Winter 2024 - 19

blocked. A blocked coronary artery does not occur
from a gradual narrowing of the blood vessel. In
other words, a blocked or occluded artery does
not block slowly over time.
When plaque or blockage begins to form in an
artery, it does not form in the interior or what is
known as the lumen of the artery such as scale
would in a pipe. Instead, plaque accumulates
in the actual wall of the blood vessel. As the
plaque begins to accumulate inside the arterial
wall, the artery will become inflamed. This
inflammation will eventually become so severe,
that the plaque in the artery will burst or rupture
causing the plaque to spill out from the wall of
the blood vessel into the opening of the artery.
This plaque rupture causes the clotting system to
activate forming a clot within the artery. This clot
immediately blocks blood flow. Current thought
is that the unique stress pattern seen in law
enforcement can potentially accelerate plaque
rupture which results in the increased frequency
of heart attacks.
Because of an advanced understanding of the
pathophysiology of heart attacks, the concept
that heart attacks occur without warning is truly
antiquated. There are specific tests that can
detect the presence of blockages or coronary
artery disease (CAD), years before these
blockages cause symptoms. Standard stress
testing, such as exercise treadmill testing, or
bicycle stress testing will only detect blockages
that are already significant enough to obstruct
blood flow. This testing will not detect mild
plaque or blockages in their very early stages.
For this, more advanced yet simple alternative
tests are needed.
When the early stages of plaque form within
the artery wall, several things occur that can
be detected before plaque ruptures and a
heart attack occurs. A very low-dose radiation
computed tomography (CT or CAT) scan known
as a coronary artery calcium (CAC) scan can
detect little " flecks " of calcium that develop within
the coronary arteries. This scan typically costs
less than $100, uses a low dose of radiation (0.7
mSv), and can be done in a matter of minutes.
More predictive than coronary calcium scoring,
is the ability to detect inflammatory changes
within the artery by measuring certain biomarkers
seen on specific blood tests. Markers such as
oxidized LDL (OXLDL), myeloperoxidase (MPO),
asymmetric dimethyl arginine (ADMA), and
lipoprotein-associated phospholipase A2 (LpPla2)
can identify inflamed plaque and provide
evidence that the plaque is prone to rupture.
Of these markers, the most studied and most
predictive is Lp-Pla2. When this specific marker
is elevated, the risk of that individual having
plaque rupture and therefore a heart attack is
approximately 15-20% over 4 years.
From a pragmatic standpoint, the combination
of calcium scoring and Lp-PLA2 detection is
extremely useful in detecting coronary disease
years before a heart attack occurs. After studying
over 3800 police officers without any symptoms
of heart disease, 31% were found to have a
positive calcium score, 26% were found to have
an elevation of Lp-Pla2, but only 7% had both
markers - making the need to evaluate both
these tests invaluable. Shockingly, this data
clearly demonstrates that of the 3836 officers
screened, 64% had evidence of undiagnosed
coronary artery disease. Disease that can be
identified and successfully treated resulting in
fewer officers succumbing to heart attacks and
becoming statistics.
Heart attack is preventable and does not have
to be one of the top killers of men and women
in uniform. It can be detected early, and once
identified; it can be successfully treated. n
tacticaltrainingandconditioning.com | 19
http://www.tacticaltrainingandconditioning.com
Winter 2024

Table of Contents for the Digital Edition of Winter 2024
