Dr. Asim Hameedi MD

Coronary Artery Disease (CAD), also known as Coronary Heart Disease or Ischemic Heart Disease (IHD), is the most common type of heart disease in the United States. It is also the leading cause of death worldwide. Data from different epidemiological studies show about 1.72% of the world’s population suffers from CAD each year. Nine million deaths were caused by IHD globally.

What causes Coronary Artery Disease?

Coronary artery disease is caused by the formation of plaque in the wall of the blood vessels that supply blood to the heart (called coronary arteries). Plaque is made up of mainly cholesterol and fat deposits and some blood cells. This plaque is commonly known as atheroma. Over time this atheroma increases in size and causes the inside of vessels to narrow. This process is called atherosclerosis. Narrow arteries hinder the blood flow to heart muscles resulting in CAD.

SYMPTOMS OF CORONARY ARTERY DISEASE

Symptoms may go unrecognized at first, or they may only occur when the heart is over-exerting itself like during exercise. As the coronary arteries continue to narrow, less and less blood gets to the heart, and symptoms can become more severe or frequent.
Some common symptoms are:

• Chest pain
• Pain radiating to left shoulder or arm
• Shortness of breath
• Nausea or vomiting
• Epigastric pain
• Palpitations
• Fatigue

RISK FACTORS OF CORONARY ARTERY DISEASE

One can divide these factors into two categories, modifiable and non-modifiable.
Modifiable risk factors:

• Age (older than 45 years in men)
•  Male gender
•  Family history of CAD
•  ethnicity (Afro-Caribbean).

Non-modifiable risk factors:

• Smoking
• Physical inactivity
• Obesity
• Unhealthy diet
• Excessive alcohol intake
• High blood pressure
• Elevated serum cholesterol levels
• Low socioeconomic status.

About half of all Americans have at least one of these key risk factors: high BP, high cholesterol, and smoking.

Why Men are at high risk for Coronary Artery Disease?

Heart disease is the leading cause of death for men in the United States, killing 382,776 men in 2020—that’s about 1 in every 4 male deaths. For Asian American or Pacific Islander men, heart disease is second only to cancer.

Biologically, in women, different hormones during the reproductive years of life (especially estrogen) seem to have a protective effect against CAD. Comparisons between the sexes also reveal gender differences in psychosocial and behavioral coronary risk factors, including excessive alcohol consumption and smoking, favoring women. Eastern- European men score higher on stress-related psychosocial coronary risk factors (e.g., social isolation, vital exhaustion). Overall, it appears that men’s coping with stressful events may be less adaptive physiologically, behaviorally, and emotionally, contributing to their increased risk for CHD.

Sequalae of Coronary Artery Disease

Symptomatically or asymptomatically, CAD progresses to a heart attack in more than 66% of cases. Common complications of CAD are:

• Myocardial Infarction (STEMI or NSTEMI)
• Acute coronary syndrome
• Heart failure
• Cardiac arrhythmias (irregular beating of the heart)
• Sudden cardiac arrest

Risk Assessment and Diagnosis of Coronary Artery Disease

Invasive and non-invasive techniques are used to calculate the probability of CAD in a patient with above-mentioned symptoms. Some of these are:

• EKG
• Echocardiogram
• Exercise stress test
• Coronary angiogram
• Coronary artery computed tomography

How to reduce the risk of Coronary Artery Disease

A few changes to one’s daily routine, such as following, can prevent CAD or even reduce the risk of already existing CAD.

• Eat a heart-healthy diet (low salt, low fat diet)
• Get more active
• Lose weight
• Stop smoking
• Limit alcohol
• Lower blood pressure
• Relieve stress and improve mental health

Other than natural ways, pharmacological therapy also helps in reducing the complication risk of CAD.

Role of Cardiac Rehabilitation

This is an important supervised program for anyone recovering from a heart attack or IHD. It includes:

• Medical evaluation
• Physical activity
• Education about healthy living
• Emotional support and counseling