The clinical researcher
BHF Professor Martin Bennett is Head of Cardiovascular Medicine at the University of Cambridge. His work involves clinical trials on heart patient volunteers.
To help patients like Abdul.
We’re trying to develop techniques to identify the most dangerous type of plaques in the arteries. It’s not just how many you have that matters, but the type of plaque – whether it’s hard or soft. A soft plaque is more likely to burst: its contents then cause a blood clot to form around it, a bit like when a pimple bursts on the skin. If that happens in the artery around the heart, the clot will stop the blood supply, causing a heart attack.
Current angiograms (sophisticated x-rays of the arteries) can tell us where plaques are and if they’re restricting blood flow, but they can’t tell us whether or not a plaque is going to rupture.
What it involves
Fatty material called plaques can build up on the artery walls, causing narrowing of the arteries and reducing blood flow to the heart.
We scanned the arteries of heart patient volunteers using sophisticated equipment called virtual histology intravascular ultrasound (VH IVUS). This allowed us to examine individual plaques in more detail, but at that stage we still couldn’t say for certain which components make a plaque more likely to burst.
We followed up 170 of the patients for two to three years. Of those, 16 had either died, had a heart attack, or had another narrowed artery that needed treating. We looked at their medical notes and angiograms to see where in the artery the ruptured plaques were. We then compared the images of the plaques with those taken months or years before in the same patients.
Because the scans show us what the plaques are made up of, we’ve now confirmed that VH IVUS is an effective way of identifying plaques that have a high risk of rupturing.
What we need to do now is to work out how to treat those high-risk plaques
What we need to do now is to work out how to treat those high-risk plaques. At the moment, we treat an artery that’s significantly narrowed by a plaque with a balloon angioplasty and stent – a wire mesh inserted into the artery to keep it open.
However, not all high-risk plaques narrow the artery enough to warrant treatment before they burst. My team is planning to test whether treating high-risk plaques, even if they’re not significantly narrowing an artery, will reduce heart attacks. Results are a few years off.
What it means for you
In future, if you were found to have a lot of high-risk plaques, doctors would increase your medication even if your symptoms were mild. They may also consider putting stents into arteries with soft plaques even if they’re not narrowed or causing symptoms.
Knowing you have soft plaques, and are at higher risk of a heart attack, could also make you more inclined to keep taking your medication. Unfortunately many patients stop doing this over time, which is a shame as medication helps to save lives.
Read about Peter Weinberg's research into how atherosclerosis affects the artery lining
Read about Nilesh Samani's research into genetic links to heart disease
Read about Danish Saleheen's research into why heart disease affects more South Asian people
Read about patient Abdul Khan's experience of heart disease