Is it possible to take a biopsy of a cardiac artery plaque in order to determine exactly what it contains?

Hi All

I was found to have, via CT Angiogram, in July 16, a very high Calcium Agatston score of 1315.

I then had CABG in Feb 17 at age 66. The day before I asked if it was possible to do a biopsy of a plaque, to help in identifying what they contained. They said it was not possible. Is this correct?

I understand that plaques consist of - cholesterol, fatty substances, fibrin, calcium and cellular waste.

My total cholesterol has always been Low at about 3.0 to 3.6 on a vegan diet since age 40 - 71 now.

So, 'reviewing' the above, I consider that cholesterol was unlikely to be a plaque constituent, as it has always been so low.

Not sure about the other factors - however, I would place calcium at the top of the list.

This is because I took 2.4 g of calcium (twice the recommended dose) since the age of 40, when I became vegan and found out that calcium is low in a vegan diet. Since, August 17, I have been taking only 1.2 g calcium, the recommended dose. And Vit K2/Mk7, which my wife found for me - as this removes calcium from the blood and deposits it in the bones.

I had 2 scans last year and the results were Full Flow. So, for now, I am very happy with that and will continue the above.

Thanks All

Alps

[rjb112]

Why did you have the CABG? What were your symptoms at the time? Were you having angina that was interferring with your life and your activities? Or did you have CABG just because of your high coronary artery calcium score?

Considering your coronary artery calcium score, I would not be taking supplemental calcium pills.

Robert

[Hidden in reply to rjb112]

Hi Robert

I had CABG because of my high Agatston score showing blockages of 75-95% in 3 arteries.

Vegan diet is short on calcium, so take just 1.2 g the daily recommendation.

Thanks

Alps

[rjb112 in reply to Hidden]

Hi Alpsholiday,

"I had CABG because of my high Agatston score showing blockages of 75-95% in 3 arteries."

That's the structural issue: blockages in coronary arteries.

What were the functional issues?

Were you having significant angina/chest pain interferring with daily activities?

What symptoms were you having during functional activities?

"Vegan diet is short on calcium"

I routinely take in 100% or more of the RDA of calcium on a 100% vegan diet, and I never supplement with calcium.

cronometer.com

Have you looked into the calcium content of Edamame and even 'regular' soybeans?

Collard greens; turnip greens; kale; mustard greens; beet greens; bok choy; figs, etc etc etc.

Look at all the vegan wild animals.

They meet their calcium requirements obviously without calcium supplementation.

I have an even higher coronary artery calcium score than you and for that reason would never take calcium supplements.

And my cardiologists do not recommend stents or bypass because I do not have angina and am able to walk/hike/jog and run without chest pain or other cardiac symptoms.

Were you having significant cardiac symptoms with functional activities prior to your CABG?

I have a significant blockage of my left anterior descending coronary artery, aka 'the widow maker'.

Best wishes

[Hidden in reply to rjb112]

Hi Robert

Please see my profile for the full story.

Had my first ‘heart scare’ ever riding my bike up a steep hill in May 16

Nothing else before or since.

I’ll check out your vegan calcium link thanks

As I’ve suggested to you before, I would certainly be asking for a CABG with a higher Agatston score than my 1315

Thanks

Alps

[MichaelJH Heart Star]

Whilst it can be done it is rarely done as the risks usually outweigh any clinical benefit. Apart from academic interest what would you expect to gain from it?!

[Hidden in reply to MichaelJH]

Hi Michael

Thanks for your contribution.

It would be helpful to know the likely make up of a cardiac artery plaque, as then I would know for sure it contained cholesterol, or not.

If it did contain cholesterol, I would try and address that with something non- myopathic such as ezetimibe.

On a vegan diet the liver, I contend, makes exactly what the body needs?

Thanks

Alps

[Dolphin14]

Huge risk in doing something like that. I'm thinking on the same lines as Michael. What would be the point?

Just because you have a decent cholesterol level doesn't mean your arteries can't get blocked. It's only one lab identifier.

My brother had perfect cholesterol and needed a triple bypass after a heart attack.

🐬

[Hidden in reply to Dolphin14]

Good point. The more you look into this, the more it starts to occur to you that in reality the whole subject is not really understood? This was stressed during my Rehab, particularly with other countries who do all the wrong things and have a very low incidence of CHD. It seems all we can do is make what we think are informed choices based on medical advice and hope for the best, unfortunately.

[Dolphin14 in reply to Hidden]

Correct. The list of risk factors are potential risk factors. But nothing is " etched in stone"

Doing the best we can is all we can do.

🐬

[Hidden in reply to Dolphin14]

Thanks dolphin

Sorry to hear about your brother.

Please see my reply to Michael

Thanks

Alps

[Milkfairy Heart Star]

I agree with Dolphin and Michael, the risks would greatly out weigh the benefits. For this reason I would be surprised if any doctor would perform such a biopsy.

In this case 'curiosity could kill the cat. '

It is also possible to have a heart attack without obstructed coronary arteries. It's not just about the blockages.

[Hidden]

I think the OP was suggesting the biopsy could be done on the old arteries while they were doing the CABG, as in the bypassed ones? I have no idea how worth-wile or dangerous that would be.

[Milkfairy Heart Star in reply to Hidden]

Still would be risky.One of the risks would be a dissection of the coronary artery.

The inner lining of the artery being ripped.

A piece of plaque breaking off causing a heart attack or stroke.

Bleeding from the area biopsied, clot formation which again can break off, another potential cause of a heart attack and stroke.

Causing a severe coronary artery spasm another possible cause of a heart attack.

[Hidden in reply to Milkfairy]

I'll bow to your knowledge I had imagined the offending artery would now be "out of the loop" as in bypassed but I presume it is not totally bypassed, as in you can still drive through the village sort of thing?

[Dolphin14 in reply to Milkfairy]

All true. No surgeon would take the risk. If the poster finds one I would be shocked.

Surgeons want to keep their stats high. Their numbers speak to their performance.

🐬

[Hidden in reply to Milkfairy]

Hi Milk Fairy

Thanks for your contribution.

I agree with you that there would be risks doing a biopsy of a ‘live’ artery.

However, I thought the whole purpose of a Bypass is to graft new ‘roads’ and permanently seal off the old ones? So, there would not be any risk at all, as once the biopsy is taken, the artery is closed off?

Is this correct?

Or, are the bypassed arteries left ‘live’?

Thanks

Alps

[Hidden in reply to Hidden]

Hi

Yes I asked the day before my CABG if they could do a biopsy and they said it was not possible.

And yes, I thought they could take a biopsy from one of the permanently ‘closed-off’ arteries?

[Hidden in reply to Hidden]

Just had a look at the description of the operation, sounds like the graft just "tees" into the artery beyond the blockage rather than actually bypassing it.

[Hidden]

Hi Alps, very interesting post and profile. I don't really know what to say to be honest and it seems that the professionals are struggling as well. I am afraid we seem to be dealing with a very non-exact science, but I just wanted to ask, with respect - do you think that your decrease in performance could not be attributed at least in part to your advancing age? I have also been into running most of my life and lay-offs last year due to other problems have not helped but it just seems to get harder as the years go by, which I guess is natural? I now have to console myself that my 6 years junior wife is now able to beat me over 5K (albeit it in a decent time) despite her only getting into running in the last 2 years, it has seemed to be really tough to maintain any sort of consistency lately. I know how you must feel life is tough sometimes.

[Hidden in reply to Hidden]

Hi

I was riding my bike at 17 AV in November 16.

Then, after just 6 doses of Simvastatin 5 mgs, my AV speed dropped to 12 because the Vastus Medialii became achy.

Nothing to do with age at all.

Keep up your sport

Thanks

Alps

[Hidden in reply to Hidden]

It does appear they have a really bad effect on some people, you have my sympathy it must be exceedingly frustrating. Can they not offer any explanation as to why you have not recovered after stopping them?

[Chappychap]

Most cholesterol is made by your own body. If your diet is low in cholesterol then your liver makes more, if your diet is high in cholesterol your body makes less. The bottom line is that for the great majority of people diet has little impact on your cholesterol levels. For supporting evidence you could look at these studies,

pubmed.ncbi.nlm.nih.gov/197...

pubmed.ncbi.nlm.nih.gov/261...

Another important point is that cholesterol isn't the only cause of plaque. Nicotine, stress, background inflammation, airborne pollutants, excessive alcohol, trans fats, gum disease, and many other factors can all initiate and promote the growth of plaque.

Final point, the cholesterol found within plaque is a very specific sub category of cholesterol, high density LDL cholesterol. Furthermore the version within plaque is oxidised, but science hasn't yet established if this oxidation takes place before or after these cholesterol particles pass through the arterial wall. Our overall cholesterol scores are only an approximate indicator of cardiovascular risk, and a vegan diet on its own cannot guarantee protection against atherosclerosis.

[Hidden in reply to Chappychap]

Thanks Chappy. I was going to have a couple of poached eggs for lunch so maybe I will read the first one before doing so😜

[Chappychap in reply to Hidden]

Enjoy your poached eggs, I doubt they'll cause you any harm!

Personally I'm having prawns for lunch, which are famously high in cholesterol. However, I had my annual cardio check up last week and my cholesterol score was only 2.6, so again I don't think I'm at risk.

I was however disappointed to discover during the cardio check-up that my HbA1c score has crept back up ever so slightly to 34. Still well within the safe zone, but any upward move needs monitoring.

So for me it may well be that I can eat lots of eggs, prawns, or other high cholesterol foods and still keep my atherosclerosis under control, but too much sugar or carbs and I might be in real trouble if that cranks my HbA1c scores any higher.

I guess we're all different, and each of us metabolises food in our individual way, so it's unlikely there's any one diet that's right for all of us.

Bon appetit!

[Hidden in reply to Chappychap]

Well I read the article first and enjoyed them even more. Yeah I know prawns are high in it but you can't beat a good prawn curry or linguine now and again, a man's got to live on the edge. I am currently looking into links with Gum Disease which I have had all my life, along with a family history so I am doomed.

[Hidden in reply to Chappychap]

Thanks, some good points there

Alps

[Hidden]

Hi

Thanks for your helpful contribution.

And we’ll done for refusing statins

Taking them was the biggest mistake of my life.

Why did they try to put you on them?

Thanks

Alps

[Milkfairy Heart Star]

TRST have you had an angiogram?

[Milkfairy Heart Star]

Do you remember the doctor explaining the risks of having an angiogram before you signed your consent form?

An attempt to take a biopsy of plaque would increase these risks and do more harm than good.

That is the main reason why a Cardiologist would not carry out this type of biopsy