Coronary Vessels
 I’m worried about my husband. He had a heart attack in South America, and they did an emergency angioplasty and put in a stent. For a while he exercised and cut out a lot of red meat. He has slowly gone back to his old ways. He says he needs meat because he feels weak on a vegetarian diet. I’m also worried because I heard there are better stents available now. Any suggestions?
 You have several questions wrapped up in one. Let’s talk about the stents first.
When a fatty deposit accumulates in an artery, under the lining membrane of the artery (endothelium) is a collection of cholesterol, fibrin, white blood cells, calcium crystals, etc., in a little clump that bulges into the artery, narrowing it. As the narrowing reaches a 70 percent closure, the supply becomes borderline. Clot on this plaque, as the lesion is called, a little blood underneath it, or a break with lifting up of the plaque can all result in a sudden closure of the artery. The heart muscle deprived of blood and oxygen accumulates lactic acid, becomes painful, and dies. This is recognized as a heart attack.
In your husband’s case the doctors would have done an angiogram or x-ray picture of the coronary arteries and identified the narrowing. By threading a very fine tube into the artery, they are able to get a balloon in place and then inflate it. The balloon presses the plaque flatter like a trash compactor presses down the trash. This makes more room for blood to flow.
It doesn’t take long for the plaque to build back up again (in up to 50 percent of cases), so the idea of a stent was devised. A stent is like a wire mesh that can be expanded outward. It is placed in collapsed mode, then when in position, is activated to open. It is left in the artery like a little scaffolding device, holding the vessel open. This is wonderful, except that in about 10-15 percent of cases the reaction to the stretching and placement of the stent excites an excessive healing process. Healing in the body usually involves fibrous tissue that we commonly know as scar. The scar tissue contracts and narrows the artery again. This renarrowing of the artery is called restenosis. So stents that carry medication were devised. These drug-coated stents are found to reduce this renarrowing from 10-15 percent to about 5-10 percent, and even less—a very significant reduction.
Seeing that it has been a year since your husband had his stent placed, he is obviously one of the majority who does not have trouble with clinical restenosis. He is, however, likely to have trouble with a continuation of the process of atherosclerosis that gave him the heart attack in the first place.
Changing lifestyle is not easy. We all know a lot about what we should do, but not how to make the change. Relationships are the most powerful mediators of change we know of. So perhaps you can use your spousal relationship to help him. First you need to recognize that there are good fats and bad fats, good carbohydrates and bad carbohydrates, and good sources and poor sources of protein. While cutting out flesh foods is an easy way to avoid bad saturated fats, and switching to skim milk or soy milk cuts out the saturated butterfats, your husband sounds like he is stubborn. Try to switch to fish as a first step, and then look carefully at your oils. You want to cut back on fats, but at least ensure that you use good oils for the little you do use, such as olive, canola, walnut, and—very important—a little flax seed oil. Watch out for transfats. The problem here is that manufacturers are not yet required to list them, and they are unhealthy. So avoid buying baked goods, pastries, etc., that are likely heavily ladened with trans-fats. Make your own baked goods if you are going to use them.
Good carbohydrates actually can lower bad cholesterol, because they are found in those healthful unrefined grains, whole-grain breads, brown rice, and full-grain cereals.
When your husband says he feels weak on a vegetarian diet, you may not be paying attention to his protein requirements. Using tofu, texturized soy products, and—if you must use animal products—egg whites, skim milk, and clean cold-water ocean fish would be far better than red and white meats. Nuts are an excellent source of protein and antioxidents.
You must help him realize the urgency and necessity of taking his medications. A person who has had a heart attack lowers his risk of a recurrence very markedly by taking a cholesterol-lowering medicine, a beta-blocker, an ACE inhibitor, and of course, an aspirin (81 mg) daily.
Exercise is important, and you should exercise with him. He would be wise to start with a daily walk. Consult his doctor to discover how much he is capable of to start. He, and you, will benefit. But if you can’t walk outside, get the treadmill going.
If you can get a group of buddies working together, that’s even better. The support is more important than the knowledge. |
