What should I do if I find arterial plaque during a physical examination? Don’t panic! Scientific response is the key

Arterial plaques are a "frequent visitor" in physical examination reports and are also the "invisible bomb" of cardiovascular and cerebrovascular diseases. Many people fall into anxiety after discovering plaques: Does this mean that the blood vessels are blocked? Will myocardial infarction or cerebral infarction suddenly occur? In fact, the formation of arterial plaques is a long process, and scientific cognition and timely intervention are the key.

1. What exactly is arterial plaque?

Mao Tingyu, attending physician of the emergency department of Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine (affiliated hospital of Hunan Provincial Institute of Traditional Chinese Medicine) , said that arterial plaque is a typical manifestation of atherosclerosis, which is formed by the deposition of cholesterol, calcium salts, inflammatory cells and other substances on the inner wall of blood vessels, and looks like "atherosclerosis" plaque. Its structure includes:

Lipid core: mainly low-density lipoprotein cholesterol (LDL-C).

Fibrous cap: A protective layer covering the surface of a plaque.

Plaques are divided into two types: stable and vulnerable. The latter has a thin fibrous cap that is easy to rupture, which can induce thrombosis and lead to emergencies such as myocardial infarction and cerebral infarction.

2. After discovering plaques, three key issues need to be clarified

1. Location and size of plaques

Plaques in different parts of the body, such as the carotid arteries, coronary arteries, and lower limb arteries, carry different risks. For example, carotid artery plaques may affect blood supply to the brain, while coronary artery plaques may directly threaten the heart.

2. Plaque stability

Plaque properties can be assessed by ultrasound, intravascular ultrasound (IVUS), or high-resolution MRI. Vulnerable plaques require active intervention.

3. Degree of vascular stenosis

Stenosis <50% is mild, 50% to 70% is moderate, and >70% is severe. Moderate and severe stenosis may affect blood flow, and the need for surgery should be determined based on symptoms.

3. A three-step strategy for scientific response

Step 1: Adjust your lifestyle to curb plaque at the source

1. Diet: Follow the "Mediterranean diet", increase vegetables, whole grains, and deep-sea fish (rich in Omega-3 fatty acids); reduce saturated fats (such as animal offal), trans fats (such as fried foods), and added sugars.

2. Exercise: 150 minutes of moderate-intensity aerobic exercise per week (such as brisk walking and swimming) can increase high-density lipoprotein (HDL-C) and help "clean" blood vessels.

3. Quit smoking and limit alcohol consumption: Smoking directly damages the vascular endothelium. The recommended alcohol intake is less than 25 grams/day for men and less than 15 grams/day for women.

4. Control your weight: For those with BMI>24, losing 5% to 10% of your weight can significantly improve your metabolic indicators.

Step 2: Drug intervention - stabilizing plaques and reducing risks

1. Lipid-lowering drugs: Statins are the cornerstone, which can lower LDL-C, stabilize or even reverse plaques. If statins are not effective, ezetimibe or PCSK9 inhibitors can be used in combination.

2. Antiplatelet drugs: Aspirin or clopidogrel can prevent thrombosis, but they need to be used after a doctor assesses the risk of bleeding.

3. Antihypertensive/hyperglycemic drugs: The target for patients with hypertension is <130/80 mmHg, and the glycated hemoglobin for patients with diabetes should be controlled below 7%.

Step 3: Surgical intervention - the last line of defense for severe stenosis

1. Stent implantation: Suitable for patients with severe coronary artery stenosis (＞70%) and poor drug control, blood flow is restored through balloon dilatation and stent implantation.

2. Endarterectomy: commonly used for severe stenosis of the carotid artery to directly remove the plaque.

3. Bypass surgery: The choice when there are multiple vascular lesions, to create a "new channel" to bypass the blocked section.

4. High-risk groups need regular screening

The following groups are recommended to have annual carotid ultrasound examinations and, if necessary, coronary CTA or angiography:

1. Aged ＞40 years and have hypertension, diabetes, or hyperlipidemia

2. Long-term smoking, obesity (waist circumference for men>90cm, for women>85cm)

3. Immediate relatives have a history of early-onset cardiovascular and cerebrovascular disease (male <55 years old, female <65 years old)

5. Common Misconceptions About Plaque

Myth 1: “Plaques can only be removed surgically”

Early plaques can be controlled through lifestyle + medication, and surgery is only performed for severe cases.

Myth 2: “No need to worry if there are no symptoms”

Most plaques are asymptomatic before rupture, so regular follow-up is essential.

Myth 3: “Taking health supplements can dissolve plaque”

There is currently no evidence that any health supplement can replace drug treatment.

Experts advise

Director Long Huajun of the Emergency Department reminds: Arterial plaque is a health alarm sent by the body, but it is not a "death sentence". Through scientific management, there is a chance to delay or even reverse the progression of plaque. Remember that early detection, early intervention, and persistent follow-up are the ultimate magic weapon to protect vascular health.

Hunan Medical Chat Special Author: Mao Tingyu, Emergency Department, Hunan Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Hunan Institute of Traditional Chinese Medicine)

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(Edited by YT)