Soft Plaque vs Hard Plaque – Which Arterial Plaque is Dangerous?


So I had another patient this past week.
Had significant plaque but it was calcified and stable. And my coaching
consultation to them was that, “That’s stable. You just need to keep it there.”
“Nope, nope. I want it all out.” And I said, “I don’t think that’s practical but go for
it.” And as I continue to go through this discussion with this patient, it made me
realize I’ve not really given the viewers of this channel any of the
scientific evidence, the proof behind that statement, I could tell that patient
was feeling like, “You know, you’re just asking me to trust you.” I-want-to-see-it-myself kind of person so that’s actually what we’re going to do. We’re
going to look at one of the classic studies which show the calcified plaque
is much more stable. Here’s the journal. JACC – Journal of the
American College of Cardiology. Is calcified plaque really more stable? And
the title on… again April 2004. The first author was Honda. “Echolucent
carotid plaques predict…” excuse me… “Echolucent carotid plaques predict
future coronary events in patients with coronary artery disease.” So well, one
thing I would warn you, don’t get… if you look this article up, don’t get too
bogged down on that term “echolucent.” I was thinking “lucent” means light, so
therefore it’s the one on the right. I got it backwards.
If you’ll notice, all of these authors are Japanese,
I think they’ve probably picked it. May be unfortunate term, maybe not. Or I’m
just… my wife likes to accuse me of not speaking English very well anyway. But I
work for Toyota for a decade. This was not the first time that I went I wasted
on this one over an hour on bad translation and I don’t know if the
translation was bad on my side of the Japanese side. I will say this: almost
every Japanese I’ve met, their English was far greater than my Japanese. So I’m
not throwing stones. Now let’s get back to soft plaque versus hard plaque. You see
two very different types of plaque in the picture. The one on your left (I
believe it’s your left) low IBS plaque. This one as you see, there’s an outline a
faint outline of plaque and there’s a couple of little shadows in there. On
this one the right IBS flat major calcification. And by the way, there are
already plenty of studies which have been done which show you don’t have to
measure this plot. Maybe it actually measured and I’ll show it to you in just
a minute. Actually I’ll show it to you next.
This was their objective measurement of echogenicity or the amount of white or calcium in this these plaque images. They had two
very very different populations here and this one the what they call the echolucent
plaque or the soft plaque fit with this dark one up here. These fit with the
light ones. So what did that mean? So it’s crystal clear now maybe you’re
not gonna argue after seeing this that there’s a significant difference on the
image. IMT image of a soft plaque versus a hard
plaque or calcified plaque. What did it mean in terms of events? Well they
followed these people for 30 months, 14 months on average, so we’re talking a
little over a year out of a hundred about a hundred in each group. 112 people had soft plaque out of that group, there were 29 events. Did you
hear that? let’s make sure we understand that. 112 people followed for an average
of 14 months with soft plaque, 29 events. Yeah. 103 people with calcified plaques
again followed for about an average of 14 months for events, so very very
different set of risk. And now you understand why we will constantly say,
“Look, if you’ve got soft plaque, we need to deal with that issue, you need to deal
with that issue. We can’t deal with it alone. We can give you some… you know… we
can give you stuff. We’re gonna give you statins. We can give you metformin. But
the big stuff is about 30-pound weight loss you need to do if you need to do
that some of the other lifestyle types of things. So let’s look at this from a
life table perspective. If the numbers don’t mean that much to you, this is a
life table. It’s called Kaplan-Meier. This dotted line is the number event of
events that happened among the 103 people with calcified plaque.
This solid line dropped every time somebody in the other population, 112, I
think at another event. So as you can see, soft plaque is very dangerous. If you
made it this far, thank you very much for your interest. Looking forward to seeing you in
Louisville, November 8th and 9th. Get all your labs, your arterial scan, spend time
one-on-one with me, and two days of intense focus on how to prevent your
heart attack, stroke, dementia, blindness, kidney disease, erectile dysfunction.
Looking forward to seeing you there.

17 thoughts on “Soft Plaque vs Hard Plaque – Which Arterial Plaque is Dangerous?

  1. Yep! Hard plaque, plaque that is stable, doesn't cause the instant fatal heart attacks. It is true that if the build up of hard plaque continues, it would eventually cause the patient to have reduced blood flow, with all the complications of that. Dr Ford, I had my check up with my heart doctor yesterday. I showed him my CIMT results and my test blood work results. He said everything looked good. I told him about how I have changed my eating, my weight loss and the results of bringing my inflammation down to a very low level. I ask him if he thought hard plaque could be reversed and he said he didn't' think so ( I didn't tell him I was trying to achieve that) He listened to my Carotid arteries and I ask him what he was listening for (although, I already new), he said turbulence, I then ask him what did he hear and he said no turbulence. I am planning on doing another CIMT before December, just haven't got it scheduled yet. Thanks for all the videos you are making to help us get and stay healthy.
    OAG

  2. where i live the doctor's ca not distinguish between soft or hard plaque because of the hardware they say . i have calcified arteries and calcium score is 370 and cardiologist whom did the CMIT test said i got plaque. he can't say what kind. i am using rosestatine for the plaque and d3 and k2 and magnesium for calcification. should i leave the calcification alone and just be concerned about the plaque. your suggestion is valued good doctor. thanks

  3. It’s cute how you don’t speak radiology. Lucency is the ability to see through the object of interest (translucent like a window, not how bright it appears) Look up hyperechoic, hypoechoic, and anechoic as relating to ultrasound, which will kind of explain how we have extrapolated sound waves into visual terms. Yes, medical imaging is my business.

  4. Interesting video Doc. So, I would assume that soft plaque (SP) can be broken down and reduced but hard plaque (HP) is there to stay? Also, does "hardening of the arteries" refer to calcification (HP)? Depending on the extent of plaque formation, would both SP & HP have a tendency to elevate BP? Thanks for your videos!

  5. When you say “SOFT PLAQUE” do you mean what you frequently refer to as “Hot inflamed liquid plaque” – the kind created by neutrophils, monocytes, macrophage, etc. which then results in myeloperoxidase, one of the key inflammation markers? The liquid plaque that can rupture through the endothelial and cause heart attacks and strokes?

  6. How can one differentiate between soft and calcium hardened plaque?

    Calcified plaque is supposed to be 1/5 of total plaque volume.

    Does this mean that we need to worry more over uncalcified coronary arteriies?

    How does that jive with the predictive power of calcium scores?

    Calcification progresses more quickly with statins than without but when calcification progresses less that 15% yoy mortality goes way down.

    There seem to be a number of contradictory signals that do not have a coherent exegisis

  7. Thank, I'm on keto diet, since l have been on it my total colesterol has stays the same 3.7 my ldl has gone up from 2.5 to 2.9 and my hdl has gone down from 1.2 to 0.8

  8. Another excellent video. Educational content and excellent production quality. Is there any published research on the long-term stability of "hard" plaque? This study went out 30 months. The dynamism of hard plaque is relevant to those who have years of life ahead of them (assuming no unwelcomed "events."). Thank you.

  9. I'm the one with the hard calcification score of 8700. Extreme blockage in LAD. Saw a cardiologist today that thinks he can do a Atherectomy of the calcification and then install a stent. We shall see. Calcification while stable, still blocks blood flow, and if you can't reverse it in a timely manner, still needs to be taken care of.

  10. I would like for you to do videos on the merits of the following probiotics: saccharamyces boulardii and lactobacillus reuteri. Dr. Philip Oubre is a strong advocate of saccharomyces and Dr. William Davis is a strong advocate of lactobacillus reuteri. I am using both but I'm not certain if they are really helping me.

  11. Thank you Dr Brewer. Very helpful. So, should a person with significant calcified coronary artery NOT take K2 MK7 which is believed to remove / reduce coronary artery calcification?

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