Harvard Heart Letter

Do-it-yourself bypass

Helping your heart grow new blood vessels is a natural way to bypass cholesterol-clogged coronary arteries.

Picture this: You are driving down a city highway when traffic grinds to a halt. You can see a miles-long backup behind a distant construction crew that has closed off the two right lanes. Knowing the area, you merge over to a nearby exit, then follow a detour onto streets that run almost parallel to the highway. Once beyond the bottleneck, you re-enter the highway.

That's similar to what happens when cholesterol-filled plaque begins to narrow a coronary artery. Blood vessels respond to the slow, stealthy attack of artery-clogging atherosclerosis by generating a host of chemical and physical signals. An immediate action of these signals is to improve blood flow beyond the narrowing. They also bulk up tiny blood vessels that have been sitting idly in the heart since birth. As these collateral vessels grow larger, more muscular, and more interconnected, they begin to reroute some of the blood flow around the blockage (see "Growing around blocked arteries"). Such a natural bypass can keep the heart well supplied with oxygen-rich blood, much as its surgical counterpart can do.

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