Does vascular stenosis always mean coronary heart disease? Analysis of carotid artery plaque treatment guidelines.

Does narrowed coronary arteries mean coronary heart disease? With the widespread use of coronary CT angiography (320-slice CT, 256-slice CT, 64-slice CT), many patients come to Dr. Zhou with their coronary CT scans and ask, "My CT scan shows narrowed blood vessels and plaques. Do I have coronary heart disease? Do I need a stent or medication?"

Does narrowed blood vessels and plaques mean you have coronary heart disease? The answer is no. Coronary heart disease, also known as coronary atherosclerotic heart disease, is a disease caused by the narrowing of the coronary arteries to a certain extent, leading to reduced blood supply to the heart and myocardial ischemia. Therefore, for a patient to be diagnosed with coronary heart disease, two conditions must be met: first, the patient's coronary arteries must be narrowed to a certain extent (generally more than 50%); second, the patient must have signs of myocardial ischemia (such as myocardial necrosis, symptoms of myocardial ischemia such as angina, and findings of myocardial ischemia on electrocardiograms, exercise electrocardiograms, and myocardial radionuclide scans). If a patient only has symptoms of coronary artery stenosis, even if the stenosis is 30%, 50%, or even 70%, without signs of myocardial ischemia, they cannot be diagnosed with coronary heart disease; they can only be diagnosed with coronary atherosclerosis.

Does coronary artery stenosis require treatment? For patients with coronary heart disease, there is no doubt that standardized treatment is necessary to prevent the stenosis from deepening and to prevent further damage to the myocardium. But do patients with only symptoms of coronary artery stenosis, but not with coronary heart disease, also need treatment? The answer is yes, but the treatment method is not necessarily medication.

1. Lifestyle Improvement This is the foundation of treatment. Quitting smoking and limiting alcohol consumption, maintaining regular sleep, a healthy diet, and appropriate exercise can improve metabolic abnormalities in blood lipids, blood pressure, and blood sugar, controlling the progression of atherosclerosis.

2. Initiating Drug Therapy If, after a period of treatment to improve coronary artery stenosis through lifestyle modifications, the metabolic situation still does not improve, then drug therapy needs to be initiated.

Does Carotid Artery Plaque Require Treatment?: Many patients undergo carotid ultrasounds during physical examinations, and many reports indicate "carotid artery plaque or carotid artery stenosis." Patients often ask Dr. Zhou, "Dr. Zhou, how serious are carotid artery plaques? Do they require treatment?" In this lecture, Dr. Zhou will discuss the topic of carotid artery plaques.

What are Carotid Artery Plaques?: As the name suggests, carotid arteries develop atherosclerosis, resulting in atherosclerotic plaques and narrowing of the blood vessels. Carotid artery plaques are the most common manifestation of carotid artery disease. Currently, most hospitals include carotid ultrasound as a routine part of health checkups.

How Carotid Artery Plaques Form: Like the arteries of the brain and heart, the carotid artery is part of the arterial system. Therefore, its risk factors are similar to atherosclerotic lesions in other parts of the body. Major risk factors include aging, smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of exercise, and family history. However, the carotid artery is located superficially, making problems easier to detect.

What are the dangers of carotid artery plaques? If carotid artery stenosis is <50%, the patient may be asymptomatic. If carotid artery stenosis is >50%, the patient may experience symptoms related to insufficient blood supply to the brain. More importantly, the dangers include: 1. If the carotid artery plaque is unstable, it can rupture and cause stroke, manifesting as blurred or blind vision in one or both eyes, unilateral body, facial, or limb movement disorders, tingling or numbness, sudden difficulty walking, unsteady gait, or poor limb coordination, sudden dizziness or altered consciousness, aphasia, headache, memory impairment, or difficulty swallowing; 2. Carotid artery plaques are often considered a "window" into the degree of systemic atherosclerosis. Severe carotid artery stenosis is often accompanied by severe stenosis of the heart and brain blood vessels.

Do carotid artery plaques require treatment?
Drug treatment: If carotid artery plaques cause significant carotid artery stenosis (≥50%), the treatment principle is the same as for coronary heart disease or ischemic stroke (all belong to atherosclerotic cardiovascular diseases). Statins should be administered immediately to control LDL cholesterol below 1.8 mmol/L. If there are no contraindications, aspirin antiplatelet therapy should also be administered. Both types of drugs require long-term use.

If the carotid artery plaque does not cause significant stenosis (stenosis <50%), the patient should be evaluated for cardiovascular disease or other cardiovascular risk factors, such as smoking, alcoholism, obesity, hypertension, diabetes, and hyperlipidemia, before deciding whether to use statin therapy.

It should be noted that if cardiovascular disease has been diagnosed, regardless of whether there is significant carotid artery stenosis, statin therapy should be started immediately to control LDL cholesterol below 1.8 mmol/L.

Surgical treatment: For severe carotid artery plaques, carotid artery stenting or endarterectomy can be performed.

Therefore, early detection and treatment of carotid artery plaques are crucial.