And what makes the difference between before and after is the sudden formation of a thrombus, a blood clot on the atherosclerotic plaque that ends up closing the artery completely. Atherosclerotic plaques are not a simple thickening of the internal walls of the vessels, they are 'living' structures that go through phases of 'activation', during which they become unstable and therefore at risk of thrombosis, and phases of 'healing'. In the last thirty years, research has focused mainly on the mechanisms that make a plaque unstable, but these have not allowed us to identify biomarkers capable of anticipating the 'big one', i.e. heart attack or sudden death. If these 'mountains' grow in the coronary arteries (the vessels that bring oxygen and nourishment to the heart muscle) and exceed a certain height, they limit the increase in blood flow that the heart needs when making an effort». This 'volcano' is much more dangerous than the mountains because it can cause a heart attack or sudden death», says Professor Crea. However, not all atherosclerotic plaques are destined to cause a heart attack, i.e. to become a 'volcano'. We have discovered that 'eruptions' of atherosclerotic plaque mountains are very frequent, but fortunately many of them do not give symptoms because the body reacts by 'extinguishing' the volcano, i.e. healing the plaque and preventing the formation of thrombosis.