In everyone’s mind,myocardial infarctionIt is a disease of middle-aged and elderly people, but in recent years, the incidence of myocardial infarction is getting younger and younger. How to avoid myocardial infarction? First, you need to know exactly how a myocardial infarction occurs.
Cardiovascular is so narrow that a tiny plaque can block it
Let’s first understand somemyocardial infarctionBasic knowledge about it.
coronary arteryit’s forheartarteries that supply blood, and myocardial infarction refers tocoronary arteryA certain part of the blood flow is blocked, causing the heart muscle to die.
The main reason for the obstruction of blood flow is the narrowing and blocking of blood vessels, and the hardening and narrowing of blood vessels is a long-term process, so the patients with myocardial infarction are mostly people over 50 years old.
In the picture below, the protruding part on the blood vessel wall is the hardening and fibrosis caused by the accumulation of cholesterol, and the inside is cholesterol and some cell debris – this will make the blood vessel narrow and the blood flow is not smooth, which is medically called “arteriosclerotic plaque”. block”, referred to as “patch”.
usheartIt is only about the size of a fist, and the thickness of the coronary artery is similar to that of the vein on the back of the palm, with a diameter of only 0.3 to 0.5 cm, so a small plaque will cause blockage.
heart attack in young peoplesudden deathWhy can the elderly be relieved?
There are often news reports that some people who usually seem healthy have sudden myocardial infarction,sudden deathHowever, some elderly people have a bad heart, and they have angina pectoris repeatedly, but they can be relieved after a rest. How is this going?
There are two different types of atherosclerotic plaques: one is stable and the other is unstable.
● Stable sclerotic plaque
The outer layer of the plaque has thick fibrotic, calcified tissue, and proliferating smooth muscle cells with a relatively small cholesterol core.
It blocks blood vessels, leaving only a narrow pathway for blood flow. As long as the burden on the heart increases, such as emotional agitation, lifting heavy objects, climbing stairs, the blood supply is relatively insufficient, and myocardial ischemia occurs, angina pectoris will appear. When the rest is over, the burden on the heart is reduced, the oxygen demand and the blood supply are rebalanced, and it is relieved. Such patients develop over time, and the blood vessels will become more and more narrow, but there will be signs before they are completely blocked. This stable, sclerotic plaque usually occurs in older people.
● unstable atherosclerotic plaque
Its outer shell is like a thin lid, with “fat pools” accumulated inside, but it doesn’t clog blood vessels as badly as stable hardened plaque.
In the arteries blocked by unstable arteriosclerotic plaque, the channels of blood flow are usually maintained in a relatively sufficient state, and the diameter of the arteries is relatively thick. Therefore, the patient usually has no symptoms, and the exercise performance is also OK. At a certain point of time, the sclerotic plaque will suddenly rupture, and the cholesterol in it will flow out, causing a sudden and complete blockage of the coronary arteries.
Such patients may be young, usually full of energy and fast-paced. Because the coronary artery is wide enough, there is no serious calcification, and the elasticity is sufficient, the patient can perform general outings, golf and other activities without causing angina pectoris caused by insufficient myocardial blood flow.
Bad cholesterol below this value reverses arteriosclerosis and prevents myocardial infarction
unstableatherosclerosisPlaque composition is more complex. The plaques had cholesterol inside, mixed with fragments of some immune cells, surrounded by accumulations of various immune cells, smooth muscle cells, and fibroblasts.
atherosclerosisThe process of plaque formation is also more complex.
In blood vessels, the parts closest to the blood circulation are called endothelial cells. Endothelial cells are important for maintaining vascular tone, regulating immune responses, and inhibiting vascular smooth muscle proliferation. They can also inhibit platelet aggregation and prevent thrombosis. Blood vessels become less elastic with age, and if blood pressure rises, the vascular endothelium may break down.
At this point, some monocytes are attracted to the damaged endothelium, enter the arterial wall, and turn into macrophages.
After the macrophages are full of cholesterol, they will become foam cells, which will deposit in the blood vessel walls and slowly accumulate into cholesterol plaques. It also causes inflammation, fibrosis, and calcification.
When the body’s immune system is well-coordinated, the situation doesn’t get worse.
Not only that, arteriosclerotic plaque can be shrunk – when your body’s “bad cholesterol” is low to a certain level.
Bad cholesterol is low-density lipoprotein cholesterol (LDL). Eugene Braunwald, known as the “father of modern American cardiology”, once said that bad cholesterol should not be higher than 50mg/dL.
A study published in the World Journal of Cardiovascular Diseases in 2017 pointed out that when the bad cholesterol value dropped to 55-70mg/dL, the burden on the cardiovascular system caused by arteriosclerosis began to decrease. .[1]
A 2018 study in the Journal of Lipids further pointed out that bad cholesterol levels below 45mg/dL can shrink atherosclerotic plaques.
[2]
These situations make arteriosclerosis trigger myocardial infarction!
So, under what circumstances will sclerotic plaque rupture suddenly, causing acute myocardial infarction?
The force of blood flow parallel to the inner wall of the blood vessel is called shear force; the blood pressure we usually measure is the pressure acting vertically on the blood vessel wall. Both pressure and shear force may trigger plaque rupture, so sudden force, violent movement, temperature changes, emotional agitation, etc., which cause a sudden increase in flow rate and pressure, may cause plaque rupture.
When the outer layer of the plaque ruptures, the cholesterol, cell debris and inflammatory cells contained in it will run out and agglutinate with the red blood cells and platelets in the flowing blood, coagulating the ruptured plaque into a large block and completely blocking it. Blood vessels will cause myocardial ischemia, hypoxia, and myocardial cell death.
In addition, because many immune cells are involved in plaque formation, factors such as inflammation and protease degradation of the plaque shell from the inside are all associated with plaque rupture.
Different factors can lead plaques to a firm stable type or a fragile unstable type. The poor coordination of the body’s immune system can also make plaques fragile and unstable. In addition to smoking, diabetes and other reasons, mental and psychological pressure, emotional changes are related to the sudden onset of myocardial infarction in young people.
Lifestyle changes to reduce myocardial infarction risk
Therefore, the factors that cause the accumulation of arteriosclerotic plaque and make it unstable and rupture are risk factors for myocardial infarction. As long as you start to change from here, you can prevent myocardial infarction.
To sum up, the influencing factors are as follows:
● Unmodifiable risk factors: Age, gender (males are at higher risk), family history.
● Controllable risk factors: Blood pressure, cholesterol, weight, smoking, mental stress, exercise, diet, kidney function, etc.
In order to avoid these high risk factors, we can adjust our diet and exercise habits appropriately to balance our mind and body. Living habits that protect the coronary arteries can also protect the blood vessels of the whole body, especially the function and metabolism of vascular endothelial cells. It can avoid myocardial infarction and cerebrovascular disease, kidney disease, diabetes and even cancer.
However, some elderly patients have difficulty changing their living habits – their motor function is already poor, and the weight problem also degenerates the patient’s waist and knees, further inhibiting his ability to exercise. It is difficult to change the eating habits developed over the years. Although it is not impossible to eat white rice as the main source of calories, it needs to be matched with various ingredients at the same time.
Patients like this need to take blood pressure, blood sugar, cholesterol control drugs, and aspirin, and take a lot of drugs every day to reduce the risk of myocardial infarction and stroke right now.
Many people in their 40s and 50s have relatively minor health problems and may not have a strong motivation to change their living habits. When they are in their 50s or 60s, some people will start to think about maintaining their bodies. At the stage when both physical and mental strength are still strong, seize the opportunity, and there is still a chance to recuperate the body. Of course, if you can start maintenance earlier, it will be less difficult to improve your habits, and you will have more long-term benefits.
So, are the risk factors for myocardial infarction different for young adults?
Young people avoid myocardial infarction and avoid 7 major risk factors
Young people are a minority of myocardial infarction patients, but now the proportionBut there is an increasing trend. Arteriosclerotic plaque starts to build up earlier—even in 8- to 9-year-old children, and the rate of accumulation is increasing, which may be related to a trans-fatty-processed diet and an increasingly stressful life. shape related.
A study recently published in the Journal of the American Medical Association showed that young adults between the ages of 18 and 55 had a higher risk of myocardial infarction.The 7 major risk factors are: diabetes, depressionhypertension, smoking, family history of premature myocardial infarction, low family income and high cholesterol.[3]
These risk factors cover about 85% of patients, similar to those in other age groups.
Statistically, the two risk factors, depression and low family income, were more influential in younger patients with myocardial infarction—indicating that psychological and social stress has a significant impact on coronary health.
Strangely, low household income was not associated with acute myocardial infarction in men, but only in women. In addition, the most significant risk factors for women were diabetes and smoking; for men it was smoking and a family history of premature myocardial infarction – a congenital defect, in which case we need to be more Take care of your body.
And the correct way of health care is also very important.
In the 1970s, long-distance running emerged in the United States. At the time, a well-known long-distance running promoter, Jim Fixx, who had written a best-selling book promoting the benefits of long-distance running and was often on TV, died suddenly of a myocardial infarction at the age of 52. , which caused a lot of controversy at the time.
The investigation found that Fix smoked two packs of cigarettes a day for a period of time, and his work pressure was also very high; his father died of a heart attack at the age of 35, and Fix himself had a congenital abnormality in his heart. expand. At the time, it was believed that long-distance running was helpful to Fix’s health, otherwise he might have died of a heart attack sooner. However, we now have many medical studies proving that excessive exercise can actually damage the cells of the heart – and there are many cases of athletes dying prematurely.
As the saying goes, too much is too much. We need to strike a balance to better protect our health.
Living in a chaotic world, with a healthy mind, just seeHealth 1+1！
· Vitamin E is the most effective in preventing heart disease
· Heart failure is more deadly than cancer!Young people also have 3 symptoms to be vigilant
· 7 signs of myocardial infarction!A complete diagram of the causes, symptoms and self-help methods of myocardial infarction
Responsible editor: Li Qingfeng