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Coronary Artery Disease
Overview
What is coronary artery disease?
Coronary artery disease occurs when fatty
deposits called plaque (say “plak”) build up inside the coronary arteries. The coronary arteries wrap around the
heart & supply it with blood & oxygen.
When plaque builds up, it narrows the arteries
&reduces the amount of blood that gets to your heart. This can lead to serious problems, including heart attack.
Coronary artery disease (also called CAD)
is the most common type of heart disease. It' also the #1 killer of both men & women in the US.
It can be a shock to find out that you have
coronary artery disease. Many people only find out when they have a heart attack. Whether or not you've had a heart attack,
there are many things you can do to slow coronary artery disease & reduce your risk of future problems.
 What causes coronary artery disease?
Coronary artery
disease is caused by hardening of the arteries, or atherosclerosis. Atherosclerosis occurs when plaque builds up inside the arteries. (Arteries are the blood vessels that carry oxygen-rich blood throughout your body.)
Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart, it's called
coronary artery disease.
Plaque is a fatty material made up of cholesterol,
calcium & other substances in the blood. To understand why plaque is a problem, compare a healthy artery with an artery
with atherosclerosis:
- A healthy artery is like a rubber tube. It's smooth & flexible
& blood flows thru it freely. If your heart has to work harder, such as when you exercise, a healthy artery can stretch
to let more blood flow to your body’s tissues.
- An artery with atherosclerosis is more like a clogged pipe.
Plaque narrows the artery & makes it stiff. This limits the flow of blood to the tissues. When the heart has to work harder,
the stiff arteries can't flex to let more blood thru & the tissues don't get enough blood & oxygen.
When plaque builds up in the coronary arteries, the heart doesn't
get the blood it needs to work well. Over time, this can weaken or damage the heart. If a plaque tears, the body tries to
fix the tear by forming a blood clot around it. The clot can block blood flow to the heart & cause a heart attack.
What are the symptoms?
Usually people with coronary artery disease
don't have symptoms until after age 50. Then they may start to have symptoms at times when the heart is working harder &
needs more oxygen, such as during exercise.
Typical first
symptoms include:
- Chest pain, called angina (say “ANN-juh-nuh” or
“ann-JY-nuh”).
- Shortness of breath.
- Heart attack. Too often, a heart attack is the first symptom
of coronary artery disease.
Some people don't have symptoms. In rare
cases, a person can have a “silent” heart attack, without symptoms.
How is coronary artery disease diagnosed?
To diagnose coronary artery disease, doctors start by doing a physical exam
and asking questions about your past health and your risk factors. Risk factors are things that increase the chance that you
will have coronary artery disease.
Some common risk factors are being older than 65, smoking, high cholesterol,
high blood pressure, diabetes, and having heart disease in your family. The more risk factors you have, the more likely it
is that you have coronary artery disease.
If your doctor thinks you have coronary artery disease, you may have tests,
such as:
- Electrocardiogram (EKG or ECG), which checks for problems with the electrical activity of your
heart.
- Chest X-ray.
- Blood tests.
- Exercise electrocardiogram, commonly called a "stress test." This test checks for changes in
your heart while you exercise.
Your doctor may order other tests to look at blood flow to your heart. You
may have a coronary angiogram if your doctor is considering a procedure to remove blockages, such as angioplasty or bypass
surgery.
How is it treated?
Treatment focuses on taking
steps to manage your symptoms & reduce your risk for heart attack & stroke. Some risk factors you can't control, such as your age or family history.
Other risks you can control,
such as high blood pressure & high cholesterol. Lifestyle changes can help lower your risks. You may also need to take
medicines or have a procedure to open your arteries.
Lifestyle changes
are the first step for anyone with coronary artery disease. These changes may stop or even reverse coronary artery disease.
To improve your heart health:
- Don't smoke. This may be the most important thing you can do.
Quitting smoking can quickly reduce the risk of heart attack or death.
- Eat a heart-healthy diet that includes plenty of fish, fruits,
vegetables, beans, high-fiber grains & breads & olive oil. This is sometimes called a Mediterranean diet. See a dietitian
if you need help making better food choices.
- Get regular exercise on most, preferably all, days of the week.
Your doctor can suggest a safe level of exercise for you. Walking is great exercise that most people can do.
- Lower your stress level. Stress can damage your heart.
Changing old habits may not
be easy, but it's very important to help you live a healthier & longer life. Having a plan can help. Start with small
steps.
For example, commit to eating
5 servings of fruits & vegetables a day. Instead of having dessert, take a short walk. When you feel stressed, stop &
take some deep breaths.
Medicines may
be needed in addition to lifestyle changes. Medicines that are often prescribed for people with coronary artery disease include:
- Statins to help lower cholesterol.
- Beta-blockers or ACE inhibitors to lower blood pressure.
- Aspirin or other medicines to reduce the risk of blood clots.
- Nitrates to relieve chest pain.
Procedures may be done to improve blood flow
to the heart.
- Angioplasty is the treatment doctors prefer, because it isn't major surgery. During angioplasty, the doctor guides a thin tube
(catheter) into the narrowed artery & inflates a small balloon. This widens the artery to help restore blood flow.
Often a small wire-mesh tube called a stent is placed to keep the artery
open. See a picture of angioplasty with stent placement.
The doctor may use a stent that is coated with medicine, called
a drug-eluting stent. Once the stent is in place, it slowly releases a medicine that prevents the growth of new tissue. This
helps keep the artery open.
- Bypass surgery
may be a better choice in some cases, such as if more than one coronary artery is blocked. It uses healthy blood vessels to
create detours around narrowed or blocked arteries. Bypass surgery is usually an open-chest
procedure.
What else can you do?
To stay as healthy as possible, it is important
to:
- See your doctor for regular follow-up appointments. This lets
your doctor keep track of your risk factors & adjust your treatment as needed.
- Take your medicines exactly as prescribed. Do not stop or change
medicines without talking to your doctor.
- If your doctor prescribed nitroglycerin for chest pain, keep
it with you at all times.
- Tell your doctor about any chest pain you have had, even if
it went away.
- Get the support you need to succeed in making lifestyle changes.
Ask family or friends to share a healthy meal or join a stop-smoking program. Or ask your doctor about a cardiac rehab program.
In cardiac rehab, a team of health professionals provides education & support to help you make new, healthy habits.
it's in the news....
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High cholesterol & coronary artery disease
From Healthwise
What is high cholesterol?
High cholesterol
is an excess of cholesterol in your blood. Cholesterol is a type of lipid, which is a group of fats & fatlike substances
found in your body & in the foods you eat.
A high
cholesterol level is often due to a problem with your lipoproteins (low-density lipoproteins,
LDL & high-density lipoproteins, HDL), which are combinations of cholesterol, fat & protein that your
body uses to transport cholesterol & fat nutrients in your blood.
The other
important lipid nutrient that your body processes & distributes along with cholesterol is triglyceride, a fat nutrient
that your muscle cells use for energy & that your body stores in your fat tissue for later use.
Why is high cholesterol a risk factor for
coronary artery disease?
An imbalance
of these cholesterol-carrying lipoproteins can lead to a buildup of cholesterol inside your arteries.
Although
doctors don't completely understand the process, this excess cholesterol gets deposited in the walls of your arteries, which
contributes to the development of coronary artery disease. The hard plaque that forms in your arteries as a result of atherosclerosis is made largely of cholesterol.
Cholesterol
is measured in milligrams per deciliter (mg/d). The following are general guidelines for blood cholesterol levels:
- Over 240 mg/dL: High total cholesterol level
- 200 to 239 mg/dL: Borderline-high total
cholesterol level
- Below 200 mg/dL: Desirable total cholesterol
level
A desirable
cholesterol level also includes a balance of the different forms of cholesterol, which are listed below.
Low-density lipoprotein
(LDL)
LDL carries
cholesterol from the liver to other parts of the body where it's needed for cell repair & other activities. However, under
certain conditions, LDL cholesterol builds up in the walls of the arteries.
For this reason,
LDL cholesterol is often referred to as "bad" cholesterol. In general, cholesterol-lowering efforts are most often aimed at
reducing levels of LDL cholesterol to reduce the risk of atherosclerosis, heart attack & other complications.
- If you don't have a history of heart disease, then an LDL level
of:
- Less than 100 mg/dL is considered optimal.
- 100 to 129 mg/dL is considered near-optimal or above optimal.
- 130 to 159 mg/dL is considered borderline-high.
- 160 to 189 mg/dL is considered high.
- 190 & above is considered very high.
- For people with coronary artery disease, diabetes, peripheral arterial disease, heart attack, or stroke, a new optional goal is to lower your LDL below 70 mg/dL.1 (as you can see above, the underlined link words "a new optional goal," will take you to a new site within my network to show you how to make new goals, how to achieve goals, the importance of having goals & futher instruction on how to plan to achieve your goals! The underlined link word system can really work for you if you use it!)
High-density lipoprotein
(HDL)
HDL cholesterol
is often referred to as "good" cholesterol because it helps remove excess "bad" (LDL) cholesterol from the body. HDL cholesterol
picks up leftover cholesterol from the bloodstream & carries it to the liver for disposal.
Low HDL
cholesterol increases the risk of coronary artery disease & high levels of HDL cholesterol appear to help protect against
heart disease. If you're at risk for heart disease, it may be beneficial to raise your HDL cholesterol levels.
An HDL level that is:
- 60 mg/dL or higher is desirable. It reduces the risk of heart
disease, even if total or LDL cholesterol is high.
- Between 40 & 60 mg/dL is considered acceptable.
- Below 40 mg/dL is considered low. Low HDL is considered a major
risk factor for coronary artery disease in people who also have high total cholesterol levels.
Triglycerides
Triglycerides
are another form of fat found in the blood. High triglyceride levels may contribute to fat buildup in the heart arteries &
increase the risk of developing coronary artery disease (CAD).
The following are general triglyceride guideline
levels. A triglyceride level of:
- Less than 150 mg/dL is considered normal.
- 150 to 199 mg/dL is considered borderline-high.
- 200 to 499 mg/dL is considered high.
- 500 mg/dL or greater is considered very high.
Lowering
LDL & total cholesterol levels can help lower the risk of CAD, as well as heart attack, stroke & death, in
many people with average to high cholesterol levels. People at high risk for CAD are especially encouraged to keep their cholesterol
levels low.2
Did that article above just mention diabetes?
Diabetes
Diabetes is a lifelong condition in which sugar (glucose) remains
in the blood rather than entering the body’s cells to be used for energy. This results in persistently high blood sugar,
which, over time, can damage many body systems.
Symptoms of diabetes include:
- increased thirst
- frequent urination (especially at night)
- unexplained increase in appetite
- unexplained weight loss
- fatigue
- erection problems
- blurred vision
- tingling or numbness in the hands or feet
People who have diabetes are at increased risk for many serious health problems, including hardening of the arteries (atherosclerosis) & heart problems, eye problems that
can lead to blindness, circulation & nerve problems & kidney disease & kidney failure.
Diabetes is treated with diet & lifestyle changes & with medications (such
as insulin or oral medications). If blood sugar levels are kept within the recommended range, the risk for
many complications from diabetes decreases.
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Firstborn people prone to heart disease
00:01 24 April 2001
NewScientist.com news service
Emma Young
Firstborn children are more likely to develop heart disease as adults, an Italian study suggests. The team found over 60% more firstborns among a group of heart disease patients than would have been expected.
They speculate this may be because firstborns
are predisposed to developing a more coronary-prone, "type-A" personality. But other heart
experts say much more research is needed to establish that link.
"After many years of practice, we noticed a prevalence of
firstborns among people affected by coronary heart disease (CHD)," says Maurizio Ferratini
of the Fondazione Don Carlo Gnocchi, Milan, who led the research.
The team studied 348 people with CHD. They looked at birth
order, age, gender, family history of CHD & the presence of other major risk factors.
And though firstborn & subsequent children
had a similar number of risk factors for CHD, 47% of the patients were firstborn, compared with 29% of the general local population.
Psychosocial differences
"Because we found the same kinds of risk factors in both groups,
we suspect being firstborn is the likely explanation," says Ferrantini, adding that biological, social, environmental &
educational factors differ according to birth order.
He suggests that psychosocial differences might explain the
new findings:
"The family context frequently orients firstborns along a perfectionist path, giving them a
determined, winning & aggressive attitude - aspects frequently observed in subjects with a type-A personality, also known as coronary-prone."
But Craig Haslop of the British Heart Foundation says there
is no experimental evidence that firstborn children are more likely to develop type-A personalities. But if they did, it's
possible that this might put them at increased risk for CHD, he says.
"There are suggestions that Type As are more prone
to get CHD but there's no clear evidence on whether that is to do with stress itself or the way they deal with stress," says Haslop. "Maybe firstborns are more prone to not eat the right foods to deal with stress."
Ferrantini's team presented their results at the American
Heart Association's Asia Pacific Scientific Forum in Honolulu, Hawaii.
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