Why do people get blocked arteries again after bypass surgery or angioplasty?

Let me first start by explaining how the problem starts and develops. Deposition of cholesterol in the arteries of our body starts in childhood and progresses at different rates. The basic fact is that, this process is universal and is usually slowly progressive.

Now, what makes it progress faster?

There are multiple factors. The most important ones are your genetic make up, that basically predisposes you to the rate of atherosclerosis (the disease process by which the blocks develop in the arteries), your lifestyle, in the form of physical activity and diet, plus the traditional risk factors like diabetes, high cholesterol (which can be genetic or acquired) and smoking. Now this combination works together at different proportions and combinations that develops into plaques (the actual block that develops due to atherosclerosis). Some of these factors are modifiable and some are non-modifiable.

When someone presents with a blocked artery in the heart that needs either angioplasty or bypass surgery, the process of atherosclerosis is advanced. This is a stage where the risk factors have caused cholesterol deposits for a few decades. The damages done to the arteries by these risk factors are severe.

An angioplasty or a bypass surgery only treats the effect of the atherosclerotic process that has been going on for decades. Treating these blocks gives good relief from the symptoms like chest pain and breathlessness. This treatment alone does not stop the process of atherosclerosis. The only way the atherosclerotic process can be reversed or arrested is by changing our lifestyle, modifying our diet and increasing our physical activity. Managing existing risk factors like diabetes, high blood pressure and smoking is also very important.

Fortunately, today we have good drugs to reduce the cholesterol levels (statins) and modify platelet activity (aspirins). Though these drugs offer some advantages, the most important things that need to be managed are the level of physical activity and diet. I will talk about our diet for a minute and get back.

We are in a very dangerous era of eating a diet that our body is not used to, by evolution. The human race, as we know it, has been in existence for about 2.5 million years. We have been healthy eating fruits, vegetables and meat. The era of cultivation has come about in the last 10,000 years and the wave of industrialisation in the last 100 years with processed food taking high priority in the last 50 years. This is a very rapid change (in evolutionary terms) and is too quick for the human body to adapt to. This carbohydrate rich diet along with immobility, due to automobile infiltration and sedentary jobs have created a lethal formula for the development of atherosclerotic diseases, obesity and diabetes.

Having assaulted our body with all these insults for decades, we are in a tight corner where on one hand, we need to treat the consequences of our actions and in the other try to reverse the disease process.

The answer to the question that patients ask me after a procedure "Am I perfectly alright after the Angioplasty (or bypass surgery)?" is a very difficult one. "Yes, you are fine. The current problem is taken care of" is my answer. Then I go on to tell them how they are ones who are responsible for making the best out of the treatment that has been offered. The patient (and the ones who are not yet a patient) needs to understand that most of the problems they face are reversible by significantly modifying their lifestyle and diet.

I will give an example to drive the point home.

Let's say you have a car that is 5 years old and poorly maintained. You drive on bad roads filled with sharp nails and stones. You have a flat tyre. You fix it. Are you driving a new car now? No. Are you on a new good road? No. You are still driving the same car on the same road. Then of course, the probability of having another flat tyre is constantly present.

You cannot change the car (your body), but you can maintain it better (exercise & diet) and drive on a better road (lifestyle) thereby reducing the probability of another flat tyre.

Eat less, exercise more and live calm. These are the ingredients to a better life and of course, reduce the probability of having blocks again after a procedure.