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Health & Medicine for Senior Citizens

Artery Blockage Not Necessary to Significantly Increase Heart Attack Danger from Plaque

Evidence seems to indicate that non-obstructive plaques can still rupture and case heart attack, i.e., plaque is bad!

June 5, 2014 - Non-obstructive coronary artery disease was associated with a 28 to 44 percent increased risk of a major adverse cardiac event such as a heart attack or death, in a new study presented yesterday at the American Heart Association’s Quality of Care and Outcomes Research 2014 Scientific Sessions.

The rates of heart attack and death within one year following angiography increased progressively with increasing coronary artery disease (CAD) severity, even among those patients with non-obstructive CAD, researchers found.

In this study, researchers studied 40,872 veterans who underwent elective cardiac angiography from October 2007 to September 2012. The patients’ condition was categorized as normal, non-obstructive and obstructive CAD.


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“Unlike obstructive CAD, which blocks blood flow, non-obstructive CAD may initially appear less threatening on angiography tests, but it appears to have significant risk for heart attack and death” said Thomas M. Maddox, M.D., M.Sc., the study’s lead researcher, a cardiologist for the VA Eastern Colorado Health Care System and associate professor of medicine at the University of Colorado School of Medicine in Denver.

“Dismissing non-obstructive CAD as harmless could be dangerous. Our findings show there is indeed a risk, that non-obstructive damage can lead to heart attacks just like obstructive disease, and that we should consider preventive therapies for these patients.”

A similar study published in March of this year supports these findings. The researchers in this study concluded, “Our findings suggest that regardless of whether obstructive or nonobstructive disease is present, the extent of plaque detected by coronary computed tomography angiography enhances risk assessment.”

Patients with non-obstructive disease should ask their physicians about preventative therapies, like quitting smoking, healthy diets, getting enough exercise, losing weight and taking preventative medications such as aspirin and statins.

Co-authors are Maggie Stanislawski, M.S.; Gary Grunwald, Ph.D.; Steven  Bradley, M.D., M,P,H,; Manesh Patel, M.D.; Amneet Sandhu, M.D.; David Magid, M.D., M.P.H.; Benjamin Leon, B.S.; Deepak L. Bhatt, M.D.; Stephen Fihn, M.D., M.P.H.; and John Rumsfeld, M.D., Ph.D. Author disclosures are on the abstract.

The Department of Veterans Affairs funded the study.

What Is Coronary Angiography?

Coronary angiography (an-jee-OG-rah-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. The coronary arteries supply oxygen-rich blood to your heart.

A waxy substance called plaque (plak) can build up inside the coronary arteries. The buildup of plaque in the coronary arteries is called coronary heart disease (CHD).

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.


During coronary angiography, special dye is released into the bloodstream. The dye makes the coronary arteries visible on x-ray pictures. This helps doctors see blockages in the arteries.  

A procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun) is used to get the dye into the coronary arteries.

For this procedure, a thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. X-ray pictures are taken while the dye is flowing through the coronary arteries.

Cardiologists (heart specialists) usually do cardiac catheterization in a hospital. You're awake during the procedure, and it causes little or no pain. However, you may feel some soreness in the blood vessel where the catheter was inserted.

Cardiac catheterization rarely causes serious complications.

   • National Heart, Lung and Blood Institute

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