That creates an acute heart attack and often results in death or heart failure. These are the heart attacks where patients are rushed urgently into our procedure labs and need to have a blood vessel opened quickly, usually with a stent. The late actors James Gandolfini and Carrie Fisher died of this type of heart attack. We never know which of the scabs is going to rupture, but we do know that inflammation plays a role. Something irritates the cap of the scab, and it becomes susceptible to rupture, leading to subsequent blockage of the blood vessel. Interestingly, a plaque that has blocked 30 percent of a blood vessel is more likely to rupture and cause a major heart attack than one that has blocked 80 percent because the larger plaque has become calcified and hardened and is therefore less prone to rupture. Different imaging techniques help us understand which plaques are most prone to rupture, but the answer remains elusive. The best procedures we have are stress testing or taking X-rays of the heart arteries (to give something called a coronary calcium score) and measuring inflammatory markers that are specific to the heart. What's the result of this rigorous school schedule? KIPP students receive 50% to 60% more time learning than a traditional public school student would. Children would willingly put up with this environment? In many cases, when these prospective children are told about the school, they cry in reaction. I guarantee you there are many kids that start and end up dropping out because of the schedule commitment. Furthermore, a place like this also enforces great standards. I should also mention that, they have longer school years than everyone else. KIPP students go to class on Saturdays from 9 am to 1 pm and in the month of July, there's an extra three weeks of school. From 8 am to 2 pm, they go back and participate in summer school. But, now that we've seen the schedule of what happens in the school, what does it take for a typical student to actually achieve good results at KIPP? For me, I have a lot to heal from. It's odd because I knew of some of my husband's behavior and suspected even more.

But it wasn't until a counselor guided us in a disclosure process that I insisted upon some level of separation. I asked that at least for a few nights he stay with a friend or at least outside of the house. I couldn't make a decision past just a few days. After those few days, it felt okay for him to come back home. We have two young children and we both thought that they needed to see him. So for the next few weeks, I simply asked that he sleep in a different room. We managed to have dinner together with the kids. Our conversation at home was very superficial. Highly sensitive C-reactive protein (hs-CRP) is a marker of inflammation, and this can often give us useful information that the heart is irritated. The second type of heart attack occurs when blood flow demand and supply are mismatched. This happens when plaque builds up over time in the coronary arteries but doesn't always completely occlude the artery. It can also happen when there is another stressor, such as elevated blood pressure, infection, or anemia. The body needs the heart to pump blood to the other organs, but the coronary arteries are filled with plaque and the body can't get the heart to pump faster. As a result, people can develop chest pain and decreased blood flow to parts of the heart as well. How can we decrease inflammation in the heart? We know that statins decrease the inflammatory marker, highly sensitive CRP, and can stabilize plaque, even when LDL cholesterol is not elevated. That is why so many of our cardiac patients are on statins. There are decades of data to show how effective statins are in reducing cardiovascular risk, and their benefits cannot be underestimated. Outliers, from Malcolm Gladwell, describes the life of Marita, a 12 year-old attending the KIPP School in the South Bronx. Here's what she needs to do every day to thrive at KIPP Schools:

The wake up call is at 5:45 am for Martia to get a head start. Half the KIPP students actually wake up before 5:30 am. Marita goes to school from 7:25 am to 5 pm and arrives home at 5:30 pm. After that long day at school? She says hi to her mom, and then starts homework. If it's not a lot of homework that night, it will take 2 to 3 hours of her time. If there are essays, it could take up to 4 1/2 hours. With breaks for dinner and catching up with her mom, Marita will likely stay up until 11:15 pm! Our much-needed serious conversations were with a counselor. I was also quickly directed to a women's group where I did a lot of talking that I needed to do. But I also heard a lot of things that I needed to hear. While I was still incredibly hurt, angry, and unsure, we gradually resumed sleeping in the same bed. What I came to realize is that I didn't want to throw the baby out with the bath water. I believe there is hope. When women leave with spite, they take their confusion, righteous anger, blame, and pain with them, contaminating all aspects of their lives. It impacts how they feel about themselves, how they relate to others, and their parenting skills. It increases the likelihood of not completing the grief process or addressing any family of origin dynamics. As much as you vow and can't believe you'd ever repeat this experience, not addressing these issues sets you up for trauma repetition. There are also studies, however, supporting that many foods in our diet are inflammatory and cause the body to become irritated. Studies have shown that eating just one fatty meal can create endothelial dysfunction within four hours after the meal.

More on this on articles 53-72. High Cholesterol Cholesterol is an important substance for the body. It helps build the walls of our cells. It is the foundation of our sex hormones and important for formation of myelin sheaths, which are necessary for nerve conduction. When we have too much cholesterol, however, it finds other homes, such as in our heart arteries, head arteries, and legs. There are two main types of cholesterol: HDL (good cholesterol) that is responsible for removing cholesterol from the blood and taking it to the liver, and LDL (bad cholesterol) that puts it back into the blood vessel and helps to form plaque. When we are born, our LDL cholesterol levels are about 50 gm/dL. Sleep and repeat the schedule all over again 6 1/2 hours later. Malcolm describes his amazed response to Marita discussing her schedule with him. She spoke in the matter-of-fact way of children who have no way of knowing how unusual their situation is. She had the hours of a lawyer trying to make partner, or of a medical resident. It's insane to think of these KIPP students doing school like this! Before KIPP, they're used to a much more relaxed, easier lifestyle. But, let's remember, what are the benefits of a student attending the KIPP School? Marita gets trained on what it takes to truly work hard. She knows how to put in the hours to get great grades. She understands what words like grit and self-control mean. After three years of my husband having countless affairs and berating me sexually, I left him for another man. What I didn't know was that this new guy already had a girlfriend at the time.

So sure enough, it was happening again. But I was determined to make this relationship work, thinking that somehow I was just a failure at relationships. After a couple of years, he left me. I took a break from relationships for a while. Feeling better about myself, I then met another man and after a year of dating we married. Within days of my wedding I was a raving lunatic, totally searching for the other woman. I nearly drove my new husband away. He was the one who told me I should go address my issues. As our cholesterol levels go up with diet changes and other factors, we know we are more at risk for heart disease. We often hear from our patients that their children can afford to eat McDonald's food and fried chicken because they are young. Is that really true? When we look at autopsies of children who died of unrelated causes, we find fatty streaks, signifying early plaque formation. Seventy-seven percent of men who fought in the Korean War had evidence of significant atherosclerosis. The average age of those men was 22 years. We can never afford to eat poorly. The bad foods that we eat as children put us at risk for heart disease and, as we will discuss later, for autoimmune disease, cancer, and other chronic illnesses as well. The habits we create in children will last for a lifetime. It is so much easier to expose our children to healthy foods from the beginning so they will build a lifelong love of eating well. The KIPP School is only a middle school. That means there's only a couple years of sacrifice these kids need to make for a lifetime of change.