Coronary Artery Disease

Coronary artery disease is characterized by atherosclerotic plaque—the accumulation of fatty deposits along the walls of the coronary arteries—which obstructs the vessels and can decrease or block the flow of blood to the heart.

Risk Factors for Coronary Artery Disease

The most common risk factors for coronary artery disease include:

• Unfavorable lipid profile—high LDL cholesterol, high triglycerides, low HDL cholesterol
• High blood pressure
• Physical inactivity
• Smoking
• Obesity
• Diet high in saturated fat
• Diabetes
• Increasing age
• Family history
• Excessive alcohol intake
• Chronic inflammation

Symptoms of Coronary Artery Disease

The symptoms of coronary artery disease vary with the type and extent of the disease. Some women will have no symptoms, while others might have pressure or pain in the chest, also called angina.

Symptoms most commonly associated with coronary artery disease include heaviness, tightness, pressure and/or pain in the chest behind the breastbone; pain radiating in the arms, shoulders, jaw, neck and/or back; shortness of breath; weakness and fatigue; and abdominal pain and indigestion-like symptoms.

In women, persistent fatigue, flu-like symptoms and depression can also signal coronary artery disease.

Diagnosing Coronary Artery Disease

If you have several risk factors for or symptoms of coronary artery disease, your doctor will take an electrocardiogram (ECG or EKG)—a test that records the electrical activity of the heart and detects heart muscle damage. If the ECG indicates heart disease, your doctor may recommend a stress test, in which you will walk on a treadmill or ride a stationary bike while your heart, breathing and blood pressure are monitored. If your stress test suggests heart disease, you may be asked to have a cardiac angiogram, in which x-rays are taken after a contrast agent is injected into your coronary arteries to locate the narrowing, occlusions and other abnormalities of specific arteries. During angiography, you may have an intravascular ultrasound (IVUS) test to determine whether macrovascular disease is present, too.

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Treating Coronary Artery Disease

Doctors have a huge array of treatments for coronary artery disease. Your individual treatment will be determined by you and your physician after considering your age, overall health and medical history; the extent of your disease; and your feelings about different medications and therapies. Treatment may range from making lifestyle changes to reduce your risk factors, to surgery to bypass an obstructed artery. Medical treatments include:

• Statins and other medications to lower LDL cholesterol and/or triglycerides, including bile acid sequestrants and niacin.
• Antihypertensives. Medications used to lower blood pressure can also make it easier for the heart to deliver blood to the tissues.
• Antiplatelet medications, which reduce the platelets’ ability to stick together and cause clots.
• Anticoagulants, also described as “blood thinners,” work differently than antiplatelet medications to decrease the ability of the blood to clot.
• Vasodilators—drugs that relieve angina.
• Beta-blockers—drugs that regulate heart rate and blood pressure.
• ACE inhibitors—drugs that improve heart function.

Procedures to reduce the effects of coronary artery disease include:

• Coronary angioplasty, in which a catheter is used to reduce the obstruction in the blocked vessel to increase blood flow. A stent, or small metal mesh tube, may be inserted in the artery to keep it open.
• Coronary artery bypass, in which a piece of a vein is grafted above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction.
• Transmyocardial revascularization, in which a laser makes 20 to 45 small, pencil-lead-sized “channels” in the heart muscle, is reserved for patients who are not candidates for bypass surgery or stents.

Nutrition and Prevention

Reference these links for information on how to prevent heart disease and how to live a healthy lifestyle.

• Lifestyle Changes
• Exercise
• Healthy Diet
• Reduce Stress
• Stop Smoking
• Healthy Cholesterol Levels
• Reduce Sodium