Harvard Heart Letter

The problem with plaque: Even lesser amounts are still risky

Known as non-obstructive coronary artery disease, this condition can trigger heart attacks down the road.

You just had a cardiac stress test and you passed with flying colors. Does that mean you are free of heart attack risk? Not necessarily, says Dr. Ron Blankstein, assistant professor of medicine at Harvard Medical School and preventive cardiologist at Brigham and Women's Hospital.

"Stress tests are designed to pick up so-called obstructive lesions that block blood flow through the coronary artery. These are the lesions that typically cause a narrowing of at least 50% and are the ones that may cause chest discomfort during exercise or stress," he explains. But when imaging techniques such as invasive coronary angiography or CT angiography are used to view the coronary artery vessel wall, areas of plaque that are too small to impede blood flow will show up in approximately 30% of people referred for testing who haven't been diagnosed with heart disease. This finding is termed non-obstructive coronary artery disease, and until recently, it was not considered to be important to overall heart attack risk.

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