Q. Is it true that once plaque is built up in your vessels, you can’t get rid of it?
A. We asked cardiologist Nieca Goldberg, medical director of New York University’s Women’s Heart Program, to answer your question and a few others. Here's what she said.
NG: We have seen, with aggressive prevention programs and the use of cholesterol lowering drugs like statins. that we’re able to regress plaque … but to totally eliminate it, nobody’s ever proven.
MFD: What are statins? What do they do?
NG: Well, plaque is in two forms. There’s the stable and the unstable, and the unstable plaque is the soft form—the one that’s more vulnerable to breaking off and stimulating the response for clots to form in the arteries, causing heart attacks. …
The cholesterol lowering medicines—the statins—lower cholesterol, so that clearly helps you prevent more plaque. And over time—we’ve seen in studies more recently that these medications can actually reduce the size of plaque. But even more importantly, the statins can change the composition of the plaque, getting it from unstable to stable form, where it’s less likely to develop into a heart attack.
JHMFD: Does exercise help if you already have plaque?
NG: Exercise works with diet to lower cholesterol. … And actually, exercise improves the flexibility of the arteries.
JHMFD: Why does it matter if you have flexible arteries?
NG: That matters a lot because arteries with no plaque expand when you need more blood flow. Arteries with plaque lose that ability. So that what you want is, if you’re running for the bus, the arteries widen so the blood can travel faster to the heart muscle.
JHMFD: Is it important to be tested for plaque?
NG: I can see in my own patients, with all the public information, that people are really consumed with checking that they see they have plaque. … And sometimes going on the fishing expedition looking for plaque doesn’t give you any more information than checking a person’s cholesterol, blood pressure and seeing if they smoke or not—and what their family history is, and whether or not they’re diabetic.
There’s too much emphasis in our country because of the public information and, you know, the Internet … that everybody is fixated on getting a test. But what they should be doing is being fixed and very productive in working on their risk factors.
JHMFD: You’d emphasize preventing plaque?
NG: I stand on my soapbox every day for each and every one of my patients, whether they have heart disease or not, to tell them that prevention is the key. One of the things—you know, lots of people don’t like to take medicine, and I tell them, in life you have options. You can’t just stand around looking at your cholesterol numbers if they’re high. You have to invest in your health.
NIECA GOLDBERG, M.D., focuses on women’s health at her New York City practice Total Heart Care, and wrote Dr. Nieca Goldberg’s Complete Guide to Women’s Health
Last updated and/or approved: June 2010. Original article appeared in May/June 2008 former print magazine. Bio current as of May 2008. This article is not meant as individual advice. Please see our disclaimer.
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