Why should you be concerned?
Your coronary arteries are not something that you think about often. Most of us never think of them until something is wrong with them. Unfortunately, this is usually too late to prevent damage to not only to them, but other areas of your body. What is coronary artery disease? Why is it something you should be concerned about? What can you do to prevent it?
Coronary Artery Disease (CAD) is when the blood vessels that supply your heart with blood carrying oxygen and nutrients (coronary arteries) become damaged or diseased. There are several things that contribute to the damage of the coronary arteries, such as smoking, high blood pressure, high cholesterol, diabetes/insulin resistance and sedentary lifestyle. Once the damage has occurred, it makes it easier for cholesterol-containing deposits (plaque) to accumulate at the site of injury (atherosclerosis). When plaque builds up, it causes the area that the blood has to flow through inside the arteries to narrow, which decreases blood flow through the heart causing it to function less effectively. This process takes a long time, typically decades, to develop and can start as early as childhood. If the plaque breaks or ruptures, the clotting cells in your blood (platelets) clump at the site to stop the bleeding. This forms a clot and can block the artery completely. This process results in a heart attack because the blocked artery is unable to get the oxygen and nutrients to the heart’s cells past where the blockage is. Due to the process taking as long as it does and there usually aren’t symptoms until there is a serious problem, most people aren’t aware that anything is wrong until some happens.
The main symptom of CAD is chest pain, which is usually referred to as angina, that is brought on by physical or emotional stress and disappears when the stressor is stopped. The pain is often described as a pressure or tightness that feels like someone is standing on your chest. Most people say the pain occurs in middle or left side of their chest, but it can be felt in neck, arm and/or back (this is particularly true for women). The other main symptoms are shortness of breath or extreme fatigue, especially upon exertion. This is from your body not getting enough oxygen because your heart is unable to pump enough blood to meet the increased need from an increased activity level due to the narrowed open in the coronary arteries. If CAD becomes severe, it can cause several complications. The most sudden, life-threatening one is a heart attack which can have a range of symptoms from none to crushing chest pressure, pain in shoulder/arm, shortness of breath and sweating (women might complain of only jaw pain or back pain). Other complications can include heart failure and arrhythmias. In the case of CAD, heart failure is caused by areas of the heart chronically being deprived of oxygen and nutrients from either the decreased blood flow or damage from a heart attack caused by CAD. This continual deprivation causes the heart to become weak and it is unable to pump enough blood to meet your body’s needs, even when you aren’t exerting yourself. You can develop an arrhythmia (abnormal heart rhythm) is the inadequate blood flow or damage to the heart tissue interferes with your heart’s electrical impulses.
There are several things that increase your risk of developing CAD. The overall risk increases as you age because of the buildup of plaque occurs over time. Men are at a higher risk than women until women go through menopause, then their risk increases. If you have family history of CAD, then you are at increased risk. For men, if your father or brother developed CAD before the age of 55 this is especially true. For women, the same holds true if your mother or sister did before the age of 65. High blood pressure, cholesterol or diabetes are all things that increase your risk. Smoking, being overweight/obese, having high amounts of stress and limited physical activity also affect this. Often people will have more than one risk factor. The majority of the risk comes not from any particular factor, but the more you have, the greater the impact.
The most important treatment option is lifestyle changes. These can include not smoking, controlling conditions (high blood pressure, cholesterol, diabetes), staying physically active, eating a low-fat/low-salt diet, eating more fruits/vegetables/whole grains, maintaining a healthy weight and reducing/managing stress. In some cases, while you are working on changing your lifestyle, you might need the assistance of medications to help get certain risk factors under control.
Unfortunately, some people need to stay on these medications for the rest of their life because the damage that has been done to their coronary arteries can not be managed by lifestyle changes alone. One of the main groups is cholesterol-modifying medications. They decrease the amount of cholesterol in your blood, especially the low-density lipoprotein (LDL), or “bad” cholesterol. By doing this, it is decreasing the primary substance that makes up a good portion of plaque. Another class of medications are those that focus on decreasing your blood’s ability to clot, such as aspirin or other blood thinners. A third focus is to decrease the demand placed on the heart for oxygen by decreasing your heart rate and blood pressure with a group of medications called beta blockers. Two different groups that also focus on decreasing blood pressure, but work on different receptors in the heart are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). If you are having chest pain, nitroglycerin is used because it temporarily dilates coronary arteries, which decreases the heart’s demand for oxygen.
Sometimes, if there is a blockage, emergency treatment is needed to restore and improve blood flow through coronary arteries. This is usually done either by angioplasty with possible stent placement or coronary bypass surgery. With angioplasty, a catheter is inserted into an artery (typically in your groin), then a wire with a deflated balloon is passed through the catheter to the narrowed area of the coronary artery. The balloon is inflated compressing the deposits against the walls of the artery. This opens the artery to blood flow. In some cases, a stent is left in place to help keep the artery open. Coronary bypass surgery is when a graft is used to bypass the blocked coronary artery. This graft is a blood vessel that is taken from another part of your body and then attached to your heart. By doing this, it allows blood flow to go around the blocked coronary artery. This is typically done as open-heart surgery, so it is reserved for cases where there are multiple narrowed/blocked coronary arteries.
The best way to not have to deal with CAD is to prevent it to the best of your ability. This is done through similar methods as is the primary treatment goal…lifestyle changes. It is key to not start smoking or stop if you already do. Getting plenty of exercise helps to prevent a variety of conditions that put you at increased risk for CAD, such as high blood pressure, high cholesterol and diabetes. The other main component is diet that is low in fat/salt and high in fruits/vegetables/whole grains. By exercising and eating healthy, it will be easier to maintain a healthy weight. Reducing and managing stress is so important because the physiological changes that your body goes through when it is stressed cause a number of health detriments. It is essential to realize that what you do in your day-to-day life impacts your future health. This is why it is vital to make changes while still young enough in order to decrease your risk for coronary artery disease.
Coronary artery disease is serious condition because if your heart is unable to function correctly it impacts the rest of your body’s ability to function. If you have any questions or concerns about CAD, please talk to your doctor. If you would like more information about CAD, please visit the American Heart Association’s Coronary Artery Disease page at http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease—Coronary-Heart-Disease_UCM_436416_Article.jsp#.Wo7-70xFzIU