Coronary Artery Disease

Coronary artery disease (CAD) occurs when the coronary arteries, supplying blood to the heart muscle, become narrowed or blocked. This condition is primarily due to atherosclerosis, a process where cholesterol and other substances, collectively known as plaque, accumulate on the artery walls. Over time, plaques may harden or rupture, reducing blood flow to the heart, potentially causing chest pain known as angina and increasing the risk of a heart attack. CAD is a major contributor to heart-related health issues and requires medical management to prevent severe outcomes.

Causes

Coronary artery disease (CAD) develops when plaques made of fat and cholesterol build up in the heart's arteries. This process, called atherosclerosis, can start early and progresses as individuals age. CAD begins with damage to the arterial inner lining, influenced by factors such as high blood pressure, inflammation, and elevated blood sugar. Understanding these risk factors can help in managing and reducing the risk of developing CAD. They include:

• Unchangeable Risk Factors:

• Increasing age

• Male gender

• Non-Hispanic white, Hispanic, or Black race

• Family history of CAD

• Modifiable Risk Factors:

• Smoking

• Heavy alcohol use

• Low physical activity

• Unhealthy diet

• Manageable Medical Conditions:

• High cholesterol

• High blood pressure

• Diabetes

• Obesity

• Certain autoimmune conditions

Symptoms

Coronary artery disease (CAD) may not always present obvious symptoms, but common signs to watch for include chest pain or discomfort known as angina. Angina may feel like pressure, heaviness, or tightness in the chest and can extend to the arms, neck, jaw, or back. The pain often lasts less than five minutes and can be triggered by:

• Physical activity

• Cold temperatures

• Emotional stress

• Sexual activity

• Eating a meal

• Lying down

Some may experience atypical symptoms, especially women and people with diabetes, such as:

• Shortness of breath

• Indigestion

• Nausea

• Sweating

• Dizziness

• Fatigue

Seek medical attention if these symptoms occur.

Diagnosis

Diagnosis of coronary artery disease (CAD) often follows the experience of symptoms such as chest discomfort. In some cases, a heart attack might be the initial sign. Since similar symptoms can result from non-heart-related conditions, consulting a healthcare provider for an accurate diagnosis is critical, especially if symptoms emerge suddenly or intensify. Initial assessments by your primary care provider might include tests like a coronary artery calcium scan, CCTA, stress testing, and coronary angiography. Depending on the results, you may be referred to a cardiologist for further evaluation. Regular follow-ups are essential if diagnosed with CAD, and immediate medical assistance should be sought if symptoms change.

Treatments

Treating coronary artery disease (CAD) involves combining medications with lifestyle modifications. Essential lifestyle changes encompass eating a heart-healthy diet, reducing alcohol intake, quitting smoking, regular physical activity, maintaining a healthy weight, and managing stress. It's also vital to control high blood pressure, diabetes, and high cholesterol, which affect heart health.

Cardiac rehabilitation programs can aid in making these lifestyle changes, improve endurance, and help understand medication use. In some cases, revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery may be necessary for unmanageable blockages. Your healthcare team will determine the best treatment plan based on the areas and extent of CAD, and any co-existing conditions.

Medications

Medications are a key component in managing coronary artery disease (CAD). Common medications include:

• Beta Blockers: Such as metoprolol and Carvedilol, these help manage angina, reduce blood pressure, and prevent further heart attacks.

• Calcium Channel Blockers: Examples include diltiazem and Amlodipine, used for angina alone or with beta blockers.

• Nitrates: These dilate blood vessels to alleviate angina, available in long-acting (like Isosorbide Mononitrate) and short-acting forms (like sublingual nitroglycerin).

• Ranolazine: Used for angina not controlled by other medications.

• Antiplatelets: Includes Aspirin and Clopidogrel to prevent blood clots.

• Statins: Such as Atorvastatin and Rosuvastatin, they lower LDL cholesterol and reduce heart attack risk.

Your healthcare provider will tailor a medication plan to your specific needs.

Prevention

Adopting a healthy lifestyle is crucial in preventing coronary artery disease (CAD). Key preventive measures include:

• Avoid Smoking: Both smoking and secondhand smoke significantly contribute to the risk of CAD.

• Regular Exercise: Aim for 150 minutes of moderate or 75 minutes of vigorous activity weekly.

• Heart-Healthy Diet: Focus on fruits, vegetables, whole grains, and limit saturated fats, sugars, and salt.

• Healthy Weight: Keep a healthy weight to reduce CAD risk.

• Monitor Health Indicators: Regular check-ups to manage blood pressure, cholesterol, and blood sugar levels.

Gradual introduction of these lifestyle changes can significantly benefit heart health.