Fatty meals and sticky platelets : A new trigger for ACS ?
January 31, 2016 by dr s venkatesan
Every time , patients ask me what diet he or she should follow , Iam sort of amused , as my understanding of diet and cardio vascular disease is at best primitive.I used go with a standard single phrase advice “Anything in moderate should be okay “
What about going for a saturday night party doctor? One of my shrewd looking patient who was recently double stented with DES , asked.
Human body is a biological marvel.While medical professional divide it into various systems for our convenience. God doesn’t think that way .He has no systems in mind when the body was designed . There is no wonder , the alimentary system and hematological system has to interact on a daily basis with the help of circulatory system to keep the body alive. Platelets are unique blood cells that exist primarily to plug physiological bleeding if any or for self-healing at sites of tissue injury.
With human vascular system increasingly invaded by various metals and wires , platelet are a confused lot since their original biological functions are altered. They simply don’t know whether fight these foreign body , aggregate over it , flush or simply pass over these .Adding to this the powerful anti-platelet drugs targeting critical functional pathways .No wonder every other cardiovascular patient consumes at least one anti-platelet drug.
It seems diet can have direct influence of platelet function
With human beings desire to add style to food consumption and eating habits competing with top slot of purpose of living , we often forget it is same prevent us from living a good life.
There has been numerous anecdotal and study population and experience acute coronary events are more common after a heavy meal especially a fatty one .The immediate suspect has been high triglyceride and chilomicrons in blood stream shunted intestines .
It is logical to expect , these high TGLs some how act a s trigger for pro-coagulant trigger .With the core thrombus rich platelets it is assumed platelet stickiness is augmented and maintained by transient raise in triglyceride formation(Reference 1,4,5)
Glycerol component of TGL is know for its sickness and making the companions wet.
The million dolor question is , at what level of TGL and which forms of TGL make the platelet cry and attract each other ?
Diet, anti platelet drug efficacy ?
Now , patients with coronary stents has to live at the mercy of these anti-platelet drugs. The drug resistance(Clopidgrel) is threatening to be major issue.Like warfarin do we have real issue of dietary binge and acute neutralisation of anti-platelet drug efficacy that can trigger acute stent thrombosis . This is potentially important area of study .
So does a fatty meal a new trigger for ACS ? It may sound an alarmist statement .but as of now , its difficult to ignore this.So my advice for that the that smart young man with soluble stent was to avoid binge dinners that carries a definite risk of interfering with stent maintenance .
2.Effect of a single high-fat meal on endothelial function in healthy subjects.Vogel RA1, Corretti MC, Plotnick GD.Am J Cardiol. 1997 Feb 1;79(3):350-4
6.Fuhrman B, Brook JG, Aviram M. Increased platelet aggregation during alimentary hyperlipemia in normal and hypertriglyceridemic subjects. Ann Nutr Metab. 1986;30:250–60
7.Aznar J, Santos MT, Vallés J. Effect of postprandial lipaemia on platelet function in man evaluated in whole blood. Thromb Res. 1987;48:567–76.
8.Platelet lipoprotein interplay: trigger of foam cell formation and driver of atherosclerosis Siegel-Axel D1, Daub K, Seizer P, Lindemann S, Gawaz M.Cardiovasc Res. 2008 Apr 1;78(1):8-17. (Free full text link)