Atherosclerotic Plaque

Atherosclerotic Plaque is a term used to describe damage and obstruction to the linings of the arteries. When blood flow is impeded or blocked, the result can be death or disability from a stroke or heart attack. Atherosclerosis is a disease of aging that has always been prevalent.

The prevalence and severity of atherosclerosis worsens with aging. Two nutrients have been shown to dramatically slow the worsening of atherosclerotic plaque (by 95%), reduce unstable plaque, and improve endothelial function (by 66%).

Frequently Asked Questions

  • 1Why is there an Urgent Need to Increase Plaque Stability?
  • 2What is Centella asiatica?
  • 3Are there Benefits in High-Risk Patients?
  • 4How does Pycnogenol® Slow Atherosclerosis Progression?
  • 5How does Pycnogenol Improve Endothelial Function?
  • 6How does Pycnogenol® Benefit Coronary Artery Disease?
  • 7What is the Impact on Advanced Atherosclerosis?
  • There is more to preventing atherosclerosis than simply preventing the formation of plaque.
  • Much of the danger posed by plaque occurs when it becomes unstable.
  • Early on in the process, plaques are soft on the inside but covered with a hard, thick, fibrous cap on the plaque surface that faces the blood flow.
  • As long as these plaques remain thick, they are stable, meaning they are firm enough to not pose a major risk of rupturing.
  • Over time, the cap begins to thin and weaken, making the plaque more vulnerable to rupturing.
  • This is a catastrophic event that leads to sudden heart attack and stroke.
  • An important step in lowering acute cardiovascular risk therefore is to help stabilize plaques.
  • That’s exactly what Centella asiatica does.
  • Stable plaques stay where they are and don’t break loose to cause a tragic outcome.
  • It is an Asian aquatic plant long used in traditional medicine,
  • Helps stabilize thin-capped fibroatheromas, and in doing so reduces the potential for a rupture.
  • It works by promoting the formation of collagen.
  • While we typically associate collagen with the skin, this structural protein is also a prominent component of thick fibroatheromatous plaques that helps reinforce them, making them less likely to rupture.
  • The active constituents of Centella asiatica are triterpenoid molecules that improve the synthesis of collagen.
  • By boosting the production of collagen, Centella asiatica extracts promote wound healing.
  • This is key in stabilizing plaques because a plaque lesion is essentially a wound inside an arterial wall.
  • Ultimately, by promoting collagen synthesis, Centella asiatica promotes remodeling of thin-capped, soft plaques into thicker-capped, harder, and more stable structures that are less likely to rupture and cause a heart attack or stroke.
  • In addition to stabilizing plaque lesions by enhancing collagen production, basic lab studies show that Centella asiatica also has the potential to help stop the progression of atherosclerosis.
  • To achieve this, Centella asiatica reduces the adhesion of monocytes, which are immune system-derived cells that infiltrate artery linings to promote progression of atherosclerosis.
  • A study was carried out in individuals with high-risk (softer, thin-capped) atherosclerotic plaques in their femoral (main leg) arteries.
  • With individuals receiving 60 mg of Centella asiatica extract three times daily, or placebo, for 12 months.
  • The group was made up of high-risk individuals with softer, thin-capped atherosclerotic lesions in their femoral arteries.
  • The results were measured using ultrasound scans, which emits sound waves that can detect whether atherosclerotic plaque is “soft” or “hard.”
  • Soft tissue reflects back a darker image because this softer plaque absorbs more of the ultrasound wave.
  • More desirable “hard” arterial plaque bounces back brighter because it reflects back more sound waves.
  • Studies have shown that darker plaques are associated with increased risk of stroke because these soft plaques are more likely to rupture.
  • There was a significant 63% increase in the brightness of the ultrasound echo returned from the lesions in the Centella asiatica-supplemented group.
  • This indicated a lower risk for rupture. No significant change was seen in placebo recipients.
  • In addition, while plaque size increased in control subjects by 23%, Centella asiatica-supplemented patients experienced no change in plaque size.
  • Treatment with Centella asiatica reduced the risk of plaque thinning, rupture, and subsequent blockage of arteries through stabilization and hardening of plaque lesions.
  • Pycnogenol® is a standardized extract derived from the French maritime pine, Pinus pinaster. It consists of a mixture of bioactive compounds called procyanidins and phenolic acids, which have been shown to slow the progression of atherosclerosis.
  • Pycnogenol® helps slow this progression by reducing the development of fat cells and cellular signaling molecules that specifically contribute to the formation of plaque.
  • It does this by suppressing the production of adipose-differentiation-related protein.
  • This protein is crucial for the development of both fat cells and the production of various inflammatory cytokines (signaling molecules) that contribute to plaque formation and progression.
  • Pycnogenol® achieves this by reducing a major inflammation-signaling molecular complex called nuclear factor kappaB (NF-kappaB).
  • This results in lower levels of inflammation.
  • This is critical because chronic inflammation is a major factor in the development of atherosclerosis.
  • Pycnogenol® stimulates a vital enzyme called endothelial nitric oxide synthase (eNOS).
  • This is critical to the health of blood vessels because endothelial nitric oxide synthase produces nitric oxide, the signaling molecule that endothelial cells use to communicate with the smooth muscle cells in arterial walls, helping them to relax and open up arteries.
  • When the aorta was pretreated with Pycnogenol®, it prevented this dangerousconstriction of the blood vessels.
  • This beneficial effect occurred as a result of increased nitric oxide synthesis, which signals arterial wall cells to relax, producing a wider artery and increasing blood flow.
  • In addition, scientists found that increasing nitric oxide levels also decreases platelet aggregation and stickiness to vessel walls, reducing the risks of blood clots and enlarging plaques.
  • The coronary arteries are critical because they supply the heart with blood, oxygen, and nutrients.
  • Coronary artery disease develops because of plaque and inflammation that narrow the arteries, decreasing blood flow to the heart.
  • Pycnogenol® is able to improve endothelial function in patients with coronary artery disease, an effect that helps to limit the progression of atherosclerosis.
  • Treatment with Pycnogenol® produced a significant 32% increase in flow-mediated dilation and in endothelial function while placebo treatment produced no significant changes.
  • Furthermore, levels of isoprostanes (an index of how much oxidized fat is present and a measure of overall oxidant stress) fell 7% in treated subjects with no change in placebo recipients.
  • It shows that Pycnogenol® has the ability to slow the fundamental, early arterial changes leading to plaque formation and progression.
  • A study was carried out on individuals with more advanced atherosclerosis, namely, with at least one carotid or femoral arterial lesion that extended more than 50% into the arterial wall (class V) but who were, again, without symptoms at the start of the study.
  • Once again, in all groups not receiving 100 mg of Pycnogenol®, the plaque lesions increased significantly, but they did not meaningfully increase in any of the groups receiving 100 mg of Pycnogenol®.24 The following is a breakdown of each group’s percentage of plaques that worsened from class V (meaning symptom-free) to class VI (those with symptoms):
    • 48% of control subjects (worst responding group)
    • 21% of the aspirin/ticlopidine group
    • 10% of Pycnogenol® 100 mg alone
    • 11% in Pycnogenol® plus aspirin
    • 6.5% of the Pycnogenol® and Centella asiatica group (best responding group)
  • In this study, progression was defined as going from a symptom-free state to one in which symptoms occurred.
  • These were not minor symptoms, but rather those of significant loss of blood flow to the brain, such as numbness, tingling, or loss of function on the same side of the brain (for those with carotid artery plaque), or to the leg, such as pain, pallor, or numbness in the leg (for those with femoral artery plaque).
  • In other words, these figures for the Pycnogenol® and Centella asiatica combination reflect a 7.4-fold reduction in risk of developing profoundly disturbing symptoms of cardiovascular disease compared with controls, and a 3.22-fold reduction compared with the antiplatelet (aspirin/ticlopidine) group.
  • Even more exciting is that when compared to the control group, those in the Pycnogenol® and Centella asiatica group had a nearly 4-fold reduction in the risk of being hospitalized for a full-blown cardiovascular event.

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