Coronary artery disease (CAD) is a specific form of atherosclerosis, a disease characterized by the buildup of deposits, or plaques, in the blood vessels. The term atherosclerosis comes from two Greek words, athero, meaning "gruel" or "paste," and sclerosis, meaning "hardness."
Atherosclerotic plaques consist of both fatty substances called lipids, and also "harder" substances, such as calcium and fibrous tissue. Over time, plaques in the blood vessels can interfere with the supply of blood to various organs of the body.
Coronary artery disease occurs when the coronary arteries, which feed the heart muscle, are affected. As the blood flow to the heart muscle is restricted, angina (chest pains) or heart attack can occur.
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What are the causes of CAD? Atherosclerosis begins early in adulthood, but it may be decades before it becomes obvious. Very early signs of plaque have been found in young soldiers killed in battle. Atherosclerosis probably begins when the innermost layer of the artery, called the endothelium, becomes damaged, allowing cholesterol to enter.
Causes of damage to the arterial wall include:
- Elevated levels of cholesterol and triglycerides (fats) in the blood
- High blood pressure
- Tobacco smoke (Once the endothelium is damaged, fats, cholesterol, fibrin, platelets, cellular debris, calcium, and other substances can catch on the damaged spot and over time become deposited in the artery wall, stimulating the development of plaques. In some instances, atherosclerosis may weaken the blood vessel wall, causing the vessel to become wider, rather than narrower.)
- Diabetes (High blood sugar levels damage the interior linings of blood vessels throughout the entire body, not just the heart. This can cause PAD. Diabetes is a leading cause of PAD, heart attack and stroke.)
Although the dangers of narrowed blood vessels are well known, widening can also be a serious problem. It can develop into an aneurysm. This often occurs in the aorta (the main artery in the heart), but it can also occur in the coronary arteries. A blood vessel can also widen at the same spot where a plaque forms. If this occurs, the inside diameter of the blood vessel may change only slightly, despite the presence of the plaque. This explains why some people can have a fairly normal stress test or angiogram but can still have coronary artery disease and even heart attacks.
What are the risk factors for CAD? Scientists continue to investigate the possible causes of coronary artery disease. Although there does not seem to be one specific cause, there are certain characteristics that have been linked to coronary artery disease and heart attacks. These are called risk factors.
Although you can do much to lower your risk for CAD, some factors you can't control. These include:
- Age. However, although older age is typically associated with heart attack, today that is not necessarily true. Younger people are having heart attacks due to an increase in risk factors.
- Gender. Coronary artery disease is the #1 killer of both men and women. Both genders need to pay attention to risk factors.
- Family history of heart disease. If your mother, father or siblings were diagnosed with coronary artery disease before age 60, you have increased risk.
There are some risk factors that women should be aware of and discuss with their physician. You have an increased risk of CAD if you have had:
- Certain pregnancy complications, including preeclampsia and gestational diabetes
- Chronic inflammation conditions, such as lupus and rheumatoid arthritis
There are some risk factors you can control. By reducing your risks, you are taking steps to live healthier and lessen your chances of developing heart disease. Here is what you can do to reduce your risk of coronary artery disease:
- Don't Smoke: Tobacco use lowers your level of good cholesterol, raises your blood pressure, and promotes clotting.
- Control cholesterol: Most heart disease is the result of cholesterol-rich, fatty buildup that narrows the vessels that supply blood to your heart. There are two sources of cholesterol - your body, which makes cholesterol to aid digestion and the foods you eat.
- Know your LDL: LDL, or bad cholesterol, accounts for most of the cholesterol in your blood and is considered most responsible for the formation of plaque. Most people with CAD require medication to achieve target LDL levels.
- Control high blood pressure: High blood pressure damages arteries, setting the stage for plaque formation. It also increases the stress on the heart muscle which may cause damage to the organ.
- Exercise: People who have had heart attacks may increase their chances of survival if they change their habits to include regular physical activity. Exercise can help control blood fats and blood glucose, maintain weight and lower blood pressure.
- Keep blood sugar within normal ranges: People with diabetes are very susceptible to CAD. It is especially important for people with diabetes to control their blood glucose, as well as blood pressure and cholesterol.
- Manage stress: Stress is a normal part of everyone's life. It is not stress that increases your risk for CAD, but how you cope with it.
- Control your weight: By itself, obesity increases your risk for CAD. Obesity also contributes to other risk factors, including hypertension, high blood cholesterol and diabetes.
What are the symptoms of CAD? Angina
, or chest pain, is one of the noticeable signs of coronary artery disease. It is a warning sign that the heart is temporarily not getting enough blood and oxygen to handle its workload. Angina does not cause permanent damage to the heart muscle. Angina can feel like a heart attack, but it is different. Most angina attacks last from 2 to 15 minutes. This is because the blood supply is reduced but not cut off.
In some cases, heart attack
may be the first sign of CAD. A heart attack happens when one of the arteries that brings blood to the heart muscle is blocked. A portion of the heart muscle is damaged or dies due to inadequate blood flow. Symptoms of heart attack range from chest tightness, pain or discomfort, to lightheadedness, fainting or sweating. Other symptoms, more common in women, include unusual fatigue and sleeplessness. Heart attack requires immediate medical attention - call 9-1-1.
Other warning signs of CAD include:
- Feeling of indigestion or "fullness"
- Discomfort, aching, pressure, tightness, heaviness, or burning sensation in or near the chest, back, arms, shoulders, between shoulder blades, neck, throat or jaw
- Shortness of breath
- Fatigue with activity (exertion)
Other symptoms, more common in women:
- Unusual fatigue
What is the treatment for CAD?
While coronary artery disease is a chronic condition that cannot be cured, there are steps you can take to treat and stabilize it, and also improve your quality of life, including:
- Eat a diet low in fat and cholesterol
- Be more active
- If you use tobacco, quit
- Maintain a healthy weight
- Take medications, as prescribed by your physician
- Manage stress
Other than lifestyle changes, the treatments that have the best track record in prolonging life are non-invasive and include medications such as aspirin, cholesterol-lowering drugs (statins), and beta-blockers. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are also included among the most successful medications.
Coronary Artery Disease Fast Facts
What is it? A heart condition occurring when the coronary arteries that bring oxygen-rich blood to the heart muscle are clogged with plaque
What are the symptoms?
- Shortness of breath
- Heart attack
- Fatigue with activity (exertion)
What is the treatment?
- Lifestyle changes
- Medication, such as aspirin, statins, beta-blockers, ACE inhibitors and ARBs