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Learn more about coronary artery disease – the No. 1 cause of death for over 20 years.
Coronary artery disease (CAD), also known as ischemic heart disease (IHD), involves a number of symptoms caused by the considerable narrowing (or even complete blockage) of the lumen of the coronary arteries – the blood vessels that provide nutrients and oxygen to the heart muscle. This narrowing leads to an insufficient blood supply and oxygen deficiency in the heart muscle. Coronary artery disease can be chronic (stable CAD) or acute (e.g. myocardial infarction).
CAD is the most prevalent cardiovascular disease while myocardial infarction and sudden cardiac death are the most common causes of death in the developed world.
In 98% of cases, the root cause of CAD is atherosclerosis of the coronary arteries, which means a build-up of atherosclerotic plaque (made of cholesterol and inflammatory cells) on the arterial walls. Gradual accumulation of plaque in a blood vessel can either limit or completely block the blood flow, resulting in cardiac ischemia.
CAD is diagnosed on the basis of collecting medical history from the patient and performing a number of assessments, including:
Therefore, in order to accurately assess the severity of CAD, diagnostic tests are essential.
The probability of developing CAD is higher in patients with the following risk factors:
Excessive levels of cholesterol drive the atherosclerotic process in the blood vessels, including coronary arteries. It is essential to determine the patient’s lipid profile and introduce suitable treatment, as needed, at the doctor’s discretion. There are a number of available cholesterol stabilizing medications which can help achieve the desired therapeutic targets in relation to the level of low-density lipoprotein LDL, sometimes referred to as the “bad cholesterol”.
Hypertension is defined as high blood pressure; the commonly accepted threshold is 140/90 mmHg. Hypertension is a lifestyle disease and the most important risk factor for premature death worldwide. This is why regular control of blood pressure and appropriate treatment reduces the risk of complications such as myocardial infarction and stroke.
Predisposition to CAD can be inherited with genes received from our parents.
If there is a family history of cardiovascular disease, it is vital to take some preventive measures early on, such as physical activity, healthy diet, body weight control, smoking cessation, blood pressure control, and control of blood cholesterol and sugar levels.
Diabetes mellitus is a metabolic disease caused by the abnormal secretion or function of insulin. The early stages are usually asymptomatic, which is why screening is essential (measuring fasting blood glucose levels).
Diabetes mellitus significantly promotes the atherosclerotic lesion development in coronary arteries, so diagnosing this disease, followed by maintaining normal blood sugar levels and effective anti-diabetic treatment, are necessary for the prevention of CAD.
The chemical compounds contained in tobacco smoke, apart from evidently contributing to the development of cancer, have an equally toxic influence on the cardiovascular system. They damage the endothelium, the cellular layer that lines the inner layer of our blood vessels. This in turn accelerates plaque development. This process can take place in any artery, including the ones in the legs, the brain, and around the heart.
The risk of coronary artery disease increases with age. In the middle aged population, its incidence is greater among men. The female sex hormones – estrogens – protect blood vessels from atherosclerosis to some extent. After menopause, when their levels drop, the risk becomes equal for both sexes.
Overweight is caused by excessive build-up of fat tissue. It is classified with the use of body mass index (BMI). Studies unequivocally confirm there is a relation between pathological BMI values (>25) and the risk of cardiovascular disease.
The reduction of body weight can substantially contribute to managing diabetes and hypertension, opening the door to a longer and better life.
Low physical activity coupled with an unhealthy diet can lead to obesity and diabetes mellitus. Regular, moderate exercise can protect us from a number of diseases, including CAD, and is recommended even after the latter has been diagnosed.
CAD develops slowly and can have no manifestations at first. With time, however, the symptoms do appear and increase in both frequency and severity as the disease progresses.
The most common symptoms, especially following physical activity, include:
At the early stage, the symptoms only appear after intense exercise, but as the disease progresses, they can be induced by increasingly lighter physical activity, including everyday activities, eventually appearing even at rest at more advanced stages of the condition.
Sometimes, the first sign of CAD is myocardial infarction: intense chest pain, discomfort, and dyspnea that usually persists for over 20 minutes and does not subside with the administration of nitroglycerine. These symptoms require immediate medical attention.
Heart disease requires medical diagnosis.
Call 112 immediately if you think you might be having a heart attack.
If a thrombus that formed in a coronary artery breaks free and floats to the brain, in rare cases this can lead to stroke.
Symptoms of stroke may include:
Together with your doctor, arrange for a comprehensive treatment plan.
Change of lifestyle
The first step in treating coronary artery disease is to reduce the risk factors. This requires making some changes to your lifestyle:
More exercise
Physical activity helps lose weight, improve fitness and reduce stress. Most people could reduce their risk of heart attack by walking for 30 minutes five times a week or making 10,000 steps a day. You should discuss your workout routine with your treating physician.
All drugs should be used as prescribed by your doctor – both heart disease medications and other drugs to treat any concomitant diseases.
If coronary artery disease has already caused acute complications such as a heart attack or stroke, a cardiac rehabilitation program is recommended to reduce the risk of any future complications, facilitate recovery and improve quality of life.
It is important to regularly attend follow-up visits and follow the doctor’s recommendations. This is necessary to keep your health under control, monitor your treatment and make any necessary adjustments.
Coronary artery disease is a chronic condition. It cannot be cured, but with the right treatment its progress can be stopped. The treatment consists of making changes to your lifestyle, treating any concomitant diseases, taking the right drugs, and – if that is not enough – undergoing invasive or surgical procedures.
Coronary artery disease cannot be completely prevented. This is because there are factors we have no control over, such as genetics, age or sex. What we can do, though, is minimize the likelihood of developing the disease by leading a healthy lifestyle, undergoing the right diagnostics and treating any co-existing diseases.
Risk factors that are beyond our control are old age, the male sex, family history of heart disease and genetics.
However, there are a number of risk factors you can do something about. These are lifestyle changes: losing weight, quitting smoking if you are a smoker, controlling and keeping appropriate blood pressure and cholesterol levels. The more risk factors there are, the greater the risk of developing coronary artery disease. This is why it is important to be in charge of the ones you can control.
