To put this in perspective, a woman in the United States is 7 to 8 times more likely to die from heart disease than she is from breast cancer.
Here are the typical arguments put forth, almost always by doctors, which invariably result in my need/desire to counter: Before diving into this topic it’s really important for me to acknowledge the person who has taught me almost everything I know about this disease, beginning back in 2011 when I first became aware that I basically had no idea what atherosclerosis was. Tom Dayspring’s generosity has been remarkable and I’m humbled to be his most sponge-like student.
Consequently, prevailing opinion held that coronary angiography would be able to gauge the atherosclerotic process at all stages of disease.
However, in 1987, Glagov and colleagues proposed an alternative model of atherosclerosis development.
I had dinner with Tom’s son and his wife once and I described Tom to them as a national treasure. He is a nationally-recognized educator and his writing and presentations are devoured by fanatics like me across the globe.
Michael Rothberg wrote a fantastic article on the misconception of the “clogged pipe” model of atherosclerosis.
By the time that happens, eleven other pathologic things have already happened and you’ve missed the opportunity for the most impactful intervention to prevent the cascade of events from occurring at all.
To reiterate: atherosclerosis development begins with plaque accumulation in the vessel wall, which is accompanied by expansion of the outer vessel wall without a change in the size of the lumen.
Traditionally, the atherosclerotic process was believed to involve plaque accumulation that prompted the gradual narrowing of the lumen, with the eventual development of stenosis.
Stenosis then caused impaired control of flow (stable angina) and plaque rupture and thrombosis (unstable angina and MI).