Risk for Repeat Heart Attacks

B O S T O N, Sept. 27 -- The good news: You’ve just survived a heart attack.

The bad news: Your heart troubles could get worse, if your attack was caused by one of several “vulnerable plaques” — tiny, inflamed buildups of fat that burst and plug up blood vessels — any of which could be a ticking time bomb for another attack.

Doctors have come to believe as many as two-thirds of all heart attacks are caused by these vulnerable plaques brewing on blood vessel walls, which become inflamed and suddenly rupture for undetermined reasons. The other third are due to fatty blockages, or clogged arteries, and rarely, vessel spasms.

A new study being published in this week’s New England Journal of Medicine lends further credence to the theory that plaques in several locations throughout the heart’s vessels increase the likelihood of further heart disruptions.

Tip of the Iceberg “When you have a heart attack, the area that emerges is the tip of the iceberg,” explains the study’s lead author, James A. Goldstein, a cardiologist at the William Beaumont Hospital in Royal Oak, Mich. “There is corrosion in the pipes throughout the house.”

In the study, Goldstein and his colleagues examined the angiograms, or the X-ray images of the heart’s blood vessels, from 253 heart attack patients and found that 40 percent of them had several remaining unstable plaques throughout the vessels in their hearts.

Those patients with the multiple plaques, he found, were more likely to be repeat offenders for heart attack within the year. They were also more likely to develop symptoms that require repeated repeat angioplasty or bypass surgery, he says.

Goldstein says these findings may suggest a new treatment style for heart attack patients, including taking megadoses of cholesterol-lowering drugs and anti-inflamatory medications immediately after the attack to stabilize the remaining plaques, as well as interventional surgery on the plaques that look especially “nasty” and rupture-prone.