Vulnerable Plaque – What it is and why it is so important

Heart attack and stroke are the leading cause of morbidity and mortality in the Western world and increasingly in many other parts of the world. For many years physicians thought these were the consequence of a gradual narrowing of important vessels until blood could no longer pass. In recent years we learned that this simple picture is incomplete and that most heart attacks and strokes cannot be explained that way.

Scientists discovered that it was not a hardened narrowing of a vessel that caused these problems, but a soft plaque in the wall of the vessel that could suddenly rupture. The soft plaque that is prone to rupture is also known as “vulnerable plaque”. When a weakened soft atherosclerotic plaque ruptures it can cause an acute blood clot in the vessel. The medical term for this is atherothrombosis. The thrombosis halts the blood flow in the vessel which causes the damage of the heart or brain, which we know as heart attack or stroke.

While the narrowing of the vessels usually causes signs or symptoms such as angina before causing life-threatening problems, vulnerable plaque does not – a heart attack or stroke is usually the first manifestation that there is something wrong. These first events cause death or permanent disability in more than half of the cases.

The good news is that scientists have a good deal of understanding how these plaques form, how they weaken and eventually rupture. Experts are confident that there are ways to prevent these or prevent them from rupturing and causing permanent harm. The one big problem remains – how do we find people who have them?