EP215: Plaque Rupture and Erosion

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Welcome to Doctor Warrick's Podcast Channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love.

In this podcast, Doctor Warrick Bishop discusses the difference between plaque that can rupture and plaque that can erode, both of which can lead to heart attacks.

Plaque forms at points of stress within the artery, with cholesterol and inflammation being key components. Ruptured plaque is associated with 60% of heart attacks, while plaque erosion is associated with 40%. Plaque erosion occurs when the lining of the cells of the cap separating the cholesterol from the blood is removed, allowing a clot to form. Plaque rupture occurs when the thin fibrous cap separating the plaque from the contents of the blood vessel ruptures and breaks. Plaque can be assessed through histology, inferred symptoms, ECG, blood tests, functional testing, and imaging. Studies have shown that high-dose statin and PCSK9 inhibitor can modify plaque composition and get regression of plaque. Lowering LDL cholesterol can bring stability to coronary arteries and reduce ruptured plaques. Plaque erosion is a fascinating space that requires further study.

- Plaque can either rupture or erode, both of which can lead to heart attacks.
- Plaque forms at points of stress within the artery, with cholesterol and inflammation playing a role.
- Ruptured plaque is associated with 60% of heart attacks, while plaque erosion is associated with 40%.
- Plaque erosion is more likely to be associated with unstable angina, while ruptured plaque is slow and almost instantaneous.
- Plaque rupture is defined by a thin fibrous cap breaking down, while plaque erosion is defined by the loss of endothelium above the thick fibrous cap.
- Plaque erosion is a more stable phenomenon than ruptured unstable plaque, with less calcification and inflammation.
- Plaque can be assessed through histology, inferred symptoms, ECG, blood tests, functional testing, and imaging.
- Intravascular ultrasound and optical coherence tomography are both effective tools for imaging plaque.
- High-dose statin and PCSK9 inhibitor can modify plaque composition and get regression of plaque.
- Lowering LDL cholesterol can bring stability to coronary arteries and reduce the risk of ruptured plaques.

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