normal, stress at home can still cause it to rise. It may look good in the Doctors surgery, but at home it could be much higher. There is also believed to be a genetic factor. Some people just seem more prone to disease and I believe several genes have now been identified which differ us from people with high longevity (100+ yrs). If you picture the chemical and mechanical processes involved with atherosclerosis, I would have thought 18months is easily enough time.
My first two angiograms, just 6 months apart, showed a huge difference in how much the disease had spread, especially the right artery which had formed a total blockage half way down.